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EPAD 2017 - Paul Enders

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PCa screening from a patient perspective
Paul Enders, Europa Uomo and member EAU PCa Guidelines Panel

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EPAD 2017 - Paul Enders

  1. 1. Prostate Cancer screening from a patient’s perspective Paul Enders Europa Uomo and member EAU Prostate Cancer Guidelines Panel
  2. 2. Screening • Screening: systematic examination of asymptomatic men (at risk), initiated by health authorities • Early detection is initiated by the patient and/or his physician.
  3. 3. Screening • Objective of screening and early detection is to reduce PCa caused mortality and to reduce the risk of developing advanced and metastatic PCa, which may be related to a dramatic loss in quality of life. • Europe-wide, men should be aware of the importance of early detection.
  4. 4. Screening, Points of Criticism Screening and early detection tests under controversial discussions • Not efficient • Too much over-diagnosis • Too much overtreatment
  5. 5. Comparison of Screening on some Types of Cancer • Breast Cancer (9 randomised Studies (650 000 participants) NNS 1792 RRR 22% after 14 years Fletcher: Screening for BC 2010 NNS other sources: (adjusted to age) 377 to 1339 • Colon Cancer NNS 489 Coloscopy • Prostate Cancer (ERSPC Rotterdam Section adjusted to non-attendance, contamination) NNS 293 after 13 years L. Bokhorst et al., European Urology August 2013
  6. 6. Diagnosis of Prostate Cancer (simplified) PSA Tastunter- suchungDRE Biopsy Decision Follow up tests ! Active Surveillance Active Therapy Watchful Waiting Surgery, Radiotherapy, medical treatment Therapy if progressing Therapy if Symptoms
  7. 7. EAU guidelines recommendations
  8. 8. Screening, early detection Early detection: • An early detected tumour may be cured. • Treatment with less undesirable side effects is possible • Low risk tumours need no prompt treatment or no treatment at all. (Active Surveillance) • Risk of overtreatment No early detection: • Tumour detected by symptoms, curative treatment no longer possible. • Tumours, curable were missed • An advanced tumour may reduce quality of life • No concern by diagnosis of an insignificant tumour
  9. 9. • Better differentiation between low risk an high risk PCa. • Improve reliability of biopsy results (imaging). • Reduce the remaining risk of AS. EU should promote early detection diagnosis of men at risk based on the most recent EAU guidelines for screening and early detection. Still to be done
  10. 10. TV discussion: Question to an journalist, arguing against screening and refusing for himself early detection testing: Assumed, you were diagnosed with an advanced prostate cancer no longer curable. Would you regret, that you have not had early detection tests? An interesting question
  11. 11. Would you regret, that you have not had early detection tests? Think about your answer to this question. Thank you for listening!
  12. 12. Thank you for listening !

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