Landmark prostate cancer screening trial launches in the UK

The first men have been invited to take part in Prostate Cancer UK’s TRANSFORM trial, kicking off the biggest prostate cancer screening study in a generation. The £42m trial is being co-led by UCL, Imperial, Queen Mary University of London, and the Institute of Cancer Research. 

The trial will be delivered in partnership with the NHS through the National Institute for Health and Care Research (NIHR), which has committed £16m, with the remaining £26m funded by Prostate Cancer UK through its supporters and other generous founding partners.  

Among the six research leads are Professors Mark Emberton and Caroline Moore from the UCL Division of Surgery & Interventional Science, who will work with their co-lead researchers, as well as 16 co-applicants from across the UK. TRANSFORM builds on 20 years of UCL research in prostate cancer diagnosis and screening.

We learned from our previous attempts at prostate cancer early detection that the tools we had available to us were very blunt. Though they were the only tools we had at the time and better than nothing. 

Now we have a different set of tools, including the ability to ‘see’ the cancer by virtue of MRI scans. This puts us in a position to determine what combination of tests work best to identify which men are at risk of cancers and which, if left alone, would impact on their quantity and quality of life.” 

Professor Emberton, Professor of Interventional Oncology at UCL and Consultant Oncologist at UCLH

Professor Caroline Moore, Head of Urology at UCL and an Honorary Consultant Urological Surgeon at UCLH, said: “We know that PSA screening reduces prostate cancer deaths, but we believe that new tools, such as MRI and polygenic risk scores, could reduce deaths much more quickly, and with much less harm than traditional PSA based screening. I am delighted that we are launching TRANSFORM to find the best way to find the cancers that kill, and to invite those at most risk to take up the offer of screening.” 

Polygenic scoring combs through a person’s DNA and calculates how likely they may be to develop a disease. It can be useful to detect an individual’s predisposition to conditions like common cancers. 

Today the first men will begin receiving letters from their GPs, inviting them to join the landmark trial designed to make diagnosis earlier, safer and more effective. It aims to revolutionise diagnosis by testing the most promising screening techniques available, including PSA blood tests, genetic spit tests and fast MRI scans, combined in ways that have never before been tested in a large-scale screening trial.   

The opening of TRANSFORM comes as the UK National Screening Committee (NSC) is soon to announce its decision on whether current evidence supports the introduction of screening for prostate cancer in the UK.  

TRANSFORM goes far beyond this existing evidence, testing new ways to diagnose the disease that could find the cancers that today’s methods miss. However, the trial will also quickly produce robust new information about the tests we currently use. If the NSC decides there is insufficient evidence to recommend screening now, these early results could help shift the evidence in favour of screening in as little as two years.  

TRANSFORM has also been specifically designed to help tackle inequalities in prostate cancer research and care. Black men are twice as likely to get prostate cancer and twice as likely to die from it. Yet historically too few Black men have been recruited into trials to generate reliable evidence of how effective screening would be for them. To help address this, at least one in ten men invited to the trial will be Black, and the charity and trial team will work with Black community leaders and organisations to ensure good representation of Black men in the trial, to ensure that future evidence is informed by, and reliable for, the men who stand to get the most benefit from screening.  

Laura Kerby, Chief Executive at Prostate Cancer UK, said: “The future of prostate cancer screening starts today. It’s incredible to see the launch of this once-in-a-generation trial that so many people have worked to make possible, from our scientists to our amazing supporters raising funds.  

“We’re delighted that the UK government, through the NIHR, has partnered with us to help make TRANSFORM a success, and has committed an incredible £16m of funding. We are also incredibly grateful to all our founding partners and major donors who have got us to this exciting milestone. Now we need the public to stand up and be part of it. The men signing up for the study, and the people who donate to keep it running, will have the power to help save thousands of lives each year in the UK and even hundreds of thousands globally.”  

Those recruited this week will form part of the initial 16,000 men taking part in stage one, which will test new techniques against the current NHS diagnostic pathway. The approaches that prove most effective will then be tested in a much larger group of up to 300,000 men, making it the biggest prostate cancer trial launched in more than two decades. The massive scale of TRANSFORM will also allow the creation of the biggest ever bank of prostate cancer samples, images and data to power the development of new tests and treatments for decades into the future.  

It is not possible to volunteer for the trial, but anyone who receives a letter is encouraged to take part.

Professor Hashim Ahmed, Chief Investigator of the TRANSFORM trial and Chair of Urology at Imperial College Healthcare NHS Trust and Professor of Urology at Imperial College London, said: “TRANSFORM is truly game-changing. As the biggest and most ambitious trial I’ve ever been part of, the start of recruitment today marks a pivotal step towards getting the results men urgently need to make prostate cancer diagnosis safe and more effective so that we can unlock the potential of prostate cancer screening in the UK.   

“Combining our world-class team of UK researchers, the latest screening techniques like fast MRI scans, PSA blood tests and genetic tests, we can find the best way to screen men for prostate cancer – minimising late diagnosis, saving more lives and doing so with fewer harms. Importantly, we’ve designed the study so that we can evaluate promising new tests as soon as they’re developed.”  

The trial will recruit men aged 50-74 (or 45-74 for some groups known to have poorer outcomes, such as Black men). The first testing site to open is the InHealth Community Diagnostic Centre in Ealing, with more opening soon across the UK. Men will be invited directly by their GPs, so the trial mirrors how a future screening programme would operate.  

At £42 million, TRANSFORM is the biggest single research investment ever made by Prostate Cancer UK and has been backed financially by seven founding partners: Cockburn Shaw Legacy; Freddie Green and Family Charitable Foundation; Garfield Weston Foundation; Movember; National Institute for Health and Care Research (NIHR); Omaze; and Paddy Power.  

Steve Kavanagh, 64, from North Baddesley in Hampshire, was diagnosed with prostate cancer in 2023.  

Steve said: “My dad and a close friend both had prostate cancer, so I was always very aware of my risk and had regular PSA tests over the years.  

“My level was higher than normal without being alarming, and when I was referred for more tests, at first they didn’t find anything. But when I was finally diagnosed, my consultant told me he thought the cancer could have been there for four years already and had been missed or was not visible in an earlier biopsy – it was found after a second scan and targeted biopsy.  

“That’s what makes TRANSFORM so important. It’s not just about giving everyone PSA tests, it’s about finding the best way to make sure that if you do have cancer, it isn’t missed. I’d really encourage anyone who can to support Prostate Cancer UK, and if you get a letter inviting you to take part in TRANSFORM, please consider saying yes. It could make all the difference.”