A new analysis of global data on prostate cancer by the American Cancer Society indicates that incidence and mortality rates have stabilised or declined in most countries over the past five years.
But some European countries, such as Lithuania, Estonia, Latvia and Bulgaria, are not following the trend and are still showing high incidence and mortality. Overall, in 2012, prostate cancer was the most commonly diagnosed cancer among men in 96 countries and was the leading cause of death in 51 countries.
An ambitious new fundraising campaign asking members of the public to “Cycle to the Moon” has been launched by Europa Uomo’s member organisation in the UK, Tackle Prostate Cancer. The aim is to raise awareness as well as funds.
With a target of raising £250,000, the charity is engaging with cycling clubs to encourage members to raise money for prostate cancer through charity rides throughout the UK. It wants them to collectively ride the 250,000 miles to the moon with a target of £1 per mile being donated.
Alongside Cycle to the Moon, Tackle is promoting a similar “Bike to the Moon” initiative for motorcycle clubs. “Many motorcycle clubs are generous donors to charitable causes and the age profile of many of their members is probably the age when men should be getting tested for prostate cancer,” says Roger Wooton, Chairman of Tackle Prostate Cancer.
The European Association of Urology’s Guidelines Office has formally announced a change in its guidance on how to diagnose prostate cancer. The guidelines now recommend there should be no prostate biopsies without a positive multiparametric MRI beforehand.
The change takes into account recent research, and aims to improve diagnostic accuracy and prevent unnecessary interventions. Speaking at a guideline meeting during the EAU Congress, Professor Caroline Moore, Reader in Urology from University College London, said there was no doubt that standard biopsy in men with a negative MRI can have unfortunate results.
“Side-effects of biopsy are common, and current treatment rates are much higher than recommended,” she said. ““Five-year detection rates of significant cancer in men with negative MRI and no TRUS biopsy are low. I recommend that we hold fire, rather than end-fire.”
According to Europa Uomo’s Secretary, John Dowling, who was at the meeting, a welcome feature of the discussion was the emphasis on the patient being involved in decisions whether or not to perform a biopsy if the MRI proves negative.
Caroline Moore said: “Discussion with the patient is important and I’m pleased to see that in the 2019 EAU Guidelines. It’s a recognition that this is a preference-sensitive decision. A man might prefer greater certainty at the expense of side-effects and expense. Or he might be very confident in the fact we’re not missing the sort of disease that might impact his life and be happier to forego the biopsy.”
Quality of life for men with prostate cancer is a priority for clinicians, scientists and patient groups in the coming year, Europa Uomo’s Secretary told a high level session at this year’s EAU (European Association of Urology) Congress in Barcelona.
Speaking at the European School of Oncology (ESO) Prostate Cancer Observatory meeting, alongside leading urologists and researchers, John Dowling said that profession should have the quality of life of patients with prostate cancer as a foremost concern when deciding on treatment and professional priorities.
The session allowed leaders in the field of prostate cancer to give a forecast for the next year. They discussed the growing consensus that mpMRI scans should precede biopsy in diagnosis, and patient support for the option of active surveillance.
“Patients are sometimes quite willing to trade off some degree of overall longevity for quality of life and quality of life will improve if some of the things we heard about today become mainstream,” said John Dowling, being interviewed for EAU TV after the session.
Presentations by Europa Uomo at urologists’ international meeting in Barcelona have emphasised the importance of three pillars of action to help men with prostate cancer: increased awareness, early detection and treatment in specialist multidisciplinary centres.
Hundreds of urologists gathered in Spain for the annual congress of the European Association of Urology (EAU). At the start of the event, John Dowling, Europa Uomo’s Secretary, made a presentation outlining the need for change at a meeting organised by the European School of Oncology’s Prostate Cancer Observatory on innovation and care.
On Sunday, he made a presentation at the EAUPatient Information session. He quoted the results of a Europa Uomo survey which indicated that just 48% of men are aware of prostate cancer risks and PSA testing. There was a lack of patient information and offer of active surveillance for low risk prostate cancer patients in Europe, he said.
And he drew attention to the significant impact that metastasis and treatment side effects could have on the quality of life of men living with prostate cancer.
Europa Uomo’s Prostate Cancer Patient Officer, based in Poland, is helping to build new prostate cancer patient organisations in Europe
Europa Uomo is supporting the growth new organisations for men with prostate cancer in Eastern and Central Europe – with the help of a young researcher and campaigner based in Warsaw. For the past 10 years, Izabella Pawlowska has helped with translation and administration for the Polish prostate cancer patients organisation, and in 2018 she began working with Europa Uomo to help build patient representation in other countries.
She has been working with Board member Stig Lindahl, making contact with prostate cancer patients in countries where there is currently no patient organisation, and offering support to existing organisations that need strengthening.
This is valuable work, says Stig: “By providing a number of good examples from existing organisations in other parts of Europe, we hope they can find a ‘menu’ that is suitable to the environment in their own country.”
A European PSA-based screening programme for prostate cancer is on its way, according to the European Association of Urology (EAU).
Following publication of a new policy paper on prostate cancer screening, published with Europa Uomo and other organisations, EAU has announced it will be making the case for screening at important European meetings.
It will be promoting the issue at the EU’s Innovative Partnership on Action Against Cancer (IPAAC) WP5 meeting on 20th May, and at the Romanian EU Presidency Conference on cancer prevention and cancer monitoring and data use. The hope is to influence cancer control plans of EU member states.
Active surveillance – monitoring rather than treating prostate cancer after diagnosis – may put a significant psychological burden on men with prostate cancer, according to a study by one of Europa Uomo’s members, the Danish prostate cancer patients’ organisation PROPA.
PROPA surveyed members who were currently under active surveillance (AS), asking them how worried they were under AS. Out of a response of 191, 4% said they were seriously worried, 33% said they were somewhat worried, and 41% said they were a little worried. Nearly a third said they had regrets about delaying treatment.
Active surveillance – monitoring rather than treating prostate cancer that hasn’t spread – is a good approach for men under 60 as well as older men, according to new research in the Journal of Urology.
The study is significant because previous studies have indicated that younger men and their families are anxious that active surveillance may not be advantageous over time.
The American study compared two groups of men with low volume, low risk prostate cancer. One group began active surveillance when they were younger than 60 years and the other began when they were 60 or older. After six years, the investigators found no significant difference in progression-free survival, treatment-free survival, metastasis-free survival or prostate cancer specific survival.
The authors, from Massachusetts General Hospital in Boston, conclude: “Active surveillance is a safe and effective approach which spares any properly selected men younger than 60 years with low risk prostate cancer from intervention, provides adequate time for intervention if required, and shows durable disease specific survival.”
Europa Uomo has joined with European urological associations, scientific experts, policy makers and other patient organisations to call for national screening programmes for prostate cancer across Europe.
In a new policy paper, launched in the European Parliament with support from MEPs, the organisations say that the European Parliament and EU member states should ensure that the European Commission considers whether PSA-based screening should be implemented at European level.
The paper was issued jointly by Europa Uomo, Cancer Control Joint Action, the European Cancer Patient Coalition and the European Association of Urology (EAU) at a special event to mark European Prostate Cancer Awareness Day (EPAD). “The European Union can no longer continue to overlook the most common cause of cancer in men in Europe,” says the policy paper.
Action is urgent in the light of new evidence from the European Randomised Study of Screening for Prostate Cancer that PSA screening reduces prostate cancer mortality by 21%. “As such, PSA screening results in mortality reduction are obviously better than in breast or colon cancer screening,” says the paper.
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