In men treated with ADT following primary or salvage radiotherapy, statin use was associated with improved overall and PCa-specific survival. In patients treated with Intermittent Androgen Deprivation, statin use was associated with a trend towards longer time off treatment. A prospective trial of statins in men commencing ADT is warranted.

The widespread use of statins has been the subject of much debate generally among cardiac clinicians and others. In this study the prostate cancer patients in the statin arm appeared to have a significant gain in term of disease progression and overall survival compared to the non-statin participants in the trial.

The trial results and conclusions were first published in European Urology, Volume 79, Issue 4, April 2021, pps 446-452.

The same issue of the journal also published an editorial on the this paper titled: Statins and Prostate Cancer: Bias, Precision Medicine, or Population Health? Full text of the editorial is available here by generous permission of the author Prof. Konrad H. Stopsack.

In the aftermath of two large-scale studies that first reported in 2009, American prostate cancer clinicians took a different view from that of their Europeans peers about the efficacy of PSA screening. The American view is reflected in the NEJM article by H. Gilbert Welch & P.C. Albertsen, it appears that the US Preventive Task Force was correct to recommend against screening. The view taken in Europe has been guided by the results of the European Randomised Study of Prostate Cancer Screening which suggested that there was an advantage to screening in terms of lives saved. The view adopted in Europe appears to have developed along the lines that PSA screening on an organised and risk-assessed basis can enable early detection and significantly reduce over-treatment. See another American view indented note below:

In another recent US study by Sharma et al., it was observed that from 2008 to 2016, the mean percentage of men undergoing PSA screening decreased from 61.8% to 50.5%, whereas the mean age-adjusted incidence of metastatic PCa at diagnosis increased from 6.4 to 9.0 per 100,000 men. The Sharma study showed that reductions in PSA screening across the United States were associated with increased incidences of metastatic PCa. States with larger declines in PSA screening had bigger increases in the incidence of metastatic PCa at diagnosis.  Read more here.

From its peak in the early 1990s, U.S. mortality due to prostate cancer has decreased from 39 per 100,000 men to 19 per 100,000 men — essentially by half. Although everyone agrees that this reduction is good news, there is considerable disagreement about why it happened. The controversy has profound implications for the future of prostate-specific antigen (PSA) screening.

Europa Uomo disagrees with the view taken by Welch & Albertsen. It must be accepted that there was extensive overtreatment in the past but the clinical guidelines and policy in Europe now suggest that overtreatment can be offset by an organised population screening including appropriate risk assessment. To abandon PSA testing now without an inexpensive, effective alternative would be to risk “throwing out the baby with the bathwater”. Metastatic presentation would increase and this would be devastating for for the quality of life of patients and very expensive for the health funders.

References
1. NEJM article
2. Sharma study: Association of reductions in PSA screening across states with increased metastatic prostate cancer in the United States. Presented at the virtual 2021 Genitourinary Cancers Symposium, February 11, to 13. Abstract 228. Also Renal and Urology News 14 February 2021

Many readers will be familiar with this story from previous press coverage but the notion that some dogs with a highly developed olfactory sensitivity may be trained to detect prostate cancer may be more than an amusing newspaper story. These stories have now been the subject of a serious study that appears to provide some basis for the claim. The results of a trial led by Medical Detection Dogs in Milton Keynes, England, suggest that trained dogs can detect advanced prostate cancer (PCa) in urine samples with high specificity and sensitivity.

The study, published in PLoS One can be accessed here. Alternatively see the report in HotSheet (p.1+8).

The dogs were trained to detect Gleason 9 PCa in urine collected from biopsy-confirmed patients. The canine olfaction system was 71% sensitive and 70-76% specific at detecting Gleason 9 cancer.

• Active Surveillance Webinar
For more information, see the third article in this Update.

• Outcomes of the Special General Assembly
The Special General Assembly adopted the proposed changes to the terms of office of the current Board whereby the members serve for a maximum of four years rather than three. The Assembly went on to approve the implementation arrangements so that the former 3 year term will gradually return as the existing Board complete their terms.

• Forthcoming Virtual General Assembly
The General Assembly will again be a virtual meeting due to the continuing Covid-19 crisis and will now take place on Saturday 19th June 2021 at 11am CET using the Zoom platform.

The Annual Report will issue not later than 19 May and member organisations are advised that if they wish to make any proposals for consideration by the GA they should do so not later than the 17th May.

• Board Meeting on 16 March, 2021
EPF: Europa Uomo is a candidate for membership of the European Patients’ Forum. Vice-Chairmen Guenter Carl and John Dowling and Treasurer Ioannis Vanevos will attend the EPF General Assembly as observers on Saturday 17th April.

Active Surveillance: The Board approved the patient programme on Active Surveillance proposed by Guenther Carl and Cosimo Pieri. The first of three Webinars will take place on Tuesday, 20 April 2021 at 6pm CET (see 3rd article of this Update).

EUPROMS II : The initial round of inquiries to companies seeking financial support for EUROPROMS II was very favourably received and the Board decided to proceed with preliminary arrangements for the project.

EUPROMS I : It was reported to the Board that two Abstracts prepared by Prof. Monique Roobol and her team on the QoL study had been submitted for the EAU Congress and for EPAG. The result of the submission will be known in due course.

ECPC Joint Letter: A proposal from ECPC for a joint letter about cancer care was agreed.

Review of PCa Trials: André Deschamps reported on a meeting with Covance. Further information is to be provided.

Location of GA 2022: The Board approved a proposal from PKS (ProstaatKankerStichting) to hold next year’s GA in The Netherlands.

EAU Patient Information Day: The launch of a training programme for Androgen Deprivation Treatment will be the highlight of the in-person Patient Day organised by the EAU’s Patient Office. The date is September 4th. A meeting of the advocacy group EPAG will take place in association with this meeting and Europa Uomo’s Board will meet in the same location that weekend. Assuming it remains an in-person meeting it will be the first opportunity for Board members to meet in person since the meeting in Dublin in January 2020.

Next Meeting: The Board will next meet (virtually) on 18th May.

O’Keefe and others make the point that innovations in technologies for early detection of diseases are gaining increasing attention. The print and online media is a key avenue through which tests are promoted to asymptomatic individuals, and it could have an important role in encouraging realistic expectations of the benefits and harms of early detection, including unnecessary diagnoses. Evidence suggests that medical media coverage tends to overplay benefits, downplay harms, and ignore conflicts of interest, but there are few data on coverage of early detection tests.

Overtesting, Overdiagnosis, Overtreatment

In a commentary on the O’Keeffe study Eleftherios Diamandis and others examined the biases associated with reports of health news by scientific journals and public media and concluded that in most cases the authors of such reports stress the possible benefits but ignore the harms. This is especially true for asymptomatic testing (also known as screening). We have also examined the same question and concluded that over-testing can lead to over-diagnosis and over-treatment, which, overall, can harm patients.

More recently, as the authors point out, they saw a strong push by academic investigators and companies about circulating tumour DNA testing for early cancer detection. However, the authors calculations have shown that this testing will only be able to detect large, symptomatic tumours. They have further stressed the need for journals to provide space for healthy debates of such controversial issues, since biased reporting favours the good news, not the bad news.

Read abstracts and commentaries for free using the links below.  Full text requires a payment or subscription.

Global Media Coverage of the Benefits and Harms of Early Detection Tests | Breast Cancer | JAMA Internal Medicine | JAMA

This recent article from the Atlantic magazine is about much more than the BioNTech-Pfizer and Moderna vaccines. It not only explains what mRNA is and how it has been around for several decades but also the possibilities of mRNA in non-Covid-19 uses. It should be borne in mind that the current development of mRNA may have begun four decades ago in the search for a treatment for HIV. mRNA vaccines have also proved very powerful for use against the deadly Ebola virus.

How mRNA Technology Could Change the World | The Atlantic