European Prostate Cancer Awareness Day 2019

1. How to organize / re-introduce PSA screening
N. Mottet
Urology department
St Etienne
Chairman EAU-ESTRO-ESUR-SIOG prostate cancer guidelines

2. Disclosure
None with the topic

4. SCREENING ?
Unchanged in 2019

5. AT RISK ?
Genetic testing (such as BRCA) considered too preliminary to be included
Population at risk
Unchanged in 2019

6. EARLY PSA IN GUIDELINES
Very early PSA suggested
Early PSA (40-45 yrs of age) predicts PCa mortality / advanced disease
at diagnosis Vickers BMJ 2013, Carlsson BMJ 2014, Preston J Clin Oncol 2016
THEN decreases follow up pressure if not at risk
Unchanged in 2019

7. AT RISK: WHAT TO DO ?
Once at risk, what to do ?
2019 table

8. OFFERED TOOLS
Risk calculator
Pereira-Azevedo Transl Androl Urol 2018
For free
30 – 40% biopsy less

9. OFFERED TOOLS
Biological tests
Van Oort. Prost Cancer Prost Dis 2017
Constant limitations
Most studies: retrospective
No clear definition of high risk disease (outside Gleason often > 7)
Intrinsic test validity almost never done
Cost effectiveness still questionable for many

10. Mp MRI: THE NEW TOOL
mpMRI
2019 table
Mp-MRI quality control: a must have

11. HOW OFTEN ?
Intervals for early detection
Individualized based on risk
Unchanged in 2019

12. WHEN TO STOP ?
When to stop ?
Therefore no definitive age limit [Droz Eur Urol 2017]
But comorbidities: the main discriminating factor
Charlson comorbidity index: validated tool in PCa
Unchanged in 2019

13. LOW RISK FINDING
Dealing with overtreatment
Intermediate risk
Unchanged in 2019

14. TO CONCLUDE
Finally
Early diagnosis: only way to find "early" aggressive lesions
Awareness of men
Individualization and and counseling mandatory
Cutting the link between diagnosis / treatment
Clarifying clinically significant PCa to be improved