Research Supports Risk-Based Screening for Prostate Cancer

Data from the world’s largest prostate cancer screening study provides further evidence to support the introduction of a targeted screening program for the disease, researchers said.

In 2009, the European Randomized Trial of Prostate Cancer Screening (ERSPC) showed that screening can reduce prostate cancer mortality by 20-35 percent. But the earlier and more frequent diagnoses that screening allows for also means men are living longer with their cancer — and there are still concerns about its impact on their quality of life.

The new analysis – presented today at the Annual Congress of the European Association of Urology (EAU22) – reveals that men undergoing screening spend longer in the early stages of the disease with no signs of progression, which quality of life is known to improve. least affected. However, because the treatment the men receive is the same, men whose cancer was discovered in normal clinical practice see their disease course more quickly after diagnosis. However, if the disease metastasizes, the number of years men spend with metastatic disease is similar in both groups.

The researchers, from the Erasmus MC Cancer Institute of the University Medical Center Rotterdam, analyzed data from just over 43,000 men in the Dutch cohort of the ERSPC. The ERSPC recruited more than 180,000 men in eight countries in the 1990s, half of whom were randomized to participate in a prostate cancer screening program that included regular PSA testing.

The new study looked at how long it took men to see their prostate cancer progress to different stages of the disease after diagnosis. These phases were:

1. Biochemical recurrence – when men whose prostate cancer has been treated with radiotherapy or surgery show a high level of prostate-specific antigen (PSA), indicating that the disease has returned.
2. Metastatic disease – when the cancer has spread beyond the prostate to other organs of the body and is thus untreatable.

The results show that men who are diagnosed with the disease through a screening program remain on average one year longer without progression. In men whose disease has progressed and if it has spread, this is on average two and a half years later in men in screening than in men whose cancer was discovered outside the screening program.

Sebastiaan Remmers, of the Erasmus MC Cancer Institute, who will present the research today [Saturday 2 July 2022] at EAU22, said: “Nobody wants to face a cancer diagnosis, and screening means more men know they have prostate cancer and live longer with that knowledge. While screening can lead to overdiagnosis, our research shows that it can also delay or even prevent the damage that prostate cancer can cause. That tilts the balance in favor of further developing organized individualized screening programmes.”

Prostate cancer screening is standard in only a few European countries or regions, including Lithuania and parts of Sweden. Most other countries, including the UK, do not systematically screen men for the disease due to concerns about overdiagnosis and overtreatment. PSA testing, instead, is usually done on an ad hoc basis when patients go to their doctor with concerns.

Professor Monique Roobol, of the Erasmus MC Cancer Institute, said: “Progress in the way prostate cancer is diagnosed and treated has changed the balance between risks and benefits of screening for the disease. By adequate risk stratification we can improve the detection of cancers with significantly reduce low risk. In addition, in the past, diagnosis automatically meant major treatment, such as surgery or radiation, all of which have side effects. Now we have other options for low-risk cancers, such as active surveillance, including MRI scans, which have a more limited impact on men’s quality of life.As screening reduces mortality and metastatic disease, and – as our study shows – gives men more years in those stages of the disease that have less impact, the arguments against screening become obsolete .”

The European Association of Urology, Europe’s leading authority on urological practice, research and education, is calling for prostate cancer screening as part of the European Union’s new ‘Beating Cancer’ plan. The EAU recommends a risk-based approach to prostate cancer screening, calculating the appropriate screening frequency and follow-up for each patient based on factors such as PSA level, family history, ethnicity, gene mutation, and prostate size.

Professor Hendrik Van Poppel, from the Catholic University of Leuven in Belgium, who chairs the EAU Policy Office, said: “Prostate cancer is one of the leading causes of death in men in Europe: number one in Sweden, number two in Germany and number five in many other countries. In the UK, more men die each year from prostate cancer than women from breast cancer. Nevertheless, we do not yet have a European screening program for prostate cancer.

“The systematic and personalized approach to screening advocated by the EAU will significantly reduce the likelihood of overdiagnosis or overtreatment of cancers that pose a minimal threat. But most importantly, it will maintain the best possible quality of life for prostate cancer patients and save lives.”