Hendrik Van Poppel1, Monique J Roobol2, Christopher R Chapple3, James W F Catto4, James N'Dow5, Jens Sønksen6, Arnulf Stenzl7, Manfred Wirth8. 1. Department of Urology, University Hospitals Leuven, Leuven, Belgium. Electronic address: hendrik.vanpoppel@kuleuven.be. 2. Department of Urology, Erasmus University Medical Centre Cancer Institute, Rotterdam, The Netherlands. 3. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 4. Academic Urology Unit, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 5. Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. 6. Department of Urology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 7. Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany. 8. Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
Abstract
BACKGROUND: Recommendations against prostate-specific antigen (PSA) testing in 2012 have increased advanced-stage diagnosis and prostate cancer-specific mortality rates. OBJECTIVE: To present the position of the European Association of Urology (EAU) in 2021 and provide recommendations for the use of PSA testing as part of a risk-adapted strategy for the early detection of prostate cancer. EVIDENCE ACQUISITION: The authors combined their review of relevant literature, including the EAU prostate cancer guidelines 2021 update, with their own knowledge to provide an expert opinion, representing the EAU's position in 2021. EVIDENCE SYNTHESIS: The EAU has developed a risk-adapted early prostate cancer detection strategy for well-informed men based on PSA testing, risk calculators, and multiparametric magnetic resonance imaging, which can differentiate significant from insignificant prostate cancer. This approach largely avoids the overdiagnosis/overtreatment of men unlikely to experience disease-related symptoms during their lifetime and facilitates an early diagnosis of men with significant cancer to receive active treatment. It also reduces advanced-stage diagnosis, thereby potentially reducing prostate cancer-specific mortality and improving quality of life. Education is required among urologists, general practitioners, radiologists, policy makers, and healthy men, including endorsement by the European Commission to adapt the European Council's screening recommendations in its 2022 plan and requests to individual countries for its incorporation into national cancer plans. CONCLUSIONS: This risk-adapted approach for the early detection of prostate cancer will reverse current unfavourable trends and ultimately save lives. PATIENT SUMMARY: The European Association of Urology has developed a patient information leaflet and algorithm for the early diagnosis of prostate cancer. It can identify men who do not need magnetic resonance imaging or a biopsy and those who would not show any symptoms versus those with more aggressive disease who require further tests/treatment. We need to raise awareness of this algorithm to ensure that all well-informed men at risk of significant prostate cancer are offered a prostate-specific antigen test.
BACKGROUND: Recommendations against prostate-specific antigen (PSA) testing in 2012 have increased advanced-stage diagnosis and prostate cancer-specific mortality rates. OBJECTIVE: To present the position of the European Association of Urology (EAU) in 2021 and provide recommendations for the use of PSA testing as part of a risk-adapted strategy for the early detection of prostate cancer. EVIDENCE ACQUISITION: The authors combined their review of relevant literature, including the EAU prostate cancer guidelines 2021 update, with their own knowledge to provide an expert opinion, representing the EAU's position in 2021. EVIDENCE SYNTHESIS: The EAU has developed a risk-adapted early prostate cancer detection strategy for well-informed men based on PSA testing, risk calculators, and multiparametric magnetic resonance imaging, which can differentiate significant from insignificant prostate cancer. This approach largely avoids the overdiagnosis/overtreatment of men unlikely to experience disease-related symptoms during their lifetime and facilitates an early diagnosis of men with significant cancer to receive active treatment. It also reduces advanced-stage diagnosis, thereby potentially reducing prostate cancer-specific mortality and improving quality of life. Education is required among urologists, general practitioners, radiologists, policy makers, and healthy men, including endorsement by the European Commission to adapt the European Council's screening recommendations in its 2022 plan and requests to individual countries for its incorporation into national cancer plans. CONCLUSIONS: This risk-adapted approach for the early detection of prostate cancer will reverse current unfavourable trends and ultimately save lives. PATIENT SUMMARY: The European Association of Urology has developed a patient information leaflet and algorithm for the early diagnosis of prostate cancer. It can identify men who do not need magnetic resonance imaging or a biopsy and those who would not show any symptoms versus those with more aggressive disease who require further tests/treatment. We need to raise awareness of this algorithm to ensure that all well-informed men at risk of significant prostate cancer are offered a prostate-specific antigen test.
Keywords:
Active surveillance; Biomarkers; Early detection of cancer; Education; Multiparametric magnetic resonance imaging; Prostate cancer; Prostate-specific antigen; Risk stratification; Screening
Authors: Elena Bertelli; Laura Mercatelli; Chiara Marzi; Eva Pachetti; Michela Baccini; Andrea Barucci; Sara Colantonio; Luca Gherardini; Lorenzo Lattavo; Maria Antonietta Pascali; Simone Agostini; Vittorio Miele Journal: Front Oncol Date: 2022-01-13 Impact factor: 6.244
Authors: Sebastiaan Remmers; Daan Nieboer; L Lucia Rijstenberg; Tim Hansum; Geert J L H van Leenders; Monique J Roobol Journal: Eur Urol Open Sci Date: 2021-12-17