ESO conference tackles thorny prostate cancer issues

Controversial issues such as prostate cancer screening and the changing role of surgery in advanced diseased were discussed in the opening plenary session of the European School of Oncology (ESO) with experts acknowledging the role of timely screening while at the same time considering the dangers of over-diagnosis and treatment.

“What we need to realise is that prostate cancer screening has its role and benefits but we need to take it out from the clinical setting and move it to specialised centres,” said Prof. Monique Roobol (NL), adding that by focusing in the current debate the drawbacks of screening tools such as the prostate specific antigen (PSA), doctors might eventually lose a useful tool in detecting aggressive disease particularly in younger patients.

The ESO conference precedes the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC15) which will open tomorrow in Barcelona and provides a platform for various onco-urological experts to re-assess current treatment strategies and look at best practices and prospects.

In her lecture “Who is at risk? Population screening or individualized prediction?” Roobol gave an overview of the gains, challenges and prospects in providing a structured approach to diagnosing prostate cancer. “PSA testing will remain the mainstay of prostate cancer screening,” said Roobol as she noted that it is important how doctors define risk and that there is an urgent need for risk-stratification.

She added: “The next step is to combine (PSA testing) with other relevant information. Population-based, individualized screening will be feasible, but needs to be regulated to avoid misuse.” Roobol also stressed that currently doctors should not be carried away by hype particularly with regards to new technology, but instead based their treatment using evidence-based medicine and guidelines.

Screening, particularly PSA-based, has become a divisive item among the medical community following the results of studies in the US which indicated that the gains are minimal compared to the more worrying risks of over-treatment. Europe, on the other hand, has acknowledge the utility of screening tools but has also remained cautious on the issue of mass screening since PCa patients are diverse with very individualized disease characteristics.

Prof. Karim Touijer (USA), on the other hand, spoke on the changing role of surgery particularly with regards advance or metastatic prostate disease. He also commented on the issue of screening and said that aside from risk-adjust screening by age and PSA, additional markers are needed to increase specificity.

“Active surveillance for low-risk cancers and treatment by high-volume physicians and centers to reduce the harms of necessary treatment are also among the measures that we need to increase the benefits,” added Touijer.

In other lectures, Caroline Moore (GB) tackled the role of multiparametric MRI and highlighted the gains such as the detection of significant tumour (85% to 95%), its use for re- classificative and repeat assessments in men on surveillance and its utility in combination with other information such as biopsy and PSA kinetics.