Prostate cancer early detection: It’s time for change!
On Friday, 1 July, Prof. Peter Albers (DE), Prof. André Deschamps (BE) and Prof. Monqiue Roobol (NL), chaired the EAU22 Special Session on “Prostate cancer early detection: What men need to know”. There was a real sense of urgency in the lecture theatre for the implementation of a Europe-wide population-based screening programme.
Dr. Sigrid Carlsson (US) began her presentation, “How should early detection be organised in 2022?”, with an overview on factors to take into consideration, including life expectancy, burden of disease, resources and health policy.
“The current situation is like the wild west, we need a risk-adapted screening process, with the use of risk calculators and PSA, which will reduce referrals for MRI/biopsy testing.” Dr. Carlsson wants a call to action for a Europe-wide population-based screening programme by 2027 based on risk stratification.
According to Dr. Carlsson, prostate cancer guidelines recommend that men expected to live at least 10 more years should have their PSA level checked from the ages 60 to 70 years. If the PSA level is higher than 3 ng/mL, men should talk with their doctor about having a biopsy of the prostate. If the PSA level is between 1 and 3 ng/mL, men should see their doctor for another PSA test every two to four years. If the PSA level is less than 1 ng/mL, no further screening is recommended.
Dr. Carlsson’s five golden rules for risk-stratification prostate cancer screening in 2022:
- Get consent (shared decision-making)
- Start conversations about risks and benefits of PSA screening at 45-49
- Risk stratify screening and adapt the re-screening intervals to the man’s age, health and prior PSA
- Don’t screen men who won’t benefit
- Limit screening in older men
- Limit screening in men over 60 with a PSA < 1 ng/mL
- Don’t biopsy without a compelling reason
- Repeat the PSA, work-up for benign disease
- Consider additional biomarkers and/or mpMRI
- Recommend active surveillance for men with low-risk prostate cancer
- Refer men who need treatment preferentially to high-volume providers or centres
- Consider rehabilitation and rehabilitation strategies to improve quality of life after prostatectomy
In his presentation “EAU guidelines or recommendations?”, Prof. Nicholas Mottet (FR) talks about moving in the right direction with screening. The EAU position has a strong rationale, is absolutely in line with the PCa guidelines and is supported by selected data and patient demands, however, a study is required to show that these ideals can be implemented in practice and must be proven to be effective in real life. “Overdiagnosis and overtreatment is a real issue and if urologists overtreat, we will negate the benefits of screening”.
Prof. Andre Deschamps (BE) delivered his presentation “EUomo: The last word”, where he emphasised the need for increasing awareness of PCa and breaking the taboo around this subject. “The use of active surveillance must be maximised, and offering treatment in multidisciplinary teams will insure the best possible outcome. Surrounding care and the aftercare is critical for the best possible QoL.”
In his presentation, “When can we expect a Europe-wide early detection strategy?”, Dr. Tit Albreht (SI) discussed the urgent need to “harmonise early detection across Europe with the introduction of an organised, systematic screening for prostate cancer, working jointly with the JRC-cancer Knowledge Centre on the quality assurance and convergence strategies.”
The guidelines on prostate cancer can be a useful tool in this strategy, specifically the chapter on screening. Streamlining the efforts through the implementation of the guidelines will help promote organised screening as a safe, viable and quality-based alternative to non-organised screening or early detection strategies. It is important to define the resources needed for each of the phases in the process and enable adequate follow-up of patients and of the screen population. Lastly, solid professional and scientific grounds must be provided for adequate policy decisions to be taken.
The introduction of an organised prostate cancer screening should result in securing a transparent system with proper links to the screening registries and provide a systematic invitation system for the invited population of men. Secure adequate resources for the advanced diagnosis of the suspicious cases identified from the baseline screening, with clear follow-up recommendations supported by the urological scientific community.
The EAU and national societies should provide instructions for implementation, including guidance and education, as well as promotion on this. It will be necessary to work closely with epidemiologists and define comprehensive pathways with all branches based on the PCa guidelines and screening strategy. Special attention should be given to the need for the ‘watchful waiting’ strategies used for medium-risk patients.
This special session concluded with some lively debate about how to coordinate this EU-wide approach.
Access and/or rewatch these presentations and other lectures in full via the On Demand feature of the EAU22 Virtual Platform.
