Advanced

Structured Population-based Prostate-specific Antigen Screening for Prostate Cancer : The European Association of Urology Position in 2019

Gandaglia, Giorgio; Albers, Peter; Abrahamsson, Per Anders LU ; Briganti, Alberto; Catto, James W.F.; Chapple, Christopher R.; Montorsi, Francesco; Mottet, Nicolas; Roobol, Monique J. and Sønksen, Jens, et al. (2019) In European Urology 76(2). p.142-150
Abstract

Prostate cancer (PCa)is one of the first three causes of cancer mortality in Europe. Screening in asymptomatic men (aged 55–69 yr)using prostate-specific antigen (PSA)is associated with a migration toward lower staged disease and a reduction in cancer-specific mortality. By 20 yr after testing, around 100 men need to be screened to prevent one PCa death. While this ratio is smaller than for breast and colon cancer, the long natural history of PCa means many men die from other causes. As such, the nonselective use of PSA testing and radical treatments can lead to overdiagnosis and overtreatment. The European Association of Urology (EAU)supports measures to encourage appropriate PCa detection through PSA testing, while reducing... (More)

Prostate cancer (PCa)is one of the first three causes of cancer mortality in Europe. Screening in asymptomatic men (aged 55–69 yr)using prostate-specific antigen (PSA)is associated with a migration toward lower staged disease and a reduction in cancer-specific mortality. By 20 yr after testing, around 100 men need to be screened to prevent one PCa death. While this ratio is smaller than for breast and colon cancer, the long natural history of PCa means many men die from other causes. As such, the nonselective use of PSA testing and radical treatments can lead to overdiagnosis and overtreatment. The European Association of Urology (EAU)supports measures to encourage appropriate PCa detection through PSA testing, while reducing overdiagnosis and overtreatment. These goals may be achieved using personalized risk-stratified approaches. For diagnosis, the greatest benefit from early detection is likely to come in men assessed using baseline PSA levels at the age of 45 yr to individualize screening intervals. Multiparametric magnetic resonance imaging as well as risk calculators based on family history, ethnicity, digital rectal examination, and prostate volume should be considered to triage the need for biopsy, thus reducing the risk of overdiagnosis. For treatment, the EAU advocates balancing patient's life expectancy and cancer's mortality risk when deciding an approach. Active surveillance is encouraged in well-informed patients with low-risk and some intermediate-risk cancers, as it decreases the risks of overtreatment without compromising oncological outcomes. Conversely, the EAU advocates radical treatment in suitable men with more aggressive PCa. Multimodal treatment should be considered in locally advanced or high-grade cancers. Patient summary: Implementation of prostate-specific antigen (PSA)-based screening should be considered at a population level. Men at risk of prostate cancer should have a baseline PSA blood test (eg, at 45 yr). The level of this test, combined with family history, ethnicity, and other factors, can be used to determine subsequent follow-up. Magnetic resonance imaging scans and novel biomarkers should be used to determine which men need biopsy and how any cancers should be treated.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cancer-specific mortality, Prostate Cancer, Prostate-specific antigen, Screening, Stage migration
in
European Urology
volume
76
issue
2
pages
142 - 150
publisher
Elsevier
external identifiers
  • scopus:85065425964
ISSN
0302-2838
DOI
10.1016/j.eururo.2019.04.033
language
English
LU publication?
yes
id
c41d64b6-e3bd-4c7d-970c-f9a36b28237c
date added to LUP
2019-06-04 12:56:09
date last changed
2019-09-17 04:55:57
@article{c41d64b6-e3bd-4c7d-970c-f9a36b28237c,
  abstract     = {<p>Prostate cancer (PCa)is one of the first three causes of cancer mortality in Europe. Screening in asymptomatic men (aged 55–69 yr)using prostate-specific antigen (PSA)is associated with a migration toward lower staged disease and a reduction in cancer-specific mortality. By 20 yr after testing, around 100 men need to be screened to prevent one PCa death. While this ratio is smaller than for breast and colon cancer, the long natural history of PCa means many men die from other causes. As such, the nonselective use of PSA testing and radical treatments can lead to overdiagnosis and overtreatment. The European Association of Urology (EAU)supports measures to encourage appropriate PCa detection through PSA testing, while reducing overdiagnosis and overtreatment. These goals may be achieved using personalized risk-stratified approaches. For diagnosis, the greatest benefit from early detection is likely to come in men assessed using baseline PSA levels at the age of 45 yr to individualize screening intervals. Multiparametric magnetic resonance imaging as well as risk calculators based on family history, ethnicity, digital rectal examination, and prostate volume should be considered to triage the need for biopsy, thus reducing the risk of overdiagnosis. For treatment, the EAU advocates balancing patient's life expectancy and cancer's mortality risk when deciding an approach. Active surveillance is encouraged in well-informed patients with low-risk and some intermediate-risk cancers, as it decreases the risks of overtreatment without compromising oncological outcomes. Conversely, the EAU advocates radical treatment in suitable men with more aggressive PCa. Multimodal treatment should be considered in locally advanced or high-grade cancers. Patient summary: Implementation of prostate-specific antigen (PSA)-based screening should be considered at a population level. Men at risk of prostate cancer should have a baseline PSA blood test (eg, at 45 yr). The level of this test, combined with family history, ethnicity, and other factors, can be used to determine subsequent follow-up. Magnetic resonance imaging scans and novel biomarkers should be used to determine which men need biopsy and how any cancers should be treated.</p>},
  author       = {Gandaglia, Giorgio and Albers, Peter and Abrahamsson, Per Anders and Briganti, Alberto and Catto, James W.F. and Chapple, Christopher R. and Montorsi, Francesco and Mottet, Nicolas and Roobol, Monique J. and Sønksen, Jens and Wirth, Manfred and van Poppel, Hendrik},
  issn         = {0302-2838},
  keyword      = {Cancer-specific mortality,Prostate Cancer,Prostate-specific antigen,Screening,Stage migration},
  language     = {eng},
  number       = {2},
  pages        = {142--150},
  publisher    = {Elsevier},
  series       = {European Urology},
  title        = {Structured Population-based Prostate-specific Antigen Screening for Prostate Cancer : The European Association of Urology Position in 2019},
  url          = {http://dx.doi.org/10.1016/j.eururo.2019.04.033},
  volume       = {76},
  year         = {2019},
}