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EAU 2020

EAU 2020: Screening Strategy and Active Surveillance in 2020

(UroToday.com) As part of a plenary presentation at the European Association of Urology (EAU) Virtual Annual Meeting assessing “Modern prostate cancer imaging in daily practice,” Chris H. Bangma, MD, presented his perspective on screening approaches and active surveillance (AS) in 2020. He began with an overview of prostate cancer, highlighting worldwide variation in prostate cancer detection, incidence, and mortality. The role of prostate cancer screening is somewhat controversial with benefits depending on a balance of prostate cancer mortality reduction compared to overdetection, overtreatment, and the morbidity of this. In general, an understanding of these factors has lead to a move to voluntary, individual-level decisions regarding prostate cancer screening, rather than mass, population-wide initiatives.

He then highlighted a number of screening trials in prostate cancer in Europe. The more recent of these have all incorporated magnetic resonance imaging following initial serum screening tests, as highlighted in the following figure.
Europe_ProstateCancer_Screening.png

Dr. Bangma highlighted efforts from the EAU to harmonize access to screening for all citizens across the EU. Personalized screening efforts begin with an assessment of the patient including their age and comorbidity to determine their potential to benefit from early prostate cancer diagnosis. He recommended MRI informed and preferably transperineal prostate biopsy.

Where prostate cancer screening diagnoses low aggressivity tumors, active surveillance seeks to minimize the harms of this detection. The Movember GAP3 project is currently collecting worldwide data on surveillance. The transition from AS to active treatment occurs not infrequently. While this may be due to true disease progression, it may also be due to initial under-diagnosis. Therefore, improvements in initial assessment may decrease rates of AS failure. Approaches to improve this include the use of MRI and MRI-targeted biopsy.MRI_targeted_biopsy_MRI.png

Ongoing surveillance intensity is important in maintaining good oncologic outcomes for patients undergoing AS. Dr. Bangma highlighted recent data from the Sunnybrook cohort showing that decreased compliance with prostate biopsy resulted in increased rates of metastatic disease. The role of MRI in surveillance remains controversial. While some believe that imaging may supplant repeated biopsy, this is not widely accepted.

In conclusion, Dr. Bangma highlighted the role of MRI in improving prostate cancer diagnosis and management, particularly the reduction of overdiagnosis of low-risk disease.

Presented by: Chris Huibert Bangma, MD, Erasmus MC, Rotterdam, Netherlands 

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Twitter: @WallisCJD at the Virtual 2020 EAU Annual Meeting #EAU20, July 17-19, 2020.