Europa Uomo contributes to major session on early detection at EAU Congress

Europa Uomo Chairman Guenther Carl emphasised the importance of Europe-wide risk-stratified screening  – as now recommended in urology guidelines and by the European Commission – at the European Association of Urology (EAU) Congress in Paris.

“We want to be sure that men are getting proper treatment at the right time, not when they have metastases and when the chances of cure are low,” he said, providing the patient perspective in a session on risk-adapted screening.  “If there is a suspicion of risk, then with the man’s consent, a risk calculator and an MRI should be applied. Without doubt we need imaging.”

“We want the same criteria across Europe,” he said. This was why the PRAISE-U project, to align early detection protocols and guidelines across EU Member States, was so important.

Monique Roobol,  head of the scientific office at Erasmus Medical Centre in Rotterdam and a leader of PRAISE-U, said that “one-size fits all” screening results in unnecessary testing and overdiagnosis, but individually tailored risk-based screening is different. However, the way that a risk-stratified strategy is implemented might vary across Europe, she said. Availability of multiparametric MRI (mpMRI) screening, for example, varies. PRAISE-U would look carefully at the needs of EU member states if they were to introduce a population-based screening programme.

This work will begin in April. “It will lead to real-world, risk-based, population-based screening data becoming available from different member states,” she said.

News that suitable MRI scans might become more widely available came in a game-changing session from Veeru Kasivisvanathan, Professor of Urology at University College London, who announced the results of the PRIME study, comparing biparametric (bp) and multiparametric (mp) MRI scanning for prostate cancer detection. The study found that bpMRI was not inferior to mpMRI in detecting clinically significant prostate cancer.

"Biparametric MRI without dynamic contrast enhancement should become the new standard of care for prostate cancer diagnosis providing image quality is good," he said. “This will increase accessibility, cost-effectiveness and adoption of prostate MRI."

Chris Bangma, Professor of Urology at Erasmus Medical Centre, provided a pragmatic perspective on the current “European laboratory of prostate cancer screening experiments”. He pointed to new research in The Lancet indicating that the number of men diagnosed with prostate cancer worldwide will double to 2.9 million a year by 2040. “The EU has a problem, and we have to solve it,” he said.

“For prostate cancer patients, ‘best’ means access, information and speed,” he said. Whilst acknowledging that many questions remain about the best way forward for prostate cancer screening – including how to overcome the issues of manpower restrictions and waiting lists in health systems – the risk-based, step-wise approach “offers an attractive personalised option”.

“Regional incidence and facilities will determine the local approach,” he said.