A recent study conducted by Tampere University and the University of Helsinki has revealed that a new three-step prostate cancer screening method is effective in identifying a significant number of aggressive cancers. Despite these findings, most countries, including Finland, have not yet implemented population-level screening programs. The ProScreen trial, led by Tampere University and the University of Helsinki conducted a study on a three-step prostate cancer screening method to see if it could lower mortality rates and minimize the overdiagnosis of insignificant prostate cancers, which was a common problem with previous screening methods.
Many prostate cancers are considered insignificant because they do not cause symptoms even without treatment and are often found during autopsies. Treating these cancers does not provide any benefits but can still harm the patients’ quality of life.
The screening method utilizesThe ProScreen study involves two blood tests and, when necessary, magnetic resonance imaging (MRI) of the prostate. Previous screening methods only relied on the prostate-specific antigen test (PSA).
In the ProScreen study, 7% of participants had positive results for both blood tests and were then invited to undergo a prostate MRI. In approximately half of these cases, an MRI detected a suspicious area, leading to a prostate biopsy.
Eventually, cancer was found in about 2% of the participants, with clinically insignificant cancers diagnosed in four in a thousand men.
The findings demonstrate that PSA screening can reduce the mortality rate from prostate cancer to some extent. However, the number of unnecessary cancer diagnoses resulting from PSA screening outweighs the benefits. Professor of Epidemiology Anssi Auvinen from Tampere University stated, “The new results indicate that the current three-step method produces fewer insignificant cancer diagnoses compared to PSA screening.”
The diagnosis of prostate cancer with a favorable prognosis is not advantageous. Some prostate cancers are clinically insignificant, meaning they will not progress to the symptomatic stage or cause any harm.Paraphrased:
The initiator of the project, Professor of Urology Antti Rannikko from the University of Helsinki, emphasizes that identifying these hidden cancers does not have any advantages and should not be diagnosed. “The majority of tumors discovered through previous PSA screenings are low-risk cases that are likely to be overdiagnosed. Most of them do not progress to the symptomatic stage, even when left untreated. If a prostate cancer with a good prognosis is diagnosed, the primary treatment is always active surveillance,” Rannikko explains. Local prostate cancer is normally treated with surgery or radiation therapy.The most frequently observed treatment side effects are problems with achieving an erection, loss of control over urination, and bowel issues.
The primary objective of screening is to decrease mortality rates associated with cancer
Over 60,000 men between the ages of 50 and 63 were included in the research, with participants being randomly assigned to either undergo the three-step screening process or be part of a control group with no intervention.
The study is ongoing and will eventually encompass the nearby municipalities of Tampere and Helsinki. Those who have previously taken part will be asked to participate in a new screening after 2 to 6 years based on the results of their initial screening.First screening.
No mass screening program has been implemented in Finland or in most other European countries, but there is an ongoing health policy debate on this issue.
Researchers have found only preliminary evidence of the potential benefits of the new screening model. However, the initial results suggest that significant benefits may be possible in the future. The extent of these benefits can only be determined after a 10-year follow-up period, during which the impact on prostate cancer mortality will be analyzed.
“The goal of cancer screening is always to reduce mortality. The primary factor in decisions regarding cancer screening is the potential impact on reducing cancer-related deaths.”Evening should always be the reduction of mortality to be gained,” Auvinen says. “The ProScreen study, due to its large size and randomised design, can produce the research evidence needed to justify screening decisions,” he adds. There is currently no reliable research data on the benefits and harms of MRI screening.
The study was carried out by a large team of researchers, including radiologists, pathologists, urologists, and experts from other fields at Tampere University and Tampere University Hospital (TAYS), as well as the University of Helsinki and Helsinki University Hospital (HUS). The cooperation partners included the l.Local laboratory networks and Lund University.
The 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 supported the study. The research article was published in the JAMA — Journal of the American Medical Association. Prostate cancer is the most common cancer in men.
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