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. 2023 Dec 1;13(12):1677.
doi: 10.3390/jpm13121677.

Navigating through the Controversies and Emerging Paradigms in Early Detection of Prostate Cancer: Bridging the Gap from Classic RCTs to Modern Population-Based Pilot Programs

Juan Gómez Rivas  1 , Renée C A Leenen  2 , Lionne D F Venderbos  2 , Jozien Helleman  2 , Irene de la Parra  1 , Vera Vasilyeva  3   4 , Jesús Moreno-Sierra  1 , Partha Basu  5 , Arunah Chandran  5 , Roderick C N van den Bergh  2   6 , Sarah Collen  3   4 , Hein Van Poppel  4   7 , Monique J Roobol  2 , Katharina Beyer  2 ; The PRAISE-U Consortium
Collaborators, Affiliations

Navigating through the Controversies and Emerging Paradigms in Early Detection of Prostate Cancer: Bridging the Gap from Classic RCTs to Modern Population-Based Pilot Programs

Juan Gómez Rivas et al. J Pers Med. .

Abstract

Over the last three decades, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening have steered the conversation around the early detection of prostate cancer. These two randomized trials assessed the effect of screening on prostate cancer disease-specific mortality. Elevated PSA levels were followed by a systematic sextant prostate biopsy. Standard repeat testing intervals were applied. After controversies from 2009 to 2016 due to contradicting results of the two trials, the results aligned in 2016 and showed that early PSA detection reduces prostate cancer-specific mortality. However, overdiagnosis rates of up to 50% were reported, and this sparked an intense debate on harms and benefits for almost 20 years. The balance between harms and benefits is highly debated and has initiated further research to investigate new ways of early detection. In the meantime, the knowledge and tools for the diagnostic algorithm improved. This is a continuously ongoing effort which focuses on individual risk-based screening algorithms that preserve the benefits of the purely PSA-based screening algorithms, while reducing the side effects. An important push towards investigating new techniques for early detection came from the European Commission on the 20th of September 2022. The European Commission published its updated recommendation to investigate prostate, lung, and gastric cancer early detection programs. This opened a new window of opportunity to move away from the trial setting to population-based early detection settings. With this review, we aim to review 30 years of historical evidence of prostate cancer screening, which led to the initiation of the 'The Prostate Cancer Awareness and Initiative for Screening in the European Union' (PRAISE-U) project, which aims to encourage the early detection and diagnosis of PCa through customized and risk-based screening programs.

Keywords: PRAISE-U; early detection; overdiagnosis; overtreatment; prostate cancer; screening.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Work packages. PRAISE-U project.
Figure 2
Figure 2
Work package leads. PRAISE-U project.
See this image and copyright information in PMC

References

    1. Bray F., Kiemeney L.A. In: Epidemiology of Prostate Cancer in Europe: Patterns, Trends and Determinants BT-Management of Prostate Cancer: A Multidisciplinary Approach. Bolla M., van Poppel H., editors. Springer International Publishing; Cham, Switzerland: 2017. pp. 1–27. - DOI
    1. Van Poppel H., Roobol M.J., Chapple C.R., Catto J.W.F., N’Dow J., Sønksen J., Stenzl A., Wirth M. Prostate-specific Antigen Testing as Part of a Risk-Adapted Early Detection Strategy for Prostate Cancer: European Association of Urology Position and Recommendations for 2021. Eur. Urol. 2021;80:703–711. doi: 10.1016/j.eururo.2021.07.024. - DOI - PubMed
    1. Hogenhout R., Remmers S., van Slooten-Midderigh M.E., de Vos I.I., Roobol M.J., ERSPC Rotterdam Study Group From Screening to Mortality Reduction: An Overview of Empirical Data on the Patient Journey in European Randomized Study of Screening for Prostate Cancer Rotterdam After 21 Years of Follow-up and a Reflection on Quality of Life. [(accessed on 9 September 2023)];Eur. Urol. Oncol. 2023 :S2588-9311(23)00172-4. Available online: http://www.ncbi.nlm.nih.gov/pubmed/37690917. - PubMed
    1. Van Neste L., Hendriks R.J., Dijkstra S., Trooskens G., Cornel E.B., Jannink S.A., de Jong H., Hessels D., Smit F.P., Melchers W.J.G., et al. Detection of High-grade Prostate Cancer Using a Urinary Molecular Biomarker–Based Risk Score. Eur. Urol. 2016;70:740–748. doi: 10.1016/j.eururo.2016.04.012. - DOI - PubMed
    1. Van Poppel H., Roobol M.J., Chandran A. Early Detection of Prostate Cancer in the European Union: Combining Forces with PRAISE-U. Eur. Urol. 2023;84:519–522. doi: 10.1016/j.eururo.2023.08.002. - DOI - PubMed