European Urology Today Official newsletter of the European Association of Urology
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Vol. 31 No.4 - August/September 2019
Treating female SUI without meshes
PRECISION Trial had impact on Guidelines
Live stone surgery and hands-on training
The ESFFU examines current return to sling use
MRI now recommended before prostate biopsy in biopsy-naive men
A report from the 3rd edition of joint ESU-ESUT Masterclass
Prof. E. Costantini
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Dr. V. Kasivisvanathan
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Dr. I. Kyriazis
The EAU’s strategy to encourage timely detection of PCa Adjunct-Secretary General Van Poppel urges need to address increasing PCa mortality By Loek Keizer With a remarkable upturn in prostate cancer mortality, the time has come to encourage earlier detection says EAU Adjunct-Secretary General Prof. Hendrik Van Poppel (BE). “For years, prostate cancer screening was synonymous with overdiagnosis and overtreatment. However, with modern approaches to PSA values and the use of biomarkers we can more effectively differentiate between clinically significant and insignificant tumours. As a result of MRI imaging we can be more selective about which patients require biopsies. With active surveillance we can further reduce overtreatment.”
"Through the European Commission’s recommendation we hope to start changing national policies across the continent." The introduction of PSA-based testing has historically led to a significant drop in prostate cancer mortality since the early 1990’s, but with criticism directed at the risk of overdiagnosis and overtreatment. The drop in mortality is stagnating, and in some specific countries, mortality is increasing again: “In the UK, over 65% of the cases of prostate cancer is currently diagnosed in more advanced stages, when cure is more difficult to achieve, and more toxic. In the metastatic stage they are incurable and will become castration-resistant,” says Van Poppel.”
Policy Paper
#EUpledge4p
on
ING P S A SCRE E N TE TA S O R P F OR C A NC E R
ed nsider structur come to reco e cancer? Has the time g for prostat d PSA screenin population-base
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Prostate Canc er:
the issue
Despite prostat e cancer being more than the most commo 417,000 new nly diagnos cases and 92,000 ed cancer in little is perform men, with deaths in Europe ed on prostat e cancer manag recorded each year, very ement at EU level. The Europe an Union can no longer continu cause of cancer e to overloo death in men k the second in Europe. Recent population-bas most commo ed screening evidence demon n programmes decrease mortali strates that for prostate ty rates and cancer are that they increas families. effective, that e the quality they of life of patient s and their Urgent action is required to make sure mandated to that the new support EU European Commi Member States cancer plans. ssion is in prostate cancer screeni ng in their nationa l HOW CAN MEPs SUPPORT THIS? We need MEPs to support the following policy pledges: Pledges Push for a review of on population-bas the 2003 EU Council Recom Tick to pledge mendations ed early detectio screening n to include prostate cancer Ask timely written and oral questio Commission ns to the Europe on prostate an cancer Develop parliam entary resolut for prostate ions which include specifi cancer c targets Push your governm ent’s represe Group on Health ntatives of the Promotion, EU’s Steerin Disease Preven g of Non-Communi tion and Manage cable Disease ment s to address Support the prostate cancer EU Joint Action ‘the Innovat Against Cancer ive Partner ’ to promot ship for Action e concret e actions on Support increas prostate cancer ed EU investm ent in prostat Lend your politica e cancer researc l support to h campaigns prostate cancer and confere in your country nces on . If you agree to support one or all of completed these pledge pledge form s, please return to EUoffice@uro #EUpledge4pr the web.org and ostatecancer. don’t forget to tweet
For more details
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“PSA sampling remains the basis of our early detection options, despite the fact that for many ‘PSA screening’ has negative associations based on earlier screening programmes. Based on the initial PSA test, we can these days avoid overdiagnosis and overtreatment that may be harmful to our patients while still being able to treat those patients who would benefit from early treatment.” “All in all, there is very little that should discourage early detection,” says Van Poppel. More than 92,000 European men die of the disease every year, and in some countries prostate cancer has become the second cause of male cancer death after lung and before colorectal cancer. Profs. Chappel and Van Poppel (centre) discussing the potential of population-based PCa screening programmes with representatives of European national urological societies in Noordwijk, 21 June 2019 The EAU’s approach Following much discussion at the "EAU Meets National Societies" meeting in Noordwijk (NL) in June, Prof. Van Information Working Group is in the final stages of Poppel can lay out the EAU’s strategy to dramatically Appropriately, patient groups are also an important reduce prostate cancer mortality in Europe. part of the EAU’s strategy to improve care for prostate preparing a leaflet on prostate cancer screening. This leaflet will plainly outline the advantages and cancer patients. The EAU Patient Advisory Group or disadvantages of PSA-based early detection, and “Our approach is three-pronged: encourage early EPAG held its first General Assembly at EAU19 in detection from a medical standpoint, lobby to bring explain possible consequences for the patient after Barcelona. EAU-affiliated healthcare professionals detection. If something is detected, this might result prostate cancer on the European political agenda, and and patient organisation representatives from inform patients and the healthy male population bladder, kidney and prostate cancer groups came in a biopsy, or perhaps active surveillance will suffice. At the very least, mortality will decrease.” about the risks and benefits of early screening.” together to discuss ideas and needs and explored ways to collaborate. EPAG’s objective is to increase In 2003, the European Commission recommended patient empowerment and engagement in the "The well-informed patient is an screening for cervical, breast and colorectal cancer, development, dissemination and impact assessment but declined to include prostate cancer screening of guidelines and patient information and to support essential component of our attempts because of the risk of overdiagnosis and educational events for patients and patient advocates. to reduce PCa-related mortality." overtreatment. In 2020, new recommendations are expected to come from the European Commission and Van Poppel: “Patient organisations perform a Van Poppel sees the addition of prostate cancer to this valuable task in raising awareness about conditions “Once people realise that structured PSA-based list as vital for men’s health in Europe. and can sound the alarm in the face of increased screening at age 40-45 can pre-empt much more PCa-related mortality. They lobby their national invasive treatment of more advanced prostate cancer, Examples of initiatives that the EAU has supported or governments and generate attention among the we expect the demand for PCa early detection to (co-)organised on a European level are the bi-annual general population.” increase. By persuading the European Commission to European Prostate Cancer Awareness Day at the support screening for prostate cancer and by European Parliament, as well as the “We think that the well-informed patient is an increasing awareness among patients, we think we #EUpledge4prostatecancer that encourages essential component of our attempts to reduce can be successful in changing national healthcare individuals members of the European Parliament to PCa-related mortality. To that end, the EAU’s Patient legislation in European countries.” bring prostate cancer to the agenda.
see http://e
pad.uroweb.or g/
For almost 40 years the European Associa most pressin tion of Urolog g issues of urological y (EAU) has educational care in Europe addressed initiatives, the , through its as well as its scientific and publications. Clinical guideli nes develop ment is one with the aim of their core to assist clinicia activities ns in making decisions in a given circum informed stance.
The EAU’s Policy Paper on PSA Screening and the PCa Pledge document. Both are available from epad.uroweb.org
Cost is also an important factor: early detection and treatment can significantly decrease the costs associated with the management of more advanced prostate cancer. Prof. Van Poppel: “The cost of a PSA test is very low. It can be performed by a nurse and does not require any further actions, unlike screening for breast cancer, colon cancer or cervical cancer.” “Timely detection means more effective and cheaper treatment options, like radiotherapy or radical prostatectomy. If we detect prostate cancer at too late a stage, the costs can exceed €250,000 per individual to extend someone’s life by one or two years. As urologists, we can detect prostate cancer in an earlier stage when treatment can be offered with fewer side-effects like impotence or incontinence, a higher quality of life, and before the disease progresses.”
Van Poppel: “Healthcare is very much the realm of individual member states, and their laws and departments of health, rather than the European Union. However, through the European Commission’s recommendation we hope to start changing national policies across the continent. Our diagnosis and treatment options have improved significantly since 2003 and, together with patient organisations, we feel that the time has come to add prostate cancer to the screening recommendations. It’s up to individual countries, but the EU can send a strong message.” The EAU’s standpoint is summarised in a recentlypublished Policy Paper on PSA Screening for Prostate Cancer, which is available for download on: epad.uroweb.org “In Noordwijk we spoke to Europe’s national urology societies to, among other things, gauge their interest in recommending national prostate cancer early detection programmes in their home countries, says Van Poppel. “It seems that several countries’ societies are interested in exploring this further. We are going to inventorise each European country’s approach to screening and help where we can.” The informed patient The third prong in the EAU’s approach to reduce mortality and encourage early PCa detection is to inform Europe’s male patients on its benefits and risks. By encouraging awareness in the general population and at-risk men in particular, interest and demand for early detection can be increased. The EAU supports patient advocacy organisations and indeed addresses (potential) patients directly with information campaigns.
August/September 2019
EPAD meeting in the European parliament. From left: Prof. Monique Roobol, Michelle Battye, MEP Lieve Wierinck, Profs. Chris Chapple, Hein Van Poppel, Nicolas Mottet
www.eau20.org
Abstract submission now open! Deadline: 1 November 2019
European Urology Today
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