Summary statement on screening for prostate cancer in Europe

Heijnsdijk, Eveline A.M.; Bangma, Chris H.; Borrás, Josep María; Carvalho, Tiago M. de; Castells, Xavier; Eklund, Martin; Espinàs, Josep Alfons; Graefen, Markus; Grönberg, Henrik; Lansdorp–Vogelaar, Iris; Leeuwen, Pim J. van; Nelen, Vera; Recker, Franz; Roobol, Monique J.; Vandenbulcke, Pieter; Koning, Harry J. de

doi:10.1002/ijc.31102

Cited by 30 publications

(24 citation statements)

References 50 publications

(92 reference statements)

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“…The US Preventive Services Taskforce recommended against PSA-based prostate cancer screening for men over 70 years and or for men who do not express a preference for screening, but suggests that the decision to undergo screening with PSA should be an individual one for the patient after counselling from their doctor on the pros and cons of the test [ 2 ]. A recent consensus meeting of European experts recommended that limited prostate cancer screening should be rolled out [ 32 ].…”

Section: Investigationsmentioning

confidence: 99%

Prostate Cancer in Primary Care

2018

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Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man’s risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.

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Section: Investigationsmentioning

confidence: 99%

Prostate Cancer in Primary Care

2018

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“…Prostate cancer (PC) ranks as the second most frequently diagnosed neoplasia and the fifth leading cause of mortality in male patients with cancer, with an increasing trend in incidence . However, the mortality rate of PC has been decreasing globally, especially in high‐incidence countries, possibly because of advances in diagnostic technology such as prostate‐specific antigen (PSA) screening . The epidemiology of PC has been observed to vary among regions and races, and this indicates an influence of genetic and environmental factors, including the Western lifestyle, on the increase in the incidence of PC …”

Section: Introductionmentioning

confidence: 99%

Incidence and disease burden of prostate cancer from 1990 to 2017: Results from the Global Burden of Disease Study 2017

Zhai

Zheng

et al. 2020

Cancer

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BACKGROUND: The patterns of the incidence and mortality of prostate cancer (PC) have been changing over the years. In addition, the unclear etiology of PC necessitates further studies into the geographic distribution and age composition of patients with PC. This study was aimed at examining the patterns of the epidemiology of PC to help policymakers to allocate the limited resources of the health care system accordingly. METHODS: Annual case data and age-standardized rates (ASRs) were obtained for the incidence, mortality, and disability-adjusted life-years (DALYs) of PC according to age from 1990 to 2017 and for 21 regions, including 195 countries and territories. The estimated annual percentage changes (EAPCs) of ASRs were calculated to evaluate the incidence and mortality trends of PC. RESULTS: Worldwide, the age-standardized incidence rate (ASIR) of PC increased from 30.5 cases per 100,000 population in 1990 to 37.9 cases per 100,000 population in 2017 with an EAPC of 0.59 (95% confidence interval [CI], 0.49-0.7), whereas the mortality decreased with an EAPC of −0.73 (95% CI, −0.80 to −0.67). The ASIR was positively associated with the sociodemographic index (SDI) in most regions, and the increase in the ASIR was steeper with a higher SDI. The proportion of patients younger than 65 years increased from 23.6% in 1990 to 27.3% in 2017. CONCLUSIONS: The incidence of PC has been increasing globally, whereas its mortality and DALYs have been decreasing. These trends are particularly significant in developed regions and vary across geographic regions. Adjustments to the medical strategy by governments and medical institutions are required.

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“…Prostate cancer is the second most common cancer affecting men worldwide and accounts for 25% of all incident malignancies in males across Europe . Targeted prostate cancer screening, based on DRE and serum PSA levels, has been found to reduce mortality . Prostate biopsies are the ‘gold standard’ for confirming the diagnosis of cancer, utilising the Gleason Score as a histological prognostic indicator of tumour aggressiveness .…”

Section: Introductionmentioning

confidence: 99%

“…Targeted prostate cancer screening, based on DRE and serum PSA levels, has been found to reduce mortality [3][4][5]. Prostate biopsies are the 'gold standard' for confirming the diagnosis of cancer, utilising the Gleason Score as a histological prognostic indicator of tumour aggressiveness [3,[6][7][8][9][10][11][12]. MRI has grown in use to detect prostate cancer with the emergence of the Prostate Imaging-Reporting and Data System (PI-RADS), most recently version 2 [13].…”

Section: Introductionmentioning

confidence: 99%

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

Alabousi¹,

Salameh

Gusenbauer

et al. 2019

BJU International

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Objective To perform a diagnostic test accuracy (DTA) systematic review and meta‐analysis comparing multiparametric (diffusion‐weighted imaging [DWI], T2‐weighted imaging [T2WI], and dynamic contrast‐enhanced [DCE] imaging) magnetic resonance imaging (mpMRI) and biparametric (DWI and T2WI) MRI (bpMRI) in detecting prostate cancer in treatment‐naïve patients. Methods The Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE) were searched to identify relevant studies published after 1 January 2012. Articles underwent title, abstract, and full‐text screening. Inclusion criteria consisted of patients with suspected prostate cancer, bpMRI and/or mpMRI as the index test(s), histopathology as the reference standard, and a DTA outcome measure. Methodological and DTA data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)‐2 tool. DTA metrics were pooled using bivariate random‐effects meta‐analysis. Subgroup analysis was conducted to assess for heterogeneity. Results From an initial 3502 studies, 31 studies reporting on 9480 patients (4296 with prostate cancer) met the inclusion criteria for the meta‐analysis; 25 studies reported on mpMRI (7000 patients, 2954 with prostate cancer) and 12 studies reported on bpMRI DTA (2716 patients, 1477 with prostate cancer). Pooled summary statistics demonstrated no significant difference for sensitivity (mpMRI: 86%, 95% confidence interval [CI] 81–90; bpMRI: 90%, 95% CI 83–94) or specificity (mpMRI: 73%, 95% CI 64–81; bpMRI: 70%, 95% CI 42–83). The summary receiver operating characteristic curves were comparable for mpMRI (0.87) and bpMRI (0.90). Conclusions No significant difference in DTA was found between mpMRI and bpMRI in diagnosing prostate cancer in treatment‐naïve patients. Study heterogeneity warrants cautious interpretation of the results. With replication of our findings in dedicated validation studies, bpMRI may serve as a faster, cheaper, gadolinium‐free alternative to mpMRI.

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Summary statement on screening for prostate cancer in Europe

Cited by 30 publications

References 50 publications

Prostate Cancer in Primary Care

Prostate Cancer in Primary Care

Incidence and disease burden of prostate cancer from 1990 to 2017: Results from the Global Burden of Disease Study 2017

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

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