New results suggest combining MRI with conventional prostate surveillance may give a generally effective prostate screening system

Initial results from the Göteborg randomised screening trial indicates that using MRI (Magnetic Resonance Imaging) alongside conventional prostate cancer screening seems to offer improved cancer detection and can help avoid unnecessary biopsies.

Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths).* Screening for prostate cancer is a controversial issue, with until recently, little clear evidence that existing screening procedures, using PSA (to be followed by biopsies), were effective. In general, either the screening has tended to miss many cancers, or to give false positives, meaning that many men are subject to invasive testing and perhaps treatment which was just not necessary.

The Göteborg Trial is the Swedish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which is the largest randomized prostate cancer screening trial in the world. In 2014 results from this trial showed a significant mortality reduction with prostate-specific antigen (PSA) screening for men aged 55-69 years of age. Now new work, presented at the European Association of Urology Conference in Madrid, shows that using MRI may further improve the accuracy of prostate cancer screening. This research has been awarded the EAU’s First Prize for the Best Abstract by a Resident

A group of Swedish researchers, led by Prof Jonas Hugosson took 384 patients attending the Göteborg trial, and asked 124 of these to go for an MRI prior to having a biopsy. Those with a suspicious MRI, or with a PSA > 3 ng/ml, were referred for biopsy. These biopsies were both standard samples, where 10 tissue samples are taken at random from the prostate, and targeted biopsies, where samples were taken from the suspicious areas seen on the MRI.

The results showed that the combining PSA and MRI, followed by MRI-targeted biopsy only in men with suspicious MRI gave better prostate cancer detection (as confirmed by biopsy) than PSA scores alone followed by standard random biopsy (7.0% versus 5.2%). The results also showed that more significant (potentially aggressive) cancers were detected with PSA + MRI combined compared with using PSA as a stand-alone test in screening.

Analysing the results, the Göteborg group suggests that this combination may point to a strategy to maximise success in prostate cancer screening.

According to researcher, Dr Anna Grenabo-Bergdahl:

“From these initial results it looks like we can combine PSA levels with MRI scans to give more accurate screening results. This strategy would allow us to take men with lower PSA scores, and give them MRI scans, to confirm whether or not a biopsy is absolutely necessary. Another benefit is that the MRI helps us locate the suspect area, meaning that if we have to do a confirmatory biopsy, we have a much better idea of where the problem might be. This avoids patient stress, and means we are less likely to miss cancers”.

She continued:

“These results from the pilot study are very encouraging, but now they need to be confirmed. We are starting a trial of 40,000 patients in the Göteborg area. If we can replicate the results from our pilot study this may lead to a paradigm shift in future screening and fundamentally change the way we handle early detection of prostate cancer”.

Commenting, European Association of Urology Treasurer, Professor Manfred Wirth (Dresden) said:

“These initial results, which confirm some of the work we have been doing here in Dresden, show that MRI-targeted biopsy has the potential to change how we diagnose prostate cancer. There are still real issues to address; for example MRI is currently not cost-effective to use in routine screening. As the authors say, we are still some way off considering using MRI for routine screening, and we need a bigger study to validate these results. But this is a positive proof of principle, and certainly merits more investigation”.

Cost of dealing with incontinence after prostate operation averages €210 per year

Incontinence is a common side-effect in men after treatment for prostate cancer. Now a new study not only confirms the high rates of post-operation incontinence, but also for the first time details some of the significant economic costs facing men – on average €210 per year after surgery, in some cases rising to as much as €283 in the first year. This work is presented at the European Association of Urology conference in Madrid.

Prostate cancer is the most common cancer in men, with around 360,000 new cases every year in Europe – making it about as common as breast cancer is in women. Often the cancer can be removed by surgery, which takes out the whole prostate. But there are very common side effects, notable erectile dysfunction (impotence) and urinary incontinence. This is because the nerves which surround the prostate are often damaged during the operation, and these nerves control the ability to have an erection and to control incontinence

Now a team of doctors from the University of Nijmegen (Netherlands), in collaboration with researchers from a Dutch insurance company, have used health insurance data to reveal the extent of post-operative incontinence, and the costs of dealing with it. The team reviewed data from the Achmea Health Insurance Database, which contains information on 17% of Dutch men. With this database, they were able to review data for 2834 men who had been treated for prostate cancer. They were able to correlate the surgical procedure with post-operative incontinence, and also with the resultant insurance costs which the men claimed for incontinence material (incontinence pads/diapers).

The researchers found that on average each incontinent man spent €210 in absorbent pads, every year, with a range of €112 to €283. In the second year, the mean cost of continuing incontinence remained high, at €219 per person.

They also found that the percentage of men suffering from incontinence in the first year after a urology procedure or follow-up varied from 8% of those undergoing conservative treatment (‘watchful waiting/active surveillance’)  to 80% for those undergoing laproscopic surgery (removal of the prostate via keyhole surgery). The overall mean incontinence rate was 22.6%. In the second year after treatment, incontinence still persisted in 40% of those who had undergone a laproscopic prostatectomy.

As lead researcher Dr Maarten de Rooij said:

“It can be very distressing to suffer from incontinence, and erectile dysfunction, after a cancer operation. Our work shows that, on top of this, it can have real economic costs as well – an average of €210 per person in our study in the first year. These are continuing costs for many men whose incontinence doesn’t improve over time. In the Netherlands for example, this side-effect of prostate cancer treatment could cost up to €800,000 per year, for only the newly treated men, and we would guess that other countries would have similar costs in proportion to their population.

The work also confirms the extent of the problem of incontinence after prostate cancer treatment. Given the size of the problem, we need to attach increasing importance to making sure that patients are not treated unnecessarily, while at the same time missing as few real cancers as possible”.

Commenting for the EAU, Professor James N'Dow (University of Aberdeen), Chair of the Guidelines Office Board at the EAU said:

“The cost of incontinence after prostate cancer surgery is a neglected topic and therefore this study is important and timely as it brings back into the public domain the critical issue of the wider costs of treating prostate cancer.   The cost for incontinence quoted in this study however is an underestimate of the true cost to the patient, his family and society at large.  The MAPS study published in the Lancet confirmed that the 20 year additional cost of incontinence for a man after prostate surgery is closer to Euro € 50,000 each.  This has to change and we must do better.  The EAU is ideally placed to lead the way in doing something about this costly problem through unrivalled science, innovation and advocacy”. 

New results suggest combining MRI with conventional prostate surveillance may give a generally effective prostate screening system

Initial results from the Göteborg randomised screening trial indicates that using MRI (Magnetic Resonance Imaging) alongside conventional prostate cancer screening seems to offer improved cancer detection and can help avoid unnecessary biopsies.

Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths).* Screening for prostate cancer is a controversial issue, with until recently, little clear evidence that existing screening procedures, using PSA (to be followed by biopsies), were effective. In general, either the screening has tended to miss many cancers, or to give false positives, meaning that many men are subject to invasive testing and perhaps treatment which was just not necessary.

The Göteborg Trial is the Swedish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which is the largest randomized prostate cancer screening trial in the world. In 2014 results from this trial showed a significant mortality reduction with prostate-specific antigen (PSA) screening for men aged 55-69 years of age. Now new work, presented at the European Association of Urology Conference in Madrid, shows that using MRI may further improve the accuracy of prostate cancer screening. This research has been awarded the EAU’s First Prize for the Best Abstract by a Resident

A group of Swedish researchers, led by Prof Jonas Hugosson took 384 patients attending the Göteborg trial, and asked 124 of these to go for an MRI prior to having a biopsy. Those with a suspicious MRI, or with a PSA > 3 ng/ml, were referred for biopsy. These biopsies were both standard samples, where 10 tissue samples are taken at random from the prostate, and targeted biopsies, where samples were taken from the suspicious areas seen on the MRI.

The results showed that the combining PSA and MRI, followed by MRI-targeted biopsy only in men with suspicious MRI gave better prostate cancer detection (as confirmed by biopsy) than PSA scores alone followed by standard random biopsy (7.0% versus 5.2%). The results also showed that more significant (potentially aggressive) cancers were detected with PSA + MRI combined compared with using PSA as a stand-alone test in screening.

Analysing the results, the Göteborg group suggests that this combination may point to a strategy to maximise success in prostate cancer screening.

According to researcher, Dr Anna Grenabo-Bergdahl:

“From these initial results it looks like we can combine PSA levels with MRI scans to give more accurate screening results. This strategy would allow us to take men with lower PSA scores, and give them MRI scans, to confirm whether or not a biopsy is absolutely necessary. Another benefit is that the MRI helps us locate the suspect area, meaning that if we have to do a confirmatory biopsy, we have a much better idea of where the problem might be. This avoids patient stress, and means we are less likely to miss cancers”.

She continued:

“These results from the pilot study are very encouraging, but now they need to be confirmed. We are starting a trial of 40,000 patients in the Göteborg area. If we can replicate the results from our pilot study this may lead to a paradigm shift in future screening and fundamentally change the way we handle early detection of prostate cancer”.

Commenting, European Association of Urology Treasurer, Professor Manfred Wirth (Dresden) said:

“These initial results, which confirm some of the work we have been doing here in Dresden, show that MRI-targeted biopsy has the potential to change how we diagnose prostate cancer. There are still real issues to address; for example MRI is currently not cost-effective to use in routine screening. As the authors say, we are still some way off considering using MRI for routine screening, and we need a bigger study to validate these results. But this is a positive proof of principle, and certainly merits more investigation”.

Llamada a la acción para prevenir muertes por cáncer de próstata en Europa

Hoy se ha reunido una coalición de influyentes abogados sobre políticas en Europa y grupos de profesionales para pedir acción en el Parlamento Europeo y comprometerse de forma seria con la reducción del número de hombres afectados y que fallecen a causa del cáncer de próstata, asegurándose un acceso a tiempo a la información, tratamiento y servicios de apoyo para los hombres en riesgo o que padecen cáncer de próstata.
La llamada a la acción se ha lanzado durante la European Urology Week, como parte de una nueva campaña, la Proactive Prostates Initiative, en una reunión celebrada en Antwerp, que tiene el apoyo de Europa Uomo y de la European Association of Urology.
En la reunión, titulada Prostate Cancer: Establishing the Facts, entre los representantes incluyendo ECPC, EAU y los Miembros del Parlamento Europeo, el profesor Louis Denis, de Europa Uomo, comentó: 'Necesitamos hacer más para luchar contra el cáncer de próstata y detener la cifra de hombres que mueren o viven con la carga de esta enfermedad, y se puede hacer mucho más para mejorar la concienciación de la diagnosis primaria y el acceso a los recursos correctos, servicios y tratamientos en el momento adecuado'.
El cáncer de próstata es la tercera causa de fallecimiento entre los hombres en Europa, con más de 300.000 hombres diagnosticados cada año, de los cuales uno de cada cinco fallece a consecuencia de la enfermedad.

'Insto a la sociedad a ponerse en pie e informar sobre el cáncer de próstata para poder luchar contra esta enfermedad, "podemos"", comentó el arzobispo Desmond Tutu, Premio Nobel de la Paz de Sudáfrica y enfermo de cáncer de próstata, que apoya completamente esta instancia.
El futuro del cáncer de próstata no será brillante a menos que exista un compromiso social para cambiar la forma en la que se ve la enfermedad. El aumento del envejecimiento de la población supone que los presupuestos asociados a la enfermedad también crecerán, creando graves consecuencias sociales y económicas.
La coalición solicita acción de la sociedad, gobiernos, profesionales de la salud y hombres para que adopten una instancia más proactiva hacia el cáncer de próstata con el fin de prevenir la grave carga de enfermedad y muerte del cáncer de próstata. En particular, la llamada a la acción enfatiza la necesidad de:
- El reconocimiento de los gobiernos de la carga de morbidad y mortalidad del cáncer de próstata, por lo que se puede convertir en una prioridad superior en su agenda de la salud.
- El compromiso de los gobiernos para asegurar un apoyo sostenido para la investigación básica de un nuevo biomarcador y la investigación clínica para la comparación de tratamientos.
- Los profesionales de la salud deben formar a sus pacientes en relación a los factores para que se dé el cáncer de próstata, como el historial familiar, asegurándose que los que estén en riesgo reciban la información adecuada.
- Los médicos deben enfocar los tratamientos según los pacientes individuales, evitando un tratamiento excesivo o escaso, por medio del uso adecuado de las pruebas PSA para asegurarse de que los hombres reciben el tratamiento correcto
- La sociedad debe reunirse para construir asociaciones en ayuda a la reducción de la carga de esta enfermedad, además de identificar las acciones habituales y reducir las desigualdades existentes en el acceso al tratamiento.
La reunión Prostate Cancer: Establishing the Facts cuenta con el apoyo de la beca de formación de GlaxoSmithKline y de la European Association of Urology.