After years of decline, prostate cancer mortality has increased last years in several countries. The late detection of advanced prostate cancer, often due to a lack of awareness, is likely a reflection of this revised trend.
Although it is well-known that Prostate Specific Antigen (PSA) tests in population-based screening programmes reduce the prostate cancer mortality rate, the discussion on overdiagnosis and overtreatment continues. A good reason for the European Association of Urology (EAU) to publish a policy paper on this topic and invite European influencers to rediscuss the need for population-based prostate cancer screening programmes at a European level during the European Prostate Cancer Awareness Day (EPAD) 2019.
On 22 January 2019 policy makers, scientific experts, European associations working in the urological field and representatives of European patient groups with an interest in prostate disease gathered at the European Parliament to debate the latest evidence and case studies demonstrating the efficacy of prostate cancer screening. The Policy Paper on population-based PSA screening for prostate cancer was officially launched during the meeting and formed the starting point of the discussion.
The event was hosted by the Members of European Parliament (MEP) Ms Dubravka Šuica and Ms Lieve Wierinck, Members of the “MEPs against Cancer” group (MAC) and focussed on how early diagnosis will improve outcomes in European PCa patients. Scientists, patient representatives, urologists and politicians covered key topics such as the latest evidence, consequences of not performing PSA screening, overdiagnosis and overtreatment in a very well-attended session.
After Prof. Chris Chapple (GB) and MEP Dubravka Šuica (KR) welcomed all attendees and stressed out the importance of the discussion, Prof. Monique Roobol (NL) introduced the 35-year history of PSA by comparing it to a scenic drive from The Netherlands to Italy. After an intense route via the Swiss Alps, the question is what will we do next? Will we take a left turn and slowly disappear into the sea like Venice or return to the valleys in Switzerland?”
Prof. Peter Albers (DE) explained why we should adopt structured population-based PSA screening for prostate cancer at an early stage by comparing screening programmes for other types of cancer. “Registry data have shown that death from prostate cancer has overruled death from colorectal cancer and is now the second most cause of cancer-related death in men behind lung cancer. Still, despite the significant public health burden, relatively little is performed on prostate cancer screening at EU level, particularly in comparison to breast, cervical and colorectal cancers”, says Albers. “The aim of future PSA screening programmes should be focussed on reducing overdiagnosis. Risk-adapted screening will prevent unnecessary screening in 90% of men, is cost-effective and will still identify 1-2% of men with early PCa.”
Lessons learned in Sweden
In Sweden, prostate cancer is a major public health problem, according to Prof. Per-Anders Abrahamsson. “Mortality results from a 14-year follow-up in the Goteborg study showed that prostate cancer deaths were reduced with 44% in a randomised population-based screening trial and the absolute mortality still continues”, states Abrahamsson. According to the former EAU Secretary General it’s all about finding a balance in maximising benefits and minimising harms. His five golden rules for transforming PSA screening are the first step to success.
For part II of the report, please see Part 2.