Prostate Cancer Research

Prostate cancer is the only cancer with a Department of Health funding target for research, and the target of £4.2 million was achieved in 2003/4. This level of funding will be maintained, subject to the quality of research proposals received.

• Evaluation of a Pilot Prostate Awareness Inititative
• Urological referral in men with raised Prostate Specific Antigen levels and patterns of testing in General Practice 2002-2004
• European Randomised Study of Screening for Prostate Cancer (ERSPC)
• The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO)
• Prostate Testing for Cancer and Treatment (ProtecT)
• The E2F3 gene
• Prostate Cancer in Ethnic Subgroups (PROCESS)
• Diagnostic Value of Systematic Prostate Biopsy Methods in the Investigation for Prostate Cancer
• IMPACT

Evaluation of a Pilot Prostate Awareness Inititative

In the past there has been no uniform health education message about the early signs of prostate cancer in the UK, and levels of awareness and willingness to seek medical advice will vary across the population. The Department of Health (DH) Prostate Cancer Advisory Group approved a prostate awareness pilot initiative which aimed to increase knowledge and awareness of problems with the prostate, including prostate cancer, in men aged 50 years or more, and to encourage reporting of symptoms to GPs without causing sudden rise in GP workload.

The pilot was organized by a charity with expertise in educational programmes and was launched on 2nd October 2006. Two independent evaluations were funded separately by the NHS Cancer Screening Programmes, The qualitative study investigated the design and methods of promoting the initiative, and assessed the achievements and limitations with its delivery in reaching men across socio-economic groups and those at increased risk of prostate cancer. In visits to community venues, semi-structured interviews with staff at community pharmacies and GP surgeries, and conversations with nine community helpers it was found that nearly all intervention materials had been taken in community venues but not in all pharmacies and surgeries. The importance of intermediaries for extending the reach of the campaign into communities that traditionally professionals find hard to reach was demonstrated, and some interviewees showed attitudinal change.

Prostate Awareness Qualitative Research Report

A quantitative evaluation, conducted by the Cancer Screening Evaluation Unit, aimed to investigate whether there was a change in GP consultation rates and GP requests for PSA testing in Coventry and three control areas. A paper on these results is awaiting publication in a peer review journal and the full report will then be made available on this website. The evaluations highlight the importance of monitoring the effectiveness of delivery of any campaign from the outset, the value of using routine data on medical outcome measures and the need to integrate measures of health seeking behaviour with other outcomes. These findings inform the programme of interventions being developed through the National Awareness and Early Diagnosis Initiative developed following the report on UK The Cancer Reform Strategy¹.

¹. Department of Health. Cancer Reform Strategy. London: Department of Health, 2007.

Urological referral in men with raised Prostate Specific Antigen levels and patterns of testing in General Practice 2002-2004

A study has investigated whether there was a change in the proportion of asymptomatic men with raised PSA levels (≥3ng/mL) who were referred to urology since the launch of the Prostate Cancer Risk Management Programme (PCRMP) in November 2002. The PCRMP provides guidelines for general practitioners (GPs) on age-specific Prostate Specific Antigen (PSA) cut-off levels in asymptomatic men. The study was conducted by the Cancer Screening Evaluation Unit at the Institute of Cancer Research, and was funded by the Policy Research Programme of the Department of Health. A paper has been published in the British Journal of Cancer (Melia et al….) and the full report of the study is available. The referral rate was lower than expected if the guidelines had been followed and it did not change significantly over time. Further revision and evaluation of the PCRMP guidelines is underway.

European Randomised Study of Screening for Prostate Cancer (ERSPC)

The ERSPC study is currently the largest randomised controlled trial of prostate cancer screening. It aims to determine whether the effect of early detection and treatment of prostate cancer will reduce deaths from prostate cancer. There are eight participating centres: the Netherlands, Sweden, Finland, Belgium, Italy, Portugal, Spain and Switzerland. Recruitment to the study is still underway and the target is to recruit 180,000 men in total. Each man will be chosen at random to either be screened for prostate cancer (using the prostate specific antigen test with or without digital rectal examination) or to join a control group which will not be screened.  Early results from the trial published in March 2009 showed a decrease in mortality of 20 per cent in the screened group, although this was associated with a high level of over treatment. It was estimated that 48 men would have to receive treatment for prostate cancer in order to save one life.

The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO)

The PLCO trial is a large-scale randomised controlled trial run by the US National Cancer Institute. It aims to determine whether certain cancer screening tests reduce deaths from prostate, lung, colorectal and ovarian cancer. 154,000 men and women between the ages of 55 and 74 were recruited to the trial in 10 US screening centres between 1992 and 2001. Half of the participants were selected at random to receive specific screening tests whilst half were selected to be a control group receiving routine care. As part of the prostate screening arm men receive a prostate specific antigen test and digital rectal examination, initially and annually thereafter for five years. All participants are then followed up for a further 10 years. Early findings published in March 2009 showed no significant reduction in mortality due to prostate cancer screening.

A randomised controlled trial of treatments for localised prostate cancer is also currently underway in the UK.

Prostate Testing for Cancer and Treatment (ProtecT)

The ProtecT study was commissioned by the NHS R & D Health Technology Assessment Programme to evaluate the effectiveness, cost-effectiveness and acceptability of treatments for men with localised prostate cancer. The study will compare three treatments (active monitoring, radical prostatectomy and radical radiotherapy). Recruitment of men was undertaken in nine clinical centres in the UK over a period of five years commencing September 2001. Over 100,000 men were involved. The major objective was to assess the survival of men treated for localised prostate cancer at 5, 10 and 15 years following treatment.

The E2F3 gene

While researching bladder cancer, Professor Colin Cooper at the Institute of Cancer Research found that a gene called E2F3 was overexpressed in bladder cancer and this was associated with aggressive disease. A protein produced by the E2F3 gene was also overexpressed at high levels in 67% of prostate cancer, while no staining was present in normal healthy prostate cells. Patients with prostate cancers that overexpressed E2F3 have a worse prognosis, and the higher the level of E2F3 protein in the cancer the poorer the patient survival. Research is now underway to translate this finding into a test in the hope that patients with aggressive early cancers can be identified.

Prostate Cancer in Ethnic Subgroups (PROCESS)

A comparative study of incidence, clinical presentation and access to health care in the UK.

Death rates from prostate cancer are raised in Caribbean and West African men. The PROCESS study investigated possible reasons for this. It showed that black men in the United Kingdom have a substantially greater risk of developing prostate cancer compared with white men, although this risk is lower than that of black men in the United States. The similar rates in black Caribbean and black African men suggest a common genetic aetiology, although migration may be associated with an increased risk attributable to a gene-environment interaction.

Diagnostic Value of Systematic Prostate Biopsy Methods in the Investigation for Prostate Cancer

This is a systematic review commissioned by the NHS Cancer Screening Programmes and conducted by NHS Centre for Reviews and Dissemination (CRD) and the Horton Centre, Switzerland. It compares the diagnostic value and possible adverse effects of different systematic prostate biopsy schemes used in the diagnostic work up of men suspected of having prostate cancer. Click here for Summary and Reports

IMPACT

Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1 and BRCA2 mutation carriers and controls (IMPACT Study). This study looks at methods of early detection of prostate cancer in men who have inherited a gene thought to increase their risk of developing this disease.