Prostate cancer begins when some cells develop mutations in their DNA and start growing and dividing uncontrollably, causing normal healthy cells to die. Cancer cells will continue to grow and divide creating a tumour that can spread over time, to other tissues and organs such as the bladder, bones, lymph nodes, pelvic wall, lungs, and rectum. Prostate cancer metastasis can rarely occur in the kidneys and spleen 3 . Some of the symptoms of prostate cancer include blood in semen and urine, weak flow, bladder not fully emptied, and prolonged duration of urination. Some advanced symptoms, indicating the cancer has spread, include involuntary weight loss, reduced appetite, and pain in the testicles, back and bone 5 . It can also become metastatic, meaning it spreads to other organs, such as the bladder or, in some cases, to the bloodstream 8 .
On average, it takes two to four weeks to be diagnosed with prostate cancer following different tests and biopsies. Generally, a positive biopsy indicates the presence of cancer cells. The cancer is graded by factors such as how quickly the cells are likely to grow and how aggressive the cells are. These scores are known as the Grade Group 2 .
Figure 1 – A visual depiction of the cellular progression of prostate cancer 10 .
Currently, there is no definitive test or screening for prostate cancer. However, it is possible to determine the risks by simple factors that include PSA Levels and results of prostate examinations. Depending on the results of the previous tests, Multiparametric Magnetic Resonance Imaging (mpMRI) is performed. The mpMRI scan is preferred as it gives a more detailed image of the prostate gland, and it helps the doctor check for abnormalities, decide whether a biopsy is needed and if needed from which area is best to take it, if the cancer has spread 2 . One of the limitations is that it cannot surely confirm if there is cancer, which is why a transperineal or transrectal biopsy is needed accordingly 4 . The TRANSFORM Trial’s main purpose is to find an effective screening method which will improve diagnostic rates, without making the patient undergo unnecessary procedures that can also lead to mental distress 2 .
Other risk factors include ethnic groups- black men are more likely to get prostate cancer than any other ethnic group; currently, in the UK, 1 in 4 black men are more likely to get prostate cancer in their lives, reasons are not yet determined. The reasons are not fully known but as age increases, the risk of getting prostate cancer increases too. Most men get diagnosed between the age of 70 and 74 years. Family history and genetics are also key risk factors. The genes determine the growth, functions, and development of the body; if gene variation occurs, it often leads to cancer. In the case of prostate cancer, a BRCA1 or BRCA2 gene variation leads to the disease 8 . BRCA genes work by preventing cancer cell growth, and make sure healthy cells are growing normally. People with the BRCA2 gene variant are more likely to develop prostate cancer than those with the BRCA1 variation. Although there is no clear evidence, some researchers suggest that the BRCA1 or BRCA2 gene variation can also increase the possibility of developing this disease at a young age as well as the disease becoming aggressive and spreading more 8 .
Figure 2 – An image of a histology section showing the comparison between healthy/normal prostate tissue and cancerous prostate tissue 6 .
A large number of men are expected to take part in the TRANSFORM Trial. The trial will compare the most effective tests and provide definitive evidence indicating the best way to screen for prostate cancer; the trial will try to reduce patient death by up to 40% 7 .
This trial consists of two stages:
Stage one – this stage will consist of researching different screening options that include PSA blood tests, faster MRI scans (also known as ‘Prostagram’) as well as genetic testing to identify men that are at higher risk. The effectiveness of these new techniques will be evaluated through comparison with the NHS's existing diagnostic procedure to choose who should progress to the trial's next phase. Approximately 12,500 men will be requited, and this stage itself may take three years to complete by providing initial results 1,7 .
Stage two – this stage will consist of utilising the most effective methods found in stage one. 300,000 men are projected to participate. The trial is estimated to run for a minimum of 15 years to determine if the screening can lower prostate cancer related deaths as well as improve quality of life; it will also unveil whether patients will suffer consequences from unnecessary procedures (biopsies and invasive treatment). Most importantly, it will help identify the least harmful tests and procedures that enable the diagnosis of major cancers such as prostate cancer 1,7 .
The TRANSFORM Trial will contribute to the largest prostate cancer biomarkers in the world by collecting various samples, such as images and data, from over 250,000 men. This will help researchers make major discoveries that will guide the diagnosis and treatment of prostate cancer 1,7 .
References
1. Atkins, V., & Department of Health and Social Care. (2023). Biggest prostate cancer screening trial in decades to start in UK https://www.gov.uk/government/news/biggest-prostate-cancer-screening-trial-in-decades-to-start-in-uk
2. Cancer Research UK. (2022). Tests for prostate cancer . Retrieved 30/10/2024 from https://www.cancerresearchuk.org/about-cancer/prostate-cancer/getting-diagnosed/tests-for-prostate-cancer
3. Giridhar, K. (2023). Prostate cancer metastasis: Where does prostate cancer spread? Mayo Clinic. Retrieved 30/10/2024 from https://www.mayoclinic.org/diseases-conditions/prostate-cancer/expert-answers/prostate-cancer-metastasis/faq-20058270
4. Gravestock, P., Shaw, M., Veeratterapillay, R., & Heer, R. (2022). Chapter 12 - Prostate Cancer Diagnosis: Biopsy Approaches. In Urologic Cancers . https://doi.org/10.36255/exon-publications-urologic-cancers-prostate-cancer-biopsy
5. National Health Service (NHS). (2021). Symptoms - prostate cancer . Retrieved 30/10/2024 from https://www.nhs.uk/conditions/prostate-cancer/symptoms/
6. Newman, M. E. (2024, 17/10/2024). Study suggests a healthy diet may help keep low grade prostate cancer from progressing to more dangerous states during active surveillance https://www.hopkinsmedicine.org/news/newsroom/news-releases/2024/10/study-suggests-a-healthy-diet-may-help-keep-low-grade-prostate-cancer-from-progressing-to-more-dangerous-states-during-active-surveillance
7. O'Hare, R. (2024). New prostate cancer screening trial could save thousands of lives. Retrieved 30/10/2024, from https://www.imperial.ac.uk/news/253035/new-prostate-cancer-screening-trial-could/
8. Prostate Cancer UK. (2022). About Prostate Cancer . Retrieved 30/10/2024 from https://prostatecanceruk.org/prostate-information-and-support/risk-and-symptoms/about-prostate-cancer
9. Prostate Cancer UK. (2024). TRANSFORM Trial . Retrieved 30/10/2024 from https://prostatecanceruk.org/research/transform-trial
10. Saranyutanon, S., Srivastava, S. K., Pai, S., Singh, S., & Singh, A. P. (2020). Therapies Targeted to Androgen Receptor Signaling Axis in Prostate Cancer: Progress, Challenges, and Hope. Cancers , 12 (1).