Raadpleeg ook de lijst van niet-toxische ondersteuning bij prostaatkanker van arts-bioloog drs. Engelbert Valstar.

En als donateur kunt u ook korting krijgen bij verschillende bedrijven, waaronder bij MEDpro voor o.a. prostasol  een veel gebruikt natuurlijk middel bij prostaatkanker als alternatief voor hormoontherapie

19 april 2024: zie ook dit artikel:  https://kanker-actueel.nl/urinetest-met-18-genen-ontdekt-beter-of-prostaatkanker-hooggradig-is-of-zal-worden-dan-de-2-genentest-via-psa-blijkt-uit-nieuwe-studie.html

29 augustus 2023: Bron: BMJ

Uit een Engelse studie, de reIMAGINE studie, bij mannen in de leeftijd van 50 tot 75 jaar komt naar voren dat een MRI van de prostaat beter prostaatkanker ontdekt dan een PSA van >3 ng/mL. De onderzoekers pleiten voor een gericht gebruik van een prostaat-MRI bij verdenking van prostaatkanker om zo overbehandeling of een vervelende biopsie te voorkomen. Maar wel ook om prostaatkanker vroegtijdig te ontdekken.

Ik heb de introductie van de studie en de resultaten uit het abstract vertaald in het Nederlands met hulp van google translate:

WAT IS ER REEDS BEKEND OVER DIT ONDERWERP

Bij de Europese gerandomiseerde screening op prostaatkanker werd gebruik gemaakt van prostaatspecifiek antigeen (PSA) >3 ng/ml, of een abnormaal digitaal rectaal onderzoek (DRE) om mannen te selecteren voor een standaard transrectale biopsie. De studie rapporteerde een vermindering van 20% in de sterfte aan prostaatkanker op 16-jaars meting, maar ging gepaard met aanzienlijke overdiagnose en overbehandeling.

Door de standaard transrectale biopsie te vervangen door een prostaat-MRI en gerichte biopsie bij mannen met een MRI-laesie, bij mannen met een hoge PSA of abnormale DRE kan minstens 1 op de 4 mannen een onnodige biopsie vermijden en wordt overdiagnose en overbehandeling verminderd.

WAT DIT ONDERZOEK TOEVOEGT

We beoordelen de prevalentie van laesies op een prostaat-MRI bij mannen die zijn uitgenodigd voor een prostaatgezondheidscontrole. We ontdekten dat 1 op de 6 gescreende mannen een laesie had op de prostaat-MRI, en dat meer dan de helft van de mannen met significante kanker op een biopsie een PSA <3 ng/ml had. Minder dan 1% van de gescreende mannen had een ‘overgediagnosticeerde’ ziekte met een laag risico.

HOE DIT ONDERZOEK DE ONDERZOEKSPRAKTIJK OF HET BELEID KAN BEÏNVLOEDEN

We moeten het gebruik van een door MRI geleide aanpak van screening op prostaatkanker in een grotere Britse bevolking evalueren, om te beoordelen of deze de vermindering van de sterfte aan prostaatkanker door formele screening kan handhaven, terwijl de overdiagnose en de daarmee samenhangende overbehandeling kan worden verminderd door gebruik te maken van een door MRI geleide aanpak. 

Prevalentie van MRI-laesies bij mannen die reageren op een door een huisarts geleide uitnodiging voor een prostaatgezondheidscontrole: een prospectieve cohortstudie

Abstract:

Doelstelling
Bij mannen met een verhoogd prostaatspecifiek antigeen (PSA) vergroot MRI de detectie van klinisch significante kanker en vermindert het de overdiagnose, met minder biopsieën. MRI als screeningsinstrument is in een formeel screeningsonderzoek niet onafhankelijk van PSA beoordeeld. We rapporteren een systematische, op de gemeenschap gebaseerde beoordeling van de prevalentie van prostaat-MRI-laesies in een op leeftijd geselecteerde populatie.

Methoden en analyse
Mannen in de leeftijd van 50-75 jaar werden geïdentificeerd uit deelnemende huisartspraktijken en willekeurig geselecteerd voor uitnodiging voor een screening MRI en PSA meting. Mannen met een positieve MRI of een verhoogde PSA-dichtheid (≥0,12 ng/ml2) werden aanbevolen voor de standaard beoordeling van prostaatkanker door de National Health Service (NHS).

Resultaten
Acht huisartsenpraktijken stuurden uitnodigingen naar 2096 mannen. 457 mannen (22%) reageerden en 303 voltooiden beide screeningstests. Oudere blanke mannen reageerden het meest op de uitnodiging, waarbij zwarte mannen 20% van het acceptatiepercentage van blanke mannen hadden.

Eén op de zes mannen (48/303 mannen, 16%) had een positieve screening-MRI, en nog eens 1 op de 20 mannen (16/303, 5%) had alleen al een verhoogde PSA-dichtheid. Na beoordeling door de NHS werd bij 29 mannen (9,6%) klinisch significante kanker vastgesteld en bij 3 mannen (1%) klinisch insignificante kanker.

Twee op de drie mannen met een positieve MRI en meer dan de helft van de mannen met een klinisch significante ziekte hadden een PSA <3 ng/ml.

Conclusies:

Prostaat-MRI kan waarde hebben bij screening, onafhankelijk van PSA. Deze gegevens zullen het mogelijk maken het gebruik van MRI als primair screeningsinstrument te modelleren ter ondersteuning van grotere screeningsstudies naar prostaatkanker.  

Het volledige studierapport is gratis in te zien. Klik op de titel van het abstract:
Original research
Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study
 
  1. Caroline M Moore1,2, 
  2. Elena Frangou3, 
  3. Neil McCartan1,4, 
  4. Aida Santaolalla5, 
  5. Douglas Kopcke6,7, 
  6. Giorgio Brembilla6, 
  7. Joanna Hadley2,6, 
  8. Francesco Giganti1,7, 
  9. Teresa Marsden1,2, 
  10. Mieke Van Hemelrijck5, 
  11. Fiona Gong6, 
  12. Alex Freeman8, 
  13. Aiman Haider8, 
  14. Steve Tuck9, 
  15. Nora Pashayan10, 
  16. Thomas Callender11, 
  17. Saran Green5, 
  18. Louise C Brown3, 
  19. Shonit Punwani6,7 and 
  20. Mark Emberton2,12 
  21. on behalf of the Re-Imagine Study group
    1. Division of Surgery & Interventional Science, University College London, London, UK
    2. Urology, University College London Hospitals NHS Foundation Trust, London, UK
    3. MRC Clinical Trials Unit, University College London, London, UK
    4. Our Future Health, London, UK
    5. Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
    6. Centre for Medical Imaging, University College London, London, UK
    7. Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
    8. Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
    9. Oxfordshire Prostate Cancer Support Group, Oxford, UK
    10. Department of Applied Health Research, University College London, London, UK
    11. Division of Medicine, University College London, London, UK
    12. Faculty of Medical Sciences, University College London, London, UK
    1. Correspondence to Dr Caroline Moore; caroline.moore@ucl.ac.uk

    Abstract

    Objective In men with a raised prostate-specific antigen (PSA), MRI increases the detection of clinically significant cancer and reduces overdiagnosis, with fewer biopsies. MRI as a screening tool has not been assessed independently of PSA in a formal screening study. We report a systematic community-based assessment of the prevalence of prostate MRI lesions in an age-selected population.

    Methods and analysis Men aged 50–75 were identified from participating general practice (GP) practices and randomly selected for invitation to a screening MRI and PSA. Men with a positive MRI or a raised PSA density (≥0.12 ng/mL2) were recommended for standard National Health Service (NHS) prostate cancer assessment.

    Results Eight GP practices sent invitations to 2096 men. 457 men (22%) responded and 303 completed both screening tests. Older white men were most likely to respond to the invitation, with black men having 20% of the acceptance rate of white men.

    One in six men (48/303 men, 16%) had a positive screening MRI, and an additional 1 in 20 men (16/303, 5%) had a raised PSA density alone. After NHS assessment, 29 men (9.6%) were diagnosed with clinically significant cancer and 3 men (1%) with clinically insignificant cancer.

    Two in three men with a positive MRI, and more than half of men with clinically significant disease had a PSA <3 ng/mL.

    Conclusions Prostate MRI may have value in screening independently of PSA. These data will allow modelling of the use of MRI as a primary screening tool to inform larger prostate cancer screening studies.

    Trial registration number NCT04063566.

    Data availability statement

    Data are available upon reasonable request. The datasets generated for this study can be found in the ReIMAGINE instance of the Philips HSDP CDL at https://research-cdl-prod-cdlux.eu-west.philips-healthsuite.com/catalog. These datasets are currently accessible only to the consortium partners of the ReIMAGINE project. After completion of the project, the data will also be available to the broader clinical and scientific community via request to the ReIMAGINE Group (reimagine@ucl.ac.uk). All data released (Individual participant data (including data dictionaries)) from the consortium will appear in an anonymised format. The study protocol, statistical analysis plan, and informed consent will be available after publication.

    https://creativecommons.org/licenses/by/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

    WHAT IS ALREADY KNOWN ON THIS TOPIC

    • The European Randomised Screening for Prostate Cancer study used prostate-specific antigen (PSA) >3 ng/mL, or an abnormal digital rectal examination (DRE) to select men for a standard transrectal biopsy. The study reported a 20% reduction in prostate cancer mortality at 16 years but was associated with significant overdiagnosis and overtreatment.

    • Replacing standard transrectal biopsy with prostate MRI, and targeted biopsy in men with an MRI lesion, in men who have a high PSA, or abnormal DRE allows at least 1 in 4 men to avoid unnecessary biopsy, and reduces overdiagnosis and overtreatment.

    WHAT THIS STUDY ADDS

    • We assess the prevalence of lesions on prostate MRI in men invited for a prostate health check. We found that 1 in 6 screened men had a lesion on MRI, and over half of the men with significant cancer on biopsy had a PSA <3 ng/mL. Less than 1% of screened men were ‘overdiagnosed’ with low-risk disease.

    HOW THIS STUDY MIGHT AFFECT RESEARCH PRACTICE OR POLICY

    • We should evaluate the use of an MRI-led approach to prostate cancer screening in a larger UK population, to assess whether it could maintain the reduction in prostate cancer mortality of formal screening, while reducing overdiagnosis and associated overtreatment by using an MRI-led approach.


    Future research

    This study has been carried out in a hospital-based setting, at a single university hospital. A screening programme would need to be delivered at specialised screening centres, where consistent high quality acquisition and reporting would need to be achieved.20 Future research would need to assess the feasibility of a community-based MRI delivery programme, with use of a mobile MRI scanner, such as those used in some breast screening programmes.

    A response rate of 22% for a single paper-based invitation, during a global pandemic when people were discouraged from attending healthcare settings, is likely to increase in non-pandemic times. The differential response rate, based on age and ethnicity, needs to be addressed. In terms of age, those most likely to respond were those in the 65–70 age band, which has a higher prostate cancer incidence than younger men. In terms of ethnicity, black men were the least likely to respond to an invitation, but have a higher risk of prostate cancer than white men.

    In an ideal situation, the likelihood of response to a screening invitation would be proportionate to the risk of disease in that group. A recent model-based analysis, based on USA SEER data, suggested that increasing the intensity of PSA screening in black men between the ages of 45 and 70 would lead to a greater mortality reduction, and limited overdiagnosis, compared with historical general population screening.21 In order to design a screening study which targets men at highest risk of prostate cancer, a variety of approaches may be needed. A recent initiative by Orchid, a UK-based men’s health charity explored ways to engage black and Afro-Caribbean men either diagnosed or at risk of prostate cancer.22 Successful approaches including raising awareness among men and women in the community through roadshows and dedicated materials including a short film, and z-cards with relevant information. It also included increasing awareness among healthcare professionals about the increased risk of prostate cancer in black men.

    Further screening studies would need to incorporate other prostate cancer risk assessment approaches including non-imaging biomarkers, to assess the most efficient screening approach in the UK population. Given the incomplete overlap of the risk profiles generated by PSA and MRI, we would encourage each to be used in further research, to assess whether a stepwise approach can be adopted.

    Data availability statement

    Data are available upon reasonable request. The datasets generated for this study can be found in the ReIMAGINE instance of the Philips HSDP CDL at https://research-cdl-prod-cdlux.eu-west.philips-healthsuite.com/catalog. These datasets are currently accessible only to the consortium partners of the ReIMAGINE project. After completion of the project, the data will also be available to the broader clinical and scientific community via request to the ReIMAGINE Group (reimagine@ucl.ac.uk). All data released (Individual participant data (including data dictionaries)) from the consortium will appear in an anonymised format. The study protocol, statistical analysis plan, and informed consent will be available after publication.

    Ethics statements

    Patient consent for publication

    Ethics approval

    This study involves human participants and was approved. Ethical approval was granted by London—Stanmore Research Ethics Committee Heath Research Authority (reference 19/LO/1129). Participants gave informed consent to participate in the study before taking part.

    Acknowledgments

    We are very grateful to all of the men who responded to the invitation and participated in the study, and to our participant London GP practices: Dr Stuart Mackay-Thomas, Hampstead Group Practice; Dr Claire Chalmers-Watson, Parliament Hill Medical Centre; Dr Kingshuk Pal, Prince of Wales Medical Centre; Professor Kate Walters, The Keats Group practice; Dr David Sharpe, Bellingham Green Surgery; Dr Alexander Gilkes, Minet Green Health Practice; Dr Mehul Mathukia, Mathukia’s Surgery and Dr Hira, The Rise Group practice. We are very grateful for the collaboration of Mr Lee Berney and Mr Andrew Prugia at NOCLOR, and Jayshireen Singh at CRN. We are most grateful to Mrs Rosie Clow, Clinical Trial Manager at UCL for her assistance with the manuscript.

    References

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    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Twitter @mrsprostate

    • Collaborators Re-Imagine Study group: Trial Sponsor: University College London (UCL). Trial Coordination: UCL Urology, Research Department of Targeted Intervention, Division of Surgery and Interventional Science. Funders: The Medical Research Council, U.K. (MRC), grant number MR/R014043/1 and Cancer Research U.K. (CRUK). Screening Lead: Professor Caroline M Moore (caroline.moore@ucl.ac.uk). Professor Mark Emberton (UCL, UCLH, WS lead and/or co-applicant), Professor Hashim U Ahmed (ICL, CXH, WS lead and/or co-applicant), Professor Caroline M Moore (UCL, UCLH, WS lead and/or co-applicant), Professor Mieke Van Hemelrijck (KCL, WS lead and/or co-applicant), Professor Shonit Punwani (UCL, UCLH, WS lead and/or co-applicant), Dr Manuel Rodriguez-Justo (UCLH, WS lead and/or co-applicant), Dr Gerhardt Attard (UCL, WS lead and/or co-applicant), Professor Louise Brown (UCL MRC, Statistician), Ms Elena Frangou (UCL MRC, Statistician) Ms Chris Brew-Graves (UCL, NCITA, Co- applicant), Professor Ton Coolen (Radboud University, WS lead and/or co-applicant), Mr Steve Tuck (Patient representative, WS lead and/or co-applicant), Dr Aida Santa Olalla (KCL, Data Management), Ms Charlotte Moss (KCL, Data Management), Ms Saran Green (KCL, PPI), Mr Neil McCartan (UCL, UCLH, ICL, Clinical Project Manager), Mrs Rosie Clow (UCL, Clinical Trial Manager). Mr Ged Corbett (UCL TRO, Project Manager). Mrs Anna Wingate, Dr Teresa Marsden, Ms Joanna Hadley, Ms Fatima Akbar, Ms Hina Pervez, Ms Suparna Thakali, Ms Ashling Henderson, Ms Dizem Tekin, Dr Giorgio Brembilla, Dr Francesco Giganti, Dr Tom Syer, Mr Joey Clement, Dr Harbit Sidhu (UCL, UCLH, Site staff). Ms Elizabeth Isaac, Ms Teresita Beeston, Ms Katerina Soteriou (UCLH, Site staff). Ms Francesca Rawlins, Ms Pirruntha Sivaharan, Ms Kinnari Naik, Ms Savahnna Wolfe, Dr Henry Tam, Ms Heather Bholastewart, Dr Sarp Keskin, Ms Mariana Bertoncelli, Mr William Maynard (ICL, CXH, Site staff). Professor Charlotte Bevan (ICL, BRC), Dr Paul Boutros (UCLA – University of Toronto, BRC), Dr Andrew Feber (ICR, BRC), Dr Hayley Whitaker (UCL, BRC), Dr Alex Freeman (UCLH, BRC). Professor Caroline Dive (CRUK / University of Manchester, SAB), Professor Eytan Domany (Weizmann Institute of Science, SAB), Professor Malcolm Mason (C) (Cardiff University, SAB), Professor Anwar Padhani (ICR, SAB). Professor Eric Aboagye (ICL, SC), Professor Richard Kaplan (c) (UCL MRC, SC), Professor Chris Parker (Royal Marsden & ICR, SC), Professor Peter Parker (KCL, SC). Mr Lee Berney, Mr Andrew Prugia (NOCLOR, NOCLOR). Jayshireen Singh (CRN, CRN). Screening Study GP practices: Dr Stuart Mackay-Thomas (Hampstead Group Practice), Dr Claire Chalmers-Watson (Parliament Hill Medical Centre), Dr Kingshuk Pal (Prince of Wales Medical Centre), Prof Kate Walters (The Keats Group Practice), Dr David Sharpe (Bellingham Green surgery), Dr Alexander Gilkes (Minet Green Health Practice), Dr Mehul Mathukia (Mathukia's Surgery), Dr Hira (The Rise Group Practice).

    • Contributors CM wrote the first draft of the manuscript, and all authors reviewed and edited the manuscript. The corresponding author (CM) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. The lead author (CM) (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. CM, SP, LCB and ME contributed to study design, data interpretation. DK, GB, FGi and SP contributed to MRI reporting. NM, TM, FGo and JH contributed to clinical trial support. AF and AH contributed to histology reporting. AS and MVH contributed to data curation. EF and LCB contributed to statistical analysis. ST contributed to patient representative. SG and MVH contributed to patient and public engagement. NP and TC contributed to screening modelling.

    • Funding The ReIMAGINE study was launched with funding of £4.1 m from the Medical Research Council (grant no: MR/R014043/1) and £1 m from Cancer Research UK, as part of the MRC’s Stratified Medicine Initiative. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

    • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare support from the MRC and CRUK as above for the submitted work, and no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.Declaration of other interests. ME receives research support from the United Kingdom’s National Institute of Health Research (NIHR) UCLH / UCL Biomedical Research Centre. He has no direct conflict of interest associated with the work presented in this paper. He acts as an advisor/consultant to SonaCare Inc; Nina Medical; Exact Imaging and Angiodynamics Inc. CM is funded via an NIHR Research Professorship. She has received clinical trial funding from SpectraCure, proctor fees for HIFU proctoring from SonaCare and speaker fees from Ipsen in the last three years. She carries out research into photodynamic therapy supported by Spectracure.

      FG is a recipient of the 2020 Young Investigator Award (20YOUN15) funded by the Prostate Cancer Foundation / CRIS Cancer Foundation. FG reports consulting fees from Lucida Medical LTD outside of the submitted work.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

    Linked Articles

    prostaatkanker, Gleasonscore, PSA, MRI-prostaat, overbehandeling, reductie in sterfte


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