{
  "abstract": "Prostate cancer is a persistent and growing problem. Almost 1.5 million men were diagnosed with this condition in 2022, a figure that is projected to increase to 2.9 million by 2040.1 2 An ageing population explains some of this surge in diagnosis, but advances in cancer screening also play a significant role. In previous decades, trials that focused on screening showed suboptimal results due to high levels of false positives, overdiagnosis and potential overtreatment. The introduction of MRI in the diagnostic pathway, however, brings more efficacious prostate cancer screening closer to reality. A recent review by Bratt et al describes the challenges seen in previous trials that will surely frame the future of screening for prostate cancer.3 Meanwhile, Moore et al call for an MRI-led approach to prostate cancer screening based on findings from a UK community-based study, which piloted the strategy.4 The authors highlight that while many cancers were identified, overall response rates were generally low (1 in 5) and varied by demographic characteristics. For example, black men had just 20% of the screening invitation acceptance rate of white men. The stark effect of such inequalities is apparent across countries and healthcare systems. Studies looking at England and Wales have shown that low income and single households have reduced levels of healthcare engagement and a higher rate of metastatic prostate cancer.5 6 Responding to these inequities will be critical when implementing prostate cancer screening programmes.7",
  "authors": [
    {
      "affiliations": [
        "TBMJ, BMJ Publishing, London, UK"
      ],
      "name": "Kristoffer Thomas Stewart"
    },
    {
      "affiliations": [
        "Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK",
        "Division of Cancer Sciences, The University of Manchester, Manchester, UK"
      ],
      "name": "Ananya Choudhury"
    }
  ],
  "full_text": "Prostate cancer is a persistent and growing problem. Almost 1.5 million men were diagnosed with this condition in 2022, a figure that is projected to increase to 2.9 million by 2040.1 2 An ageing population explains some of this surge in diagnosis, but advances in cancer screening also play a significant role. In previous decades, trials that focused on screening showed suboptimal results due to high levels of false positives, overdiagnosis and potential overtreatment. The introduction of MRI in the diagnostic pathway, however, brings more efficacious prostate cancer screening closer to reality. A recent review by Bratt et al describes the challenges seen in previous trials that will surely frame the future of screening for prostate cancer.3 Meanwhile, Moore et al call for an MRI-led approach to prostate cancer screening based on findings from a UK community-based study, which piloted the strategy.4 The authors highlight that while many cancers were identified, overall response rates were generally low (1 in 5) and varied by demographic characteristics. For example, black men had just 20% of the screening invitation acceptance rate of white men. The stark effect of such inequalities is apparent across countries and healthcare systems. Studies looking at England and Wales have shown that low income and single households have reduced levels of healthcare engagement and a higher rate of metastatic prostate cancer.5 6 Responding to these inequities will be critical when implementing prostate cancer screening programmes.7With more individuals being diagnosed, we also must consider the growing complexities of treating prostate cancer. There is a clear move to a personalised medicine approach that incorporates an understanding of individual disease biology. Companion diagnostic biomarkers now allow us to recognise particular genetic mutations that are associated with prostate cancer prognosis, and the introduction of novel agents such as PARP (poly-ADP ribose polymerase) inhibitors allows us to target them. Evans et al provide initial findings from the UK’s personalised medicine experience, demonstrating that BRCA 2 (BReast CAncer gene 2) is the most common mutation in metastatic disease, with 1 in 10 cases found.8 They show there is scope for improvement due to high failure rates from poor sample quality. Despite these innovations, prostate cancer biology remains complex. Ali et al provide interesting insights into how the anatomical location of the prostate cancer might affect prognosis. In their systematic review, peripheral zone cancers had a worse outcome even when adjusted for known prognostic factors.9 This raises the question as to whether this could be related to inherent differences in the biology of these tumours.Societal influences are just as important as biological influences when it comes to cancer outcomes. In a climate where resources are limited no matter what healthcare system we work in, crafting cost-effective policies continues to be challenging. For example, colleagues in sub-Saharan Africa have faced this problem head-on by interacting with stakeholders and initiating a rational path to implementation of prostate cancer screening.10Prostate cancer, for now, remains a disease largely of older people. But there are reasons to anticipate changing demographics: Leone et al describe the possible oncogenic implications of gender-affirming hormone therapy on transgender and gender-diverse individuals.11 Additionally, Zhao et al found that early-onset prostate cancer incidence is rising fast compared with other solid tumours.12We are pleased to share this topic collection focusing on the recent progress we have seen in prostate cancer. The landscape for prostate cancer research and policy is exciting: improved biological understanding, cutting-edge technologies and innovative healthcare interventions are all on the horizon. But the next few years will require careful collaboration to ensure that persistent inequalities are mitigated and not solidified through these advances.",
  "title": "Understanding prostate cancer care: recent progress and future direction",
  "uid": "a19a22b0-141d-5f98-a228-e50fe76bdd9b"
}