The future of men’s health in the UK is potentially set to change thanks to the announcement of a huge prostate cancer screening trial that could have major implications for oncology diagnosis and treatment in the future if it goes as well as existing breast cancer screening programmes.
The TRANSFORM clinical trial, set up by both the UK government and charity Prostate Cancer UK, is the most ambitious clinical screening trial in at least two decades and could potentially save countless lives by diagnosing men and ensuring they receive treatment sooner.
Depending on its outcomes, it could potentially transform cancer care for men and men’s health in general in the UK, much in the same way the NHS Breast Screening Programme has done for women.
To understand why, it is also important to understand the TRANSFORM trial, and what it is looking for in an effective, consistent, screening method for the most common type of cancer in men.
What Is TRANSFORM?
Announced on International Men’s Day, 19th November 2023, the TRANSFORM trial aims to rectify one of the biggest and most devastating diagnosis and care gaps in oncology, one that potentially contributed to 12,000 people losing their lives.
The trial, which will most likely begin at some point in the Autumn of 2024, will test a range of screening methods that have the potential to diagnose prostate cancer consistently, accurately and quickly.
The primary method of interest is MRI scans, which whilst far from a new technology for diagnosing cancer, have not been used at scale in a screening programme.
The focus is on reducing inequality and ensuring that life-saving diagnoses are discovered early on. Whilst the trial will have a relatively broad scope for recruitment of men between 50 and 75 years of age, there is also a target that a tenth of the men in the trial are black men between 45 and 75.
Whilst there are, as of its announcement, a lot of questions that still need to be resolved regarding start dates, number of trial subjects, which screening methods will be used exactly and the research centres involved in the process, there are some aspects that have been confirmed.
The budget has been set at £42m, £16m of which is set to come from the government itself. £1.5m has been earmarked from a partnership with the long-running men’s health charity drive Movember, and the rest will be generated by Prostate Cancer UK themselves.
It will also take advantage of the existing diagnostic ecosystem, including hospitals, oncology clinics and community diagnostic centres. They would provide a wide range of tests, which a successful screening regimen would perfectly fit into.
Why Does This Matter?
Currently, whilst prostate cancer is the most common form of cancer amongst men, there is currently no national screening programme to detect it.
Part of the problem is that prostate cancer does not often have clear symptoms except at an advanced stage, and the current tests used to detect it are not necessarily universal.
The primary early-stage test used for prostate cancer is the prostate-specific antigen test (PSA), which whilst available on request, needs other tests to be used in combination with it in order to be entirely effective.
It can only detect the appearance of biomarkers typically associated with prostate cancer, cannot detect the severity of a case, and can sometimes miss cancers or lead to false positives.
A better approach is required for a widespread screening programme in order to avoid missing anyone or causing unnecessary distress through a false positive.
After all, whilst progression and stages of cancer can vary by type and indeed on an individual basis, the fairly universal rule is that the earlier a cancer is spotted, the easier it is to treat as there are far more options for treatment available and far more time for those treatments to be effective.
A widespread screening programme, as has been proven with breast cancer, is the best way to ensure that men are effectively diagnosed as early as possible to avoid more complex and intensive treatments being required, or the worst-case scenario that it is no longer curable.
On top of the benefits specific to prostate cancer, the development of TRANSFORM coincides with a number of government men’s health initiatives designed to help raise awareness of not only prostate cancer but other men’s health issues.
The main initiative in this part of the work is a comprehensive series of updates to the NHS website, focusing on improvements to pages that are primarily used by men and helping to signpost and clarify the support available for certain conditions, including both prostate and testicular cancer.
As well as this, the government established the first task and finish group dedicated to men’s health, featuring campaigners, academics and behavioural scientists.
They aim to ensure that men engage with their health and have access to services that can help prevent or provide early diagnosis of potential issues, including takeup of the NHS Health Check and future screening programmes, as well as access to a GP.
Finally, they are also recruiting for a Men’s Health Ambassador, a public-facing role for people with expertise in men’s health who would take responsibility for boosting awareness of conditions, needs and fears commonly held by men.
The primary aim is to open conversations, smash stigmas and debunk a lot of the myths and taboos that often surround men’s health topics, which in turn will help to encourage men to check themselves and take a proactive approach towards their health.
The biggest part of this work, by far, is the contribution towards TRANSFORM, and the greater the resources put towards this trial, the better the potential outcomes, not just for the ultimate report, but the future of cancer detection.
After decades of attempts and a huge body of research, 2024 could be the year that sees the first steps towards making prostate cancer more visible, more easily detected and more easily treated than ever before, and giving access to high-quality diagnosis and medical treatment to as many men in the country as possible.