How a new 15-minute MRI in a van could detect prostate cancer sooner

At the age of 58, Paul Rothwell decided to accept an invitation for a prostate cancer checkup.

He had no symptoms and had been warned that the standard prostate-specific antigen (PSA) blood test was notoriously unreliable.

However, he was delighted when his results returned a reading of 1.5 (below the threshold of 3, the level that would require further investigation for his age).

However, Paul, a semi-retired television producer from London, was also part of a research trial called ReImagine, looking at whether a new 15-minute MRI, the prostate equivalent of a mammogram for breast cancer, it is better for diagnosing the prostate. cancer than the PSA test.

To her surprise, the results of her MRI done in April 2020 revealed that she not only had the disease, but that it was aggressive enough to require treatment.

“Without the MRI I never would have known,” says Paul, 62, married with two daughters.

Following the diagnosis, in March 2021, he underwent a treatment called focal therapy on the NHS.

The two main treatments for prostate cancer, surgery to remove the entire prostate or radiation therapy, can be very effective, but they carry the risk of possible side effects, such as incontinence and impotence.

Focal therapy is more precise and treats the cancer itself rather than the entire prostate.

Paul had a form of focal therapy called High Intensity Focused Ultrasound (HIFU), which uses heat to target cancer. He is now cancer free.

“Without the MRI, I could have gone 10 to 15 years without knowing I had prostate cancer, by which time it probably would have been more advanced and more difficult to treat,” says Paul.

“I feel incredibly lucky to have been able to have the scan.”

Now, a new trial is about to begin inviting middle-aged men to the same screening Paul had, but via walk-in ‘van scan’.

The vehicle will be parked next to West Ham United’s football ground in London’s Olympic Park in a few weeks’ time, and football fans and buyers will be among those who could benefit.

The ‘van scan’ scheme is part of a trial of 800 men aged 50 to 75, the largest ever conducted with a 15-minute MRI.

Three hospitals, in addition to the van, will participate in the trial. It is based on two previous 15-minute MRI trials.

The first, the Prostagram study, conducted by Imperial College London, showed that the scan detects twice as many high-risk prostate cancers compared to a PSA test followed by a biopsy.

In the second, the ReImagine trial, at University College London (UCL), a 15-minute MRI was compared with a PSA blood test to see which is more effective in diagnosing cancer.

The results, which will be published shortly in the journal BMJ Oncology, are “very promising,” according to Caroline Moore, a professor of urology, who led this recent study.

However, ReImagine also revealed that men more likely to be affected by prostate cancer (such as those of black ethnicity) were less likely to present for testing.

The goal of the most recent trial, called Limit, is twofold: to see if the scan is more effective than PSA in detecting cancers at risk, and if providing screening in the community can encourage more men from a wide variety of ethnic groups. to introduce himself

The ‘van scan’ scheme is part of a trial of 800 men aged 50 to 75, the largest ever conducted with a 15-minute MRI (file photo)

The trial results, if positive, will be part of the growing body of evidence that could tip the scales toward a national prostate cancer screening program.

Every year, 52,000 men in the UK are diagnosed with the disease. By the time around 16 per cent are diagnosed in England and Wales, the disease has spread, according to figures from the National Prostate Cancer Audit, with more than 12,000 men dying each year.

As the Mail reported last week, there is an alarming postcode lottery in prostate cancer care which means men in the North East are almost six times more likely to receive a late diagnosis than men treated in London, for example.

British scientists are working hard to address these inequalities. Improving diagnostic tests and making these tests more accessible, through the introduction of mobile test units, are some of the solutions that are being investigated.

“We know from trial results that the 15-minute MRI is a good way to detect risk cancers that are more likely to cause problems,” explains Professor Moore.

Prostate cancer screening studies have found that some men are reluctant to come forward for screening, especially those at higher risk, he adds.

Men from black ethnic groups have twice the risk of prostate cancer, for example [scientists don’t know why but it might be linked to genes]’but they’re not always contacted by traditional screening approaches, such as an invitation letter through their GP,’ he told Good Health.

‘The Limit test will be open to men of all origins. However, we hope that by offering prostate cancer testing in the community, with the van and without the need for an appointment, we can reach a broader group.”

“Without the MRI, I could have gone 10 to 15 years without knowing I had prostate cancer, by which time it probably would have been more advanced and more difficult to treat,” says Paul.

This is not the first time a ‘men’s van’ has been used to encourage men to show up for health checks.

Last year, a mobile clinic was launched in London to encourage men over 45, who are in groups less likely to receive regular health checks, to come forward.

Results of the pilot study showed, during visits to seven locations in south London, including construction sites, that more than 600 men visited the mobile clinic for check-ups, including a PSA test: 14 were diagnosed with prostate cancer , 18 with diabetes, a quarter with possible arterial hypertension and almost three quarters with obesity.

Currently, a PSA test remains the most common way to see who needs further testing, even though the test is unreliable: 75 percent of men who score high are actually cancer-free (a false positive), while the 15 percent who do have cancer do not have an elevated PSA level (a false negative).

This causes men without cancer to undergo unnecessary testing and men with cancer to be diagnosed late.

All men over the age of 50 can ask their GP for a PSA test if they are concerned about prostate cancer; they do not need to have any symptoms.

A PSA score of 3 or higher (if the man is over 50; higher than 4 if he is 70) requires further investigation.

However, PSA levels can rise as a result of other factors, such as after vigorous cycling or sexual intercourse.

The new Limit study will take place at three hospitals: Addenbrooke’s in Cambridge, University College London Hospital and The Christie in Manchester, as well as via the mobile screening van.

Men undergoing tests at the hospital will be invited through their GP, but those who attend the mobile screening unit can ‘drop by’.

At each of the four sites, 200 men in total will have the PSA test and a 15-minute MRI, a process that will take around an hour (including paperwork), says Professor Moore.

The MRI is a ‘pants on’ test. Those tested in the van will receive their results on the spot from a trained urologist who will help them determine next steps, if necessary, while those tested in the hospital will get theirs two weeks later.

UCL researchers will monitor the results and who accepts the screening offer. To participate in the trial, which is expected to last three years, men must be between the ages of 50 and 75, with no symptoms or a previous diagnosis of prostate cancer.

Men with hip replacements are not eligible as the artificial joint makes the images difficult to read.

Gamal Turawa, 60, from Bedfordshire, was aware of his increased risk of prostate cancer as he comes from a black ethnicity, so he joined the Prostagram trial in 2018.

Gamal Turawa, 60, from Bedfordshire, was aware of his increased risk of prostate cancer as he comes from a black ethnicity, so he joined the Prostagram trial in 2018.

“I saw a Facebook post about the trial and decided to participate,” says Gamal, a motivational speaker and former police officer.

“I had no symptoms and no family history of the disease, but I have always been aware of the risk and curious given my age and history.”

He underwent a PSA blood test, a rectal examination and a 15-minute MRI at Hammersmith Hospital in London.

“Of the three tests, I preferred the MRI because it was less invasive,” he told Good Health.

After a couple of weeks, Gamal received the results, giving him the go-ahead.

“Having the MRI gave me much more confidence in the result,” he says. “It should be available to all men, and I support a prostate screening program.”