EAU issues position statement on prostate cancer screening

The European Association of Urology issued a position statement on prostate cancer screening earlier today. The full text of this position statement follows below:

ARNHEM, The Netherlands, April 16 — The European Association of Urology (EAU) has taken into consideration the recent scientific information on randomised screening studies on prostate cancer (Schröder et al., NEJM 2009). Based on the results of the European Randomised Study for Screening of Prostate Cancer (ERSPC), the EAU has formulated a position statement regarding prostate cancer screening in Europe, and the subsequent actions to be taken by health professionals and health authorities.

In summary, the ERSPC reports on a relative prostate cancer mortality reduction of at least 20% by PSA-based population screening in 162,000 asymptomatic men aged 55-69 years. For every prostate cancer death prevented, 1410 men have to undergo screening, while 48 are needed to be treated in excess of the control group population to save one prostate cancer death. Results of the PLCO (Prostate, Lung, Colon and Ovary) US randomized study of screening were also published in the same issue of the NEJM (Andriole et al., NEJM 2009) and to date show no significant effect of screening on mortality from the disease, but suffered from a significant level of contamination in the control arm. The study continues.

The EAU adopts the conclusions of the ERSPC study and recognizes the benefit of screening in terms of mortality reduction, as well as the adverse effects of overdiagnosis and overtreatment of prostate cancers which could be quantified for the first time in the setting of a randomized screening study. Further publication of relevant data is awaited from the ERSPC group in due course to inform the debate.

For the interest men’s health in Europe and elsewhere, the EAU formulates the following statements:

  • Prostate cancer is a major health problem, and one of the main causes of male cancer deaths. However, current published data are insufficient to recommend the adoption of population screening for prostate cancer as a public health policy due to the large overtreatment effect. Before screening is considered by national health authorities,the level of current opportunistic screening, overdiagnosis,overtreatment, quality of life, costs, and cost-effectiveness should betaken into account.
  • Overdiagnosis of prostate cancer leads potentially to significant overtreatment. Health professionals, especially urologists, should avoid overtreatment by developing safe methods of cancer surveillance/monitoring without invasive therapy. Invasive therapies should be tailored to patients’ needs and the prognosis of cancers diagnosed.
  • Current screening algorithms are insufficient due to a lack of specificity and lack of selectivity for aggressive cancers which require treatment. The development of novel diagnostic and prognostic markers and imaging modalities is needed urgently to enhance the predictive value of screening tools.
  • In the absence of population screening, the EAU advises men who consider screening by PSA testing and prostate biopsy to obtain information on the risks and benefits of screening and individual riskassessment.
  • The EAU and the ERSPC study group represent essential European stakeholders to further develop health strategies for prostate cancer screening.
  • The EAU promotes the quality of care for prostate cancer patients in Europe in collaboration with the patient support organization Europa Uomo (http://www.europa-uomo.org) through the development of information and guidelines.
  • The EAU wishes to support and foster research needed to develop reliable active surveillance protocols for low-risk prostate cancers, prognostic markers, and targeted therapies in order to deliver optimal patient care.

The “New” Prostate Cancer InfoLink notes only that, as far as it is aware, this is the first time that a major urology association has stated with absolute clarity that available diagnostic tests are insufficient “to recommend the adoption of population screening for prostate cancer as a public health policy.”

3 Responses

  1. IMHO, a balanced view that makes sense. I only wish that US organizations had reacted as appropriately.

    Do we have a process similar to theirs in the US with respect to “collaboration with the patient support organization Europa Uomo (http://www.europa-uomo.org) through the development of information and guidelines” ?

  2. Hello Mike,

    Right, I think I now know where your coming from regarding the screening issue.

    It’s that word “screening,” is it not?

    Within your site you have a section on “PC Awareness” which states (you may be in the middle of updating it or already have):

    “Are You Aware of Your Personal Risk?

    At a minimum, The “New” Prostate Cancer InfoLink believes that every man over the age of 40 years of age should have a conversation with his primary care physician about his personal risk for prostate cancer. Regular tests, consisting of a physical examination and a prostate-specific antigen or PSA test are appropriate for many men, particularly those over 50 and any man who may be at higher risk for prostate cancer at a younger age. ”

    I think everyone would agree that increased public awareness is key to identifying and treating prostate cancer at the earliest stage possible, which on the whole is the most cost-effective way, on a global scale!

    We only have two initial cost effective tests, i.e., the PSA test and the DRE, and these will be used for at least the next 10 years, even if a new, initial, cost-effective test arrived tomorrow, in my opinion.The main reason is all the data that has been gathered over the years relating to the two tests will be used as a datum for any new tests and again in my opinion.

    Therefore and getting back to my point, let’s scrap the word “screening” for prostate cancer using the PSA test and DRE as they are not direct tests for PC!

    So, now what do we do in the mean time?

    I think the only option is and which has been happening on a global scale for some time now is to make people aware of the positive/negative attributes of the two tests along with how an individual GP/specialist can interpret the results and question any follow-up actions or an individual make a decision to have further initial tests.

    Therefore, due to increased public awareness, we could see more initial testing carried out for various reasons — not under the heading of a “prostate cancer screening program” but because the public is more informed and still wishes to get tested even if just an initial test at age 40!

    Hope that made sense? :-)

  3. Steve: In answer to your question collaboration … we’re working on it.

    5thString: Re the word “screening” … Yes. It has become an albatross around everyone’s neck.

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