A few notes I made during the presentations which might be of interest here.
PCUK is pleased with its campaign to require mpMRI before biopsy, and I think the compliance level is now over 80% (but I didn't write that down at the time). However, the reason this is done isn't always to improve the selection for biopsy and targeting of the samples which was the aim of the PCUK campaign - often it's to meet the diagnosis window targets.
PCUK is pushing to replace TRUS with transperineal biopsies. One recent advance which has made this possible is the ability to do transperineal with just local anaesthetic now, which avoids the costs and waiting list for theatre time. A portable trolley has been developed with everything required that can be wheeled into a consulting room to perform a transperineal biopsy. Leicester, Bristol, Oxford, and UCLH are now doing this. Barts and Newham have also switched to transperineal only.
The internal NHS hospital lab cost for a PSA test is £2. There are additional costs in the requesting department (e.g. urology), such as the syringe, needle, sterile wipe, etc. The costs for the Graham Fulford Charitable Trust to do the charity tests for a reasonable number of people is around £15 each, including hiring the phlebotomists.
Interesting talk by Prof Tim Oliver suggesting some prostate cancer may have its roots in what happens to the prostate during puberty. Two factors thought to increase the chance are reduced sunlight exposure to generate vitamin D during puberty (correlated from a lack of playing outdoors), and having acne (anaerobic acne bacteria are found in some prostate cancers). There's also been the suggestion that people with dark skin in countries without equatorial sun levels during puberty will hit the lack of vitamin D issue, but currently this has been seen as too sensitive an issue for further research along these lines, and research is concentrating more on looking for a genetic difference to explain why black men are twice as likely to get PCa.
Lots of talk on screening programs. There are no wholesale screening programs anywhere in the world currently, with the big issue being no good/reliable test for PCa, resulting in over treatment and cancers being missed. The main objection raised is that of overtreatment, and it is thought this has been reducing as we get better at testing and understanding the results, and was estimated at around 4% in 2017. Selection for biopsy is getting better too - in 2008, 25% of those biopsied had PCa (3 out of 4 had negative biopsies), but this had risen to 65% in 2018 (i.e. 1 in 3 had negative biopsies).
PCa is the most common cancer for Males.
417,000/year diagnosed, 1 in 7 develop PCa before age 85, more than 2M living with PCa, 92,200/year deaths.
Annual cost of €9B.
PSA, although a poor test of PCa, is a useful biomarker for PSA risk stratification. For example, men with PSA < 1 at age 60 are extremely unlikely to die of PCa, and don't merit any further testing. That accounts for 35% of men.
Using multiple risk stratifications, the NNI (number needed to invite) to multiple PSA tests to avoid one death is around 1428, which is quite achievable. Without risk stratification, the number will be too high to be manageable.