A big randomized trial conducted at Tampere University and the University of Helsinki shows that a brand new three-step prostate cancer screening method can find a substantial variety of aggressive cancers. Population-level screening programs haven’t been launched in most countries including Finland.

The ProScreen trial coordinated by Tampere University and the University of Helsinki investigated the performance of a three-step prostate cancer screening method. The aim was to research whether the brand new method would efficiently reduce mortality while decreasing the most important antagonistic effect of previous screening methods: the overdiagnosing of insignificant prostate cancers.

Some prostate cancers are clinically insignificant because they don’t grow to be symptomatic even when left untreated. Such cancers are regularly detected at autopsy. Thus, treating cancer with a very good prognosis doesn’t bring advantages, however the treatment itself can still harm the patients’ quality of life.

The screening method utilized in the ProScreen study includes two blood tests and, if obligatory, magnetic resonance imaging (MRI) of the prostate. The previously studied screening method has only been based on one blood test, the prostate-specific antigen test (PSA).

Within the ProScreen study, each blood tests were positive in 7% of the participants they usually were invited to an MRI of the prostate. In about half of those men, a suspicious area was detected by MRI and a prostate biopsy was taken.

Cancer was eventually present in about 2% of the participants. Clinically insignificant cancers were diagnosed in 4 in a thousand men.

We’ve previously demonstrated that PSA screening can decrease prostate cancer mortality to some extent. Nevertheless, PSA screening produces so many unnecessary cancer diagnoses that the harms outweigh the advantages. The brand new results show that the three-step method now used produces fewer insignificant cancer diagnoses than PSA screening.”

Anssi Auvinen, Professor of Epidemiology, Tampere University

Diagnosing cancer with a very good prognosis isn’t helpful

Some prostate cancers are clinically insignificant, i.e. they may not progress to the symptomatic stage or cause any harm. The co-lead investigator of the project, Professor of Urology Antti Rannikko from the University of Helsinki, points out that the detection of such latent cancers doesn’t bring any advantages and that they mustn’t even be diagnosed.

“The overwhelming majority of tumors found with the previous PSA screenings are low-risk cases which can be prone to represent overdiagnosis. Most of them don’t progress to the symptomatic stage even when left untreated. If a prostate cancer with a very good prognosis is diagnosed, the first treatment is all the time lively surveillance,” Rannikko says.

Local prostate cancer will likely be treated surgically or with radiation therapy. The common uncomfortable side effects of treatment include erectile dysfunction, urinary incontinence, and bowel symptoms.

The important goal of screening is to scale back cancer mortality

The study included greater than 60,000 men aged 50-;63 years who were randomly allocated for either the three-step screening or a control group without intervention.

The study continues and the study population will expand to also include the neighboring municipalities of Tampere and Helsinki. Men who’ve already participated shall be invited to a brand new screening after 2-;6 years based on the outcomes of their first screening.

No population-level screening programme has been launched in Finland or in most other European countries but there’s a health policy debate on the subject.

In response to the researchers, only preliminary evidence of the advantages of the brand new screening model is obtainable thus far. Nevertheless, the outcomes seem to point that major advantages could potentially be achieved in the longer term. The advantages can only be estimated after a 10-year follow up when the consequences on prostate cancer mortality have been analyzed.

“The aim of cancer screening is all the time to scale back mortality. The important criterion for decisions on cancer screening should all the time be the reduction of mortality to be gained,” Auvinen says.

“The ProScreen study, attributable to its large size and randomized design, can produce the research evidence needed to justify screening decisions,” he adds. There’s currently no reliable research data on the advantages and harms of MRI screening.

The study was carried out by a big team of researchers, including radiologists, pathologists, urologists, and experts from other fields at Tampere University and Tampere University Hospital (TAYS), in addition to the University of Helsinki and Helsinki University Hospital (HUS). The cooperation partners included the local laboratory networks and Lund University.

The study was supported by Cancer Foundation Finland, Research Council of Finland, Jane and Aatos Erkko Foundation, Päivikki and Sakari Sohlberg Foundation and state research funding administered by the Pirkanmaa wellbeing county.

The research article was published in the distinguished JAMA – Journal of the American Medical Association.

Prostate cancer is essentially the most common cancer in men. As a reason for men’s cancer death, it ranks the second in Finland and the third in Europe.