Early findings from PRAISE-U pilots presented

Early results from pilots of organised PSA-based prostate cancer screening programmes across Europe have provided reassurance that only a small proportion of men tested go on to have invasive investigations.

Last week Monique Roobol, Professor at the Cancer Institute at Erasmus University Medical Centre, Rotterdam, provided some of the early data analysis from five pilot organised testing programmes in Europe, set up and appraised as part of the European Union’s PRAISE-U programme.

Data from across the five PRAISE-U pilots, being conducted in Spain, Ireland, Poland and Lithuania, shows that for every 1000 men tested, only 35 to 50 go on to be referred for a biopsy. All the programmes used a system of risk-stratification, designed to filter out those with a lower risk of invasive prostate cancer. The PRAISE-U statistics echo the findings of an earlier trial of organised, risk-based screening programme in Finland.

“I think this is important to realise that it is not the case that if you enter in population based screening, you will get a biopsy,” said Professor Roobol, speaking at a webinar on the PRAISE-U project organised by the European School of Urology.

“If you invite 1000 men to be PSA tested, we see 100 to 150 men have a PSA of 3.0 or higher. When you apply a risk stratification to that, about 50 to 75 men are being referred for MRI. Do another risk stratification using PIRADS 3, to pick out those who are at lower risk, and 35 to 50 men are actually referred for biopsy.”

The PRAISE-U project, which aims to develop a structure for how organised prostate cancer screening might be implemented in the real world, is coming to the end of its three-year term.  Professor Roobol emphasised it was important that screening programmes had to fit in with national health structures, which was why the varied settings of pilots was important.

“It’s exciting times in Europe at the moment actually, and I talk with more than 30 years of experience,” she said. “Now we have a lot of prostate cancer initiatives going on and there will be more following.”

Erik Briers, Europa Uomo Chair, also spoke at the event. With 77,000 men dying of prostate cancer every year, but no warning signs of early cancer and no prevention measures known, population-based screening is the only answer, he said.

“But we know that the EU Council is not yet really convinced – their advice was very soft,” he said. “But we are very happy with the PRAISE-U pilots, which are coming close to their reporting phase.”

“As patients, we want to find cancers when curable, which means localised. Early detection, not when the patient is in pain. And we have to be sure that low risk cancer, and selected low to intermediate risk cancers, are not treated actively but with active surveillance.”

You can find out more about PRAISE-U in the dedicated section of the Europa Uomo website.