Prostate cancer is now the most common cancer in men in the Western world. In the United Kingdom (UK), there were over 52,000 new cases diagnosed in 2016-2018 and a lifetime risk of 1 in 8. Prostate cancer (PrCa) can run in some families and research studies have identified several genetic changes in Caucasian populations that are thought to increase the risk of developing prostate cancer. Other studies have shown that men from certain ethnic groups also have a higher risk of prostate cancer, and this includes men of black African or black African-Caribbean ancestry. This study aims to look at men with a higher risk of prostate cancer based on their ethnicity, family history and/or genetic predisposition to see whether any of these genetic changes are present in their DNA (genetic material) and whether this could be a helpful screening tool in prostate cancer screening programmes. It is thought that many genetic changes are involved in the development of prostate cancer and research is being carried out worldwide to identify these genetic changes. Some of these changes may cause a very slight increase in prostate cancer risk while others may cause a much larger increase in risk of developing prostate cancer. The investigators will invite (i) men of any ethnicity with a family history of prostate cancer; (ii) men of black African or black African-Caribbean ancestry; and (iii) men of any ethnicity with a known genetic predisposition to having prostate cancer (e.g., being known to have inherited a gene mutation that increases risk of prostate and/or being known to be in the top tenth percentile of the polygenic risk score (high PRS score prior to enrolment) for targeted prostate screening (Prostate Specific Antigen (PSA) testing, MRI and a biopsy of the prostate gland) and genetic profiling. The outcome of these prostate cancer screening investigations will be compared with the genetic profiles of those taking part in the study in order to look for certain genetic changes in the gene code that are thought to increase prostate cancer risk. This research will help us to determine what the role of such genetic profiling is in a prostate cancer screening programme and if it helps identify men at high prostate cancer risk.
Men with a first degree relative (or second degree if through female line) with histologically or death certificate proven PrCa diagnosed at <70 years
Men with two relatives on the same side of the family with histologically or death certificate proven PrCa where at least one is diagnosed at <70 years
Men with three relatives on the same side of the family with histologically or death certificate proven PrCa diagnosed at any age
Men of any ethnicity with a genetic predisposition to having prostate cancer e.g., being known to have inherited a gene mutation that increases risk of prostate cancer (e.g. BRCA1, BRCA2, ATM, PALB2, MLH1, MSH2, MSH6, CHEK2 and other DNA repair gene mutations as listed in the study protocol); and/or being known to have a high polygenic risk score (PRS) (defined as being in the top tenth percentile prior to enrolment).
Previous cancer with a life expectancy of less than five years.
Previous PrCa
Negative biopsy within one year before recruitment
Co-morbidities making prostate biopsy risk unacceptable (anticoagulants or antiplatelet medication including Warfarin, Clopidogrel, Apixaban, Dabigatran or other NOAC (Novel Oral Anti-Coagulant); poorly controlled diabetes, cardiovascular/respiratory disease, immunosuppressive medication or splenectomy)
350 men in each cohort\* \*The family history cohort will overrecruit to a total of 800, until 350 participants undergo MRI \& biopsy; both the Black and high-risk gene cohorts will overrecruit to a total of 400 participants each, to replace any participants who withdrew and/or any protocol non-compliant cases (e.g. those who underwent MRI but did not complete the biopsy).
Cohort
Prospective
Prostate MRI and Biopsy
Procedure/SurgeryAll men will be offered a MRI and prostate biopsy and they can either opt to undergo these procedures at baseline irrespective of PSA level at baseline or they can undergo PSA-only screening until clinically indicated based on an age-defined PSA threshold, at which point, they will undergo prostate MRI and biopsy once their PSA reaches the threshold.
The association of specific genetic profiles and biomarkers to predict outcome of prostate screening in men at higher genetic risk
To investigate the role of targeted prostate cancer screening in men at higher genetic risk (i.e. family history, ethnicity, gene mutation status), its association with specific genetic profiles and biomarkers as predictive tools of the risk of developing prostate cancer and to correlate these with genetic risk.
The incidence and aggressiveness of prostate cancer in men at higher genetic risk.
To determine the incidence and aggressiveness of prostate cancer in these men at a higher genetic risk.
The association of Diffusion Weighted MRI (DW-MRI) findings with prostate biopsy results.
To determine whether imaging techniques such MRI can be used to identify prostate cancer when compared to prostate biopsy results.
The incidence of abnormal imaging (using 3D ultrasound combined with shear wave elastography) and correlation with biopsy outcome and to correlate standard 12 core prostate biopsies with targeted biopsies based on abnormalities identified at DWMRI.
To determine the incidence of abnormal imaging at MRI in correlation with biopsy outcome.
The association of biological sample biomarker profiles with prostate biopsy result.
To identify biomarkers from biological samples and determine their association with prostate biopsy result.
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Institute of Cancer Research, United Kingdom
Lead sponsor
Royal Marsden NHS Foundation Trust
Collaborator
University of Cambridge
Collaborator
University of Oxford
Collaborator
Queen Mary University of London
Collaborator
