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Plenary on prostate cancer: Screening and stratification

With prostate cancer (PCa) and in particular its early detection a red-hot topic for urologists in Europe, the EAU23 Plenary Session on PCa naturally drew the biggest speakers -and audiences- on the third day of the 38th Annual Congress in Milan. Aside from debates on different approaches to detection and risk stratification, the session featured a major, game-changing update from the British ProtecT trial, as well as a message from EU Commissioner for Health and Food Safety Dr. Stella Kyriakides (CY).

The ProtecT trial update came in two parts, with oncological results presented by Prof. Freddie Hamdy (GB) and an update on Quality of Life (QoL) from Prof. Jenny Donovan (GB). Fifteen years on from the conclusion of the original ProtecT trial (1999-2009), Prof. Hamdy could present some new findings:

“Survival from clinically-localised prostate cancer remains very high over a median of 15 years (96-97%), irrespective of treatment allocation. Men with metastases do not necessarily die from PCa and those who do, they have lethality features yet to be identifiable, and are not easily impacted by multimodality treatment approaches.”

Crucially, Prof. Hamdy concluded that current risk-stratification methods are unreliable and that new tools are needed. The indications for active monitoring or surveillance however can be expanded safely to intermediate-risk disease. Treatment decisions need to balance “trade-offs” between the reduction of metastases, long-term hormones, and local progression with radical treatments against their short-, medium-, and long-term impacts on sexual, urinary, and bowel function.

On QoL, Prof. Donovan told the plenary session’s audience that, based on the newly-published patient-reported outcomes, “men newly-diagnosed with localised PCa can now carefully assess the trade-offs between the benefits and harms of treatment options: in the short, medium, and long-term and using their own values and priorities to make prudent and well-informed treatment decisions.”

Session chair and chair of the EAU’s Scientific Congress Office Prof. Peter Albers (DE) hailed the results of the 15-year update as “ground-breaking” and expected them to have a big impact on the way treatment options would be approached by urologists and their patients.

The session ended with two debates that served to illustrate the different considerations that urologists face when considering active surveillance: is MRI enough for active surveillance for GG2 cancers or is a biopsy still needed, and how suitable is PSMA-PET in local evaluation of the prostate?

Politics of prostate cancer

Referring to the December 2022 agreement on the EU Commission’s proposal for cancer detection, EU Commissioner Kyriakides thanked the EAU for its role in determining the new approach:

“The past three years have taught us many lessons, most clearly that effective health policy is a collaborative effort. The European Union is determined to play its part. Last December we delivered one of the flagship initiatives, the new EU cancer screening recommendations. These suggest that member states consider a stepwise approach to evaluate the feasibility and effectiveness of organised PCa screening programmes. This is an important step forward and it opens the door for substantial funding under the EU4Health programme or other EU-funded sources. One is coordinated by the EAU, the PRAISE-U project.”

“Aiming to produce guidelines and implement pilots for PCa screening across the EU, the project will support implementation of the council recommendation. We have also earmarked additional funding under the EU4Health Programme 2023 for more projects and joint actions. In two short years, the Europe’s Beating Cancer Plan has gone from a blueprint for action to a set of concrete actions, backed by significant EU investment. Its success depends on our collaboration.”

“Let me express my gratitude to the EAU for gathering experts and expertise, for advancing care, science and research and disseminating knowledge not just among professionals but also patients.”

To (re)watch the full presentations, please visit to EAU On Demand on the Virtual Platform.