A personalized national screening program, aimed only at men who are at greatest risk of developing cancer, could prevent one in six deaths and significantly reduce overdiagnoses. The program should be based on age, genetic profile and PSA (prostate specific antigen) value and include magnetic resonance imaging before any biopsy is performed. This is the conclusion of a study conducted on computer simulations by the University College of London and the University of London, and published in Jama Network Open. The researchers created a hypothetical cohort of 4.5 million men (i.e. the number of 55-69 year-olds in England) and simulated the results that could be obtained if national screening strategies based only on age or age were introduced. age and genetic risk. “Prostate cancer is a leading cause of cancer death among men, but there is no national screening program today, because the harms (from overdiagnosis, ed.) Are believed to outweigh the benefits,” explains Tom Callender, from the Department of Applied Health Research at University College London and first author of the study. “But – he added – those with a higher genetic risk are more likely to benefit from screenings.”
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The English guidelines
Prostate cancer is the most common cancer in men: in Italy there are about 36,000 new diagnoses of the disease and 6,800 deaths every year. However, survival is among the highest: at 5 years it is 92%. In the UK, where this study was carried out, men with suspected prostate cancer are currently being tested for PSA. Those who are positive to the test, based on the guidelines of the National Institute of Clinical Excellence (NICE), are recommended an MRI before the biopsy: in this way, the ability to identify aggressive tumors increases and at the same time the risk of overdiagnosis of unnecessary treatments, and therefore of side effects, is reduced.
Comparison of strategies
In the study, a screening program was first envisioned in which all men between the ages of 55 and 69 carry out a PSA test every four years: those who exceed the threshold values also perform an MRI and, only afterwards, the biopsy. Another path was simulated in which men perform the PSA test (followed by MRI and, if necessary, biopsy) only if their personal risk, calculated based on age and the score given by their ” genetic profile ”(based on a polygenic test), reaches a certain threshold value.
The projections, which include deaths, overdiagnoses and cost-effectiveness to the healthcare system, were compared for three scenarios: no screening, universal age-based screening, and more targeted risk-based screening, with and without MRI magnetic before biopsy in patients with a positive PSA blood test. The conclusion? The best scenario, ie the one that gives the most benefits, was the one based on risk. The data show that it would therefore be necessary to screen men with a minimum risk of getting prostate cancer in the next 10 years of 3.5%, which corresponds to about half of all men between the ages of 55 and 69. .
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One in 6 fewer deaths
This program, according to the researchers’ analysis, could prevent up to 16% of prostate cancer deaths – nearly one in six deaths – and reduce overdiagnoses by 27%. Applying the 3.5% risk threshold would also be more cost-effective than screening all men between the ages of 55 and 69. Now, it is true that screening all men in that age group (the age-based strategy) would prevent more deaths from prostate cancer (20% versus 16%), but risk-based screening prevents a number of deaths quite similar, but at the same time reducing up to 70% (the percentage depends on the risk threshold used) the number of cancers diagnosed in excess (those cancers which then prove to be harmless) and the number of biopsies required by about one third.
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From the model to the real world
“Our study shows that prostate cancer screening – which could save between 16% and 20% of deaths – could be possible by using genetic risk and MRI as part of the diagnostic journey,” says Mark Emberton. , dean of the UCL medical faculty and co-author of the research, which – he concludes – “opens the way to clinical trials to study the implementation of the screening model in the real world“.
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