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, said researchers. In 2009, the European Randomised Study of Screening for Prostate Cancer (ERSPC) showed that screening can reduce mortality from prostate cancer by between 20% and 35%. But the earlier and more frequent diagnoses that screening enables also mean patients spend longer living with their cancer—and concerns have persisted about the impact of this on their quality of life.
The new analysis—presented at the European Association of Urology Annual Congress (EAU22)—revealed that patients who undergo screening spend longer in the earlier stage of the disease without signs of disease progression, where quality of life is known to be the least impaired. As the treatment the patients receive is the same, however, those in whom the cancer was detected in normal clinical practice see their disease progress faster after diagnosis. If the disease metastasizes, the number of years patients spend with metastatic disease is similar across both groups.
Analysis From ERSPC
The researchers, from the Erasmus MC Cancer Institute at University Medical Centre Rotterdam, analyzed data from just over 43,000 patients in the Dutch cohort of the ERSPC. The ERSPC recruited over 180,000 patients across eight countries in the 1990s, with half randomly assigned to enter a prostate cancer screening program of regular prostate-specific antigen (PSA) tests.
The new study looked at how long it took before patients saw their prostate cancer progress to different stages of the disease following diagnosis. These stages were:
- Biochemical recurrence: When patients whose prostate cancer has been treated with radiotherapy or surgery show a high level of PSA, indicating that the disease has returned
- Metastatic disease: When the cancer has spread beyond the prostate to other organs of the body.
The results showed that patients in whom the disease is detected through a screening program remain, on average, 1 year longer without progression. In those where their disease has progressed, if it becomes metastatic, then this is on average 2.5 years later in patients in the screening program, compared to those whose cancer was detected outside the screening program.
Commentary
Sebastiaan Remmers, a PhD candidate at the Erasmus MC Cancer Institute, who presented the research at EAU22, said, “No one wants to be confronted with a cancer diagnosis, and screening means more [patients] know they have prostate cancer and live longer with that knowledge. While screening can lead to overdiagnosis, our research shows it can also postpone—or even avoid—the harm that prostate cancer can bring. That tips the balance in favor of further developing organized individualized screening programs.”
Monique Roobol, PhD, also of the Erasmus MC Cancer Institute, said, “Advances in how prostate cancer is diagnosed and treated have changed the balance of risks and benefits associated with screening for the disease. We can reduce the detection of low-risk cancers considerably by adequate risk stratification. In addition, in the past, diagnosis automatically meant radical treatment, such as surgery or radiation, which all have side effects. Now we have other options for low-risk cancers, such as active surveillance including magnetic resonance imaging scans, which have a more limited impact on… quality of life. Given that screening reduces mortality and metastatic disease, and—as our research shows—gives [patients] more years in those stages of the disease that have less impact, then the arguments against screening are becoming outdated.”
EAU Call to Action
The European Association of Urology is calling for prostate cancer screening to form part of the European Union’s new ‘Beating Cancer’ plan. The EAU recommends a risk-based approach to prostate cancer screening, which would calculate 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.
Hendrik Van Poppel, MD, PhD, of Katholieke Universiteit 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…. Despite this, we still have no European-wide screening program for prostate cancer. The systematic and personalized approach to screening advocated by the EAU will significantly reduce the likelihood of overdiagnosing or overtreating cancers that pose minimal threat. But, most importantly, it will preserve the best possible quality of life for patients with prostate cancer and it will save lives.”
