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Plenary Session on PCa: “Are we poised for screening?”

A common thread through the talks at today’s Plenary Session on risk-adapted screening for prostate cancer is the caution that should be exercised before turning to biopsy and offering a cancer diagnosis. The fear of overdiagnosis and possibly overtreatment is shared among patients and clinicians alike, but specialists have several options to offer careful and crucial patient stratification.

The session was co-chaired by Prof. Arnauld Villers (FR) and outgoing Scientific Congress Office chair Prof. Peter Albers (DE). Prof. Albers said that the session would have a “highly political” character, following the recent EU Commission recommendation to member states to rethink their strategy to the early detection of prostate cancer.

This session, at the start of the second day of the 39th Annual EAU Congress in Paris, brought together a variety of perspectives on the matter, starting with the PCa patients’. Mr. Günter Carl (DE), Chairman of Europa Uomo and speaking on behalf of the prostate cancer patient, stressed the desire for an approach that is as uniformly across Europe as possible, with emphasis on best informing the patient and standardised use of risk calculators, MRI and interpretation of PI-RADS scores.

PRAISE-U is the most concrete result of the new political decision to explore PCa early detection in the EU. The high-profile project is being coordinated by the EAU and its Policy Office, and Prof. Monique Roobol (NL) introduced it and gave an update on its progress in its first year. She also reflected on earlier work with the European Randomized study of Screening for Prostate Cancer (ERSPC) and the drawbacks of its “one-size-fits-all” approach:

“While screening can reduce suffering from metastatic disease and PCa mortality, a one-time screening is not enough and starting at an elderly age causes more harm. The stopping age is also still under debate as the harm/benefit and life expectancy play an important role. One-size-fits-all also has the drawback of leading to many unnecessary testing procedures.”

Prof. Roobol echoed the words of Mr. Carl that overdiagnosis is a serious issue that must be avoided as much as possible. She then went on to detail the individually tailored, risk-based screening at the basis of PRAISE-U, and which different approaches participating pilot countries are offering their populations, all with the aim to avoid unnecessary biopsies and diagnosis.

Dr. Adam Kibel (US) gave the Society of Urologic Oncology (SUO) lecture, offering a US perspective on the topic, and introducing the biomarkers that uro-oncologists currently have at their disposal to assess risk for PCa patients.

CAP Trial
Presented on the day of its publication in JAMA, Profs. Freddy Hamdy (GB) and Richard Martin (GB) gave a 15-year update on the Cluster Randomized Trial of PSA Testing for Prostate Cancer (or CAP) Trial. Prof. Martin presented the latest results:

“In the control arm, 8/1000 men died of PCa. In intervention, this was reduced to 7/1000, or one fewer death per thousand men invited. Policy makers should weigh the small reduction in deaths using PSA testing against the harms of overdiagnosis and the risk of overtreatment, as shown in ProtecT.”

Prof. Hamdy summarised the trial and offered some perspective. “We have not one, but two Achilles heels: the genomic diversity of PCa, which we’re just starting to understand; as well as the question we still ask ourselves: ‘what does clinical significance actually mean?’ We see more men presenting with PCa, but the mortality rate remaining stable.”

He finally warned the audience of urologists: “before putting the biopsy needle in, be aware that you will be giving the patient a ‘PCa Passport’. Make sure that the man deserves this passport, and all that it entails before putting the needle in.”

To (re)watch the full presentations during this Plenary Session, please visit the EAU24 Resource Centre.