Prostate Cancer Screening At A Supermarket
It sounds like science fiction, but according to Mark Emberton, Professor of Interventional Oncology at University College London, prostate cancer screening could be coming to a supermarket near you.
Professor Emberton is in charge of a clinical study which he’s hoping will transform prostate cancer screening. The $6.5 million trial, which started in August of 2019, stalled in the spring because of covid, but is now back on track. His team is looking at scans that take only ten minutes, which could potentially be rolled out to the general population.
I sat down with Mark to hear about his work.
Prostate cancer screening difficulties
In the UK, there are only a few nationwide screening programs, including breast cancer for women and bowel cancer for men.1 Prostate cancer is now the most-commonly diagnosed cancer in England, but nationwide screening has proved elusive, as it has such a poor diagnostic record.2
Traditionally, tests start with a digital exam followed by a PSA blood test, neither of which are particularly accurate or trustworthy. Around 75% of men with high PSA levels don’t have cancer, but about 15% with normal PSA levels actually do.3,4 I should know: when I was diagnosed with a malignant tumor, my PSA stood at just 5.03.
"Why use a crap test?"
The current trial, called ReIMAGINE, is an acceptability study. In layman’s terms, it asks the question: can you get good, accurate results form a short MRI scan? It’s a community-based effort with GPs inviting men between 55 and 75 to attend. If successful, Mark will seek extra funding for phase two, which will likely involve several thousand men.
Prof Emberton has great faith in MRI scans and doesn’t mince his words: “Why use a crap test at the front end of a diagnostic pathway when you could use a good test?”
The simple answer to that is that a medic inserting their finger up the luckless patient’s rectum and the PSA test are very cheap. MRI machines are still very expensive, though their cost is coming down.
Debating the costs
But Mark likes to take a wholistic view, and counters that with a bad test you get false positives and false negatives. They have a cost in both human and monetary terms. If you have a good test, even though it’s more expensive, it may outperform a cheaper test in health and economic terms if its use is widespread.
He sees similarities to performing a colonoscopy to detect bowel cancer, as opposed to doing a fecal blood test. The blood test can produce false positives, whereas the endoscopy is less likely to produce false positives.5 Mark believes this is another example of an expensive test being cheaper once all the other costs are factored in.
Mark readily admits that a full 40-minute MRI scan would be impossible for mass screening. So his team is looking into 10-minute scans, with the possibility of even that being reduced.
“We’re also working in the background at even shorter sequences, four-or-five-minute sequences, so that means you can do maybe six to eight patients an hour,” he said.
He went on: “You could do it in a supermarket, because it’s a passive acquisition. You’re not putting needles into anybody. There’s no radiation, so no doctor needs to be present. So, the cost plummets.”
Just scanning prostates
He also thinks the cost of an MRI machine could further reduce if the prospect of nationwide screening becomes a reality, and he thinks that manufacturers will respond.
“If you’re just scanning prostates, you won’t need a machine that can scan brains, livers, and kidneys. The makers may be able to make a machine purely for prostate cancer screening that could be cheaper.”
He also thinks it is self-evident that a prostate biopsy should only take place after a scan. If you don’t know where to look, a biopsy may miss the cancer. He says: “It’s like playing darts with your back to the dartboard. When we do a biopsy, we like to face the dartboard!” Ouch!
Looking toward the future
Mark feels that traditional testing for prostate cancer has failed, and while he and his team have much to do, he is confident their trials are looking positive.
When it comes to getting a prostate check at a supermarket, that may well be a few years away just yet. As he says: “The amount of evidence that governments need to roll out national screening is huge. It’s a massive policy decision. We would be very happy if we can produce the data that this should be offered to men once the data is ready, and once we have all the information.”
The potential to save lives
If cancers can be detected early with reliable non-invasive tests, then this will massively reduce the number of men who currently die every year from the disease, one that is traditionally hard to detect and often shows no symptoms in its early stages.
There is a company that’s making an MRI machine for the office, so the tech is changing. Perhaps it won’t be too long before you get a prostate MRI exam while picking up the groceries.
Too many men are dying form a disease that initially they don’t know they have. A nationwide screening program could save many lives and, in the long-run, save money, too.
What was the most difficult part of your diagnosis?