ONCOLOGY

Professor Hendrik Van Poppel talks to Pharmafile about new campaigns to improve prostate cancer screening, the current standard-of-care treatments and what obstacles still need to be addressed in treatment

Professor Dr Hendrik Van Poppel (HVP): Prostate cancer is the most frequently diagnosed cancer among men in Europe but, if it is caught in the early stages, patients are able to access additional treatment options and experience more manageable side effects. Effective early detection is paramount in reducing the morbidity and mortality rate of prostate cancer.

So, publication of Europe’s Beating Cancer Plan and of the updated EU cancer screening guidelines, along with the renewed focus on EU health policy, all mark important steps towards the eradication of inequalities in cancer diagnosis and treatment.

The new screening guidelines should support Member States in ensuring that 90% of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered such screening by 2025. For the first time, the new recommendation calls for population-based organised cancer screening to include lung, prostate and, under certain circumstances, gastric cancers.

This is why we are making an urgent call for EU member states to implement risk-based prostate cancer screening recommendations in national cancer plans, because outcomes for future patients of prostate cancer would improve if this step is prioritised by national policymakers.

HVP: There has been a relative decline in prostate specific antigen (PSA)-based population screening programmes for prostate cancer in Europe. The most important issue was the overdiagnosis and overtreatment of prostate cancer, which in 2012 led the US Preventive Services Taskforce to recommend against PSA testing.

Sadly, this now means we are seeing higher rates of metastatic disease and advanced prostate cancer at time of diagnosis, which in turn is associated with an increase in mortality and poorer quality of life. The situation is compounded by men feeling uncomfortable to talk about their health or to take the initiative. In many cases, they may not be aware of what their prostate is or the need to be aware of their health, particularly as they age, or if they are part of high-risk groups such as Black men and men with a family history of the disease.

The new cancer screening recommendation is based on PSA testing to identify men at high risk of disease. These men would not undergo biopsy immediately (as before) but would receive an MRI at follow-up and this, combined with active surveillance, is expected to significantly reduce overdiagnosis and overtreatment.

HVP: The COVID-19 pandemic had a significant impact on prostate cancer as it delayed both screening and treatment for patients, resulting in a record number of advanced prostate cancer cases. In fact, a recent report from the Lancet Oncology Commission states that the disastrous effects of the pandemic on early diagnosis and treatment could set back cancer outcomes in Europe by almost a decade, making urgent action a crucial priority.

Coupled with this, prostate cancer has been relatively low on the health policy agenda of the EU. Early detection is absolutely critical to improve patient outcomes and reduce mortality. It’s important that we work with national and international policymakers to prioritise prostate cancer on political agendas and dismantle stigma around the disease – it’s often viewed as an ‘old man’s disease’, or men just simply think it won’t happen to them, but prostate cancer is a killer. To do this we need to ensure there are better resources so patients, partners and families can be fully informed about prevention, diagnosis, treatment and ongoing care. It is only by detecting cancer at earlier stages that it will be possible to reduce mortality and improve the quality of life of patients.

HVP: The new recommendations mean prostate cancer screening should be systematically implemented, using PSA testing and magnetic resonance imaging (MRI) scanning as a follow-up, in males at greater risk of prostate cancer. The screening recommendation is paying particular attention to equal access to screening and targeting the needs of particular socio-economic groups, people with disabilities and people living in rural or remote areas. Helpfully, the use of new technologies such as AI can enable the rapid processing of health data, which supports better targeted screening and may ultimately lead to quicker diagnoses.

HVP: The greatest risk factors for prostate cancer are age, being a Black man of African or Caribbean descent or having a family history of the disease. Unfortunately, studies show that an increasing proportion of individuals are diagnosed with metastatic or late-stage prostate cancer, so raising awareness is vital if we are to see the situation improve. In addition, ensuring the new cancer screening recommendations are implemented in full by every country within the EU will be critical alongside supporting health systems to treat patients holistically, with multidisciplinary teams and complementary therapies, like counselling, physiotherapy and sex therapy.

HVP: It is often argued that although lots of men get prostate cancer, it is fatal to few. This is not the case and prostate cancer is the first or second cause of male cancer death in most countries across Europe. Prostate cancer survival has improved in all EU countries in the last decade, and innovations in treatment and care across the prostate cancer pathway have offered greater opportunities to enable those affected to live longer lives. However, treatment of prostate cancer is multifaceted. The effects of hormonal treatment, for example, can include sexual dysfunction or loss of libido, and this has an impact on quality of life for not only the patient, but their partners too. Everybody should be enabled to enjoy their best possible quality of life.

HVP: If EU member states implement the recommendations for risk-based screening for prostate cancer, the result on mortality rates could have a substantial impact, with the aim being that men die with the disease rather than from the disease. The opportunity for improving the outcomes for patients in terms of psychosexual health could be significant too. We shouldn’t forget that treating depression as a result of side effects of treatment for late-stage cancer also costs money for health services. If we can avoid a patient reaching that stage in their treatment journey, then it’s not just important for their well-being, but it also reduces pressure on already stretched health services.

HVP: There are three key Calls to Action from the Let’s Talk Prostate Cancer Expert Group. The first is to prioritise prostate cancer on political agendas, to increase the knowledge and understanding of the challenges facing patients, including breaking taboos associated with prostate cancer, and the emotional and sexual health burden of the disease.

The second obstacle is healthcare inequalities. We’re calling for policymakers in Europe to support research into the inequalities that affect people with prostate cancer to close this gap. Finally, we are urging European governments to ensure a timely implementation of the EU Recommendation on cancer screening within national cancer plans. It’s an extremely positive step to see prostate cancer included in the screening recommendations, but we need the implementation to happen if we are to see real change.

This article was originally published in Pharmafocus.

References are available on request.