Monique Roobol: PSA History
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This document discusses the history of prostate cancer screening and the role of PSA testing. It notes that in the pre-screening era, 30-35% of men were diagnosed with bone metastases and 45-50% with nodal disease. PSA testing led to more early-stage diagnoses and declining metastatic disease and mortality rates. However, PSA testing rates have declined in recent years in some countries, which could lead to more advanced cases being detected if screening is not continued in a targeted way to avoid overtesting. The optimal path forward is debated.
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Material audiovisual de síntesis, con traducción y énfasis sobre comentarios del expositor. Material utilizado como motivador para discusión en grupos. Incluye el video original de la exposición.
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Monique Roobol: PSA History
- 1. The PSA (Hi)story Prof.Dr. M.J.Roobol Erasmus University Medical Center Rotterdam The Netherlands
- 2. Rationale for prostate cancer screening • 1972: Hanash et al. reported 10 years survival rates of 52% and 4% for stage A and B disease respectively. (Nowadays M+; two third of men were diagnosed with stage B).
- 3. Rationale for prostate cancer screening • 1972: Hanash et al. reported 10 years survival rates of 52% and 4% for stage A and B disease respectively. (Nowadays M+; two third of men were diagnosed with stage B). • 1984: with the DRE as the only method of diagnosis, 30-35% of men had bone metastases, and 45-50% had nodal disease [Thompson et al. 1984].
- 4. 1 out of 2 to 3 PCa patients died of their disease in the pre-screening era International Journal of Cancer vol. 85, January 2000
- 5. Then came PSA 1 • The rate of PSA based screening over the last 35 years can be compared with driving your car from the Netherlands to Italy. It starts with a rather flat drive in the Netherlands. This represents the rate of PSA screening in the late 80s. • Moving with high speed through Germany one gradually climbs to higher altitudes, i.e the rate of PSA testing in the 90s. 1. Based on: M.J.Roobol: Where we are with screening and risk prediction for prostate cancer in 2016? BJUi: 117: 381
- 6. Then came PSA and had effect! • Then the high (but very difficult to drive) summits and beautiful valleys of Switzerland are there, representing PSA testing practices in the new millennium and the decline in metastatic disease and related mortality. Schröder et al. Lancet 2012 / Eur Urol 2012 Prostatecancermortality
- 7. PSA testing ? • Finally we descend to Italy’s Po valley, comparable to especially PSA testing rates in the US after the recommendations of the USPSTF • Followed by an increase of 42% in advanced disease by 2025 Sammon et al. JAMA 2015 and Kelly et al Eur Urol Focus 2018
- 8. How to continue? • The question is what will we do next? Will we take a left turn and slowly disappear into the sea like Venice? • Returning to a situation where 1 out of 2 or 3 men died of prostate cancer? BBC news 2018 !!! http://spcsg.ca/reading-material/prostate-cancer-deaths-overtake-breast-cancer/
- 9. Obvious choice! • Or will we stop our car, look behind, see the beautiful landscape and return taking the Gotthard road tunnel, avoiding spoiling of petrol (i.e. unnecessary PSA testing and potentially harmful prostate biopsies) and go straight to the valleys of Switzerland? To be continued…