The £395 prostate cancer test that gives a more accurate diagnosis, who should consider paying for it – and why it’s not available on the NHS
The news last week that men aged over 50 will no longer have the right to a free prostate cancer test if they have no symptoms has caused a storm of protest.
It’s been reported that the Department of Health and Social Care has written to health organisations to say it is up to GPs to decide whether their patient is given the standard PSA blood test.
The decision was ‘a shocking betrayal’ that ‘will condemn thousands more men each year to a late and incurable diagnosis’, said David James, from Prostate Cancer Research. But could a different test be more useful – and should men concerned about their risk consider paying for it privately?
The test, called Stockholm3, was developed at The Karolinska Institute in Sweden in 2011. It has since become widely used in Nordic countries. It’s also been available privately in the UK for the past three years, at a cost of around £395.
Currently the standard NHS check for prostate cancer is a PSA blood test, which checks for levels of the protein prostate-specific antigen produced by the prostate.
The main problem with relying on PSA is that the result cannot reliably distinguish the type of cancer and whether it requires treatment – indeed, prostate cancer is unique in that not all tumours are aggressive: some are slow-growing and may never cause harm, meaning they can be monitored through ‘active surveillance’ rather than treated immediately.
The Stockholm3 blood test (‘3’ refers to the third, pivotal study which led to its approval) is more sophisticated: it checks PSA and four other protein markers, as well as 101 genetic markers.
These results, along with information such as the man’s age and family history, are put through an algorithm that creates a risk score for how likely the man is to develop aggressive prostate cancer.
Currently the standard NHS check for prostate cancer is a PSA blood test, which checks for levels of the protein prostate-specific antigen produced by the prostate
David James, from Prostate Cancer Research, is concerned that the Government’s decision ‘will condemn thousands more men each year to a late and incurable diagnosis’
This result is either ‘green’, a low-risk score, meaning there’s no need to be tested for another six years, or ‘red’, which suggests a raised risk and the man should be referred for further investigations (typically an MRI scan or a biopsy).
The Stockholm3 test was developed as a way to better identify cancers that need treatment.
‘The developers of Stockholm3 have basically come up with weighted influences of these individual markers to create a risk score,’ says Tim Dudderidge, a consultant urological surgeon at University Hospital Southampton.
‘So a patient might have a high risk in one area – a father who had prostate cancer, for instance – and a low risk in another. These factors, which are readily available, are then collated and the algorithm works out the patient’s overall risk.
‘It seems quite powerful at identifying bad cases – where there’s a high risk of an aggressive cancer – and at reassuring men who don’t have a significant problem.’
In a major new study, published in the Annals of Internal Medicine, the PSA test was compared with Stockholm3 in 12,670 men aged between 50 and 74 – who underwent both testing methods.
Researchers found 443 men went on to develop aggressive prostate cancer, with Stockholm3 more sensitive in detecting cases – with a 90 per cent success rate compared to 74 per cent with the PSA test.
Now the Stockholm3 test is being included in the large-scale TRANSFORM trial, which is investigating the most accurate and cost-effective way to screen men for prostate cancer on the NHS.
Dr Martin Scurr, Good Health’s GP columnist, has written about why he recommends Stockholm3 to his private patients
The trial is recruiting 16,000 men aged between 45 and 74 who will undergo different screening options – fast MRI (a 15-minute MRI scan), genetic screening (to look for inherited markers linked to the disease) and PSA tests. Blood samples will also be tested with Stockholm3. The first results are expected in about three years.
This trial will inform the introduction of a screening programme for prostate cancer – rejected in May, partly because the PSA test is increasingly seen as unreliable.
‘A downside of the PSA test is that it is unable to distinguish between cancers that will not pose any problems and those which are aggressive,’ says Professor Rakesh Heer, a consultant urologist at Imperial College Healthcare NHS Trust in London, and investigator on the TRANSFORM trial.
By picking up lower-risk cancer, ‘it can lead to over-diagnosis and excessive treatment, which can have serious side-effects such as incontinence and impotence’, he adds.
‘We want testing to pick up men with the more serious cancers – where we can prevent the cancer growing and spreading,’ says Professor Heer, who is also based at London Bridge Hospital. ‘In recent years, we’ve seen diagnostic blood tests such as Stockholm3 as more effective regarding over-diagnosis and over-treatment.’
Mr Dudderidge adds: ‘There’s strong data supporting Stockholm3. It means we would not be creating a group of men who are carrying a burden of unnecessary worry about their prostate or having tests that aren’t justified. This is a new technology I feel we should look towards using more in future.’
Good Health’s GP columnist, Dr Martin Scurr, has previously written about why he recommends Stockholm3 to his private patients.
‘It’s a better test than a PSA test – I’ve seen studies of men with a low PSA score who turn out to have prostate cancer and if they’d had Stockholm3, it would have shown they’re at higher risk.’
He adds: ‘If you have sufficient anxiety about your risk of prostate cancer but been told that you’re the wrong age to have a test – it’s worth paying for Stockholm3.’
