European Association of Urology position statement on screening for
24 April 2009
The European Association of Urology (EAU) has taken into
consideration the recent scientific information on randomised screening
studies on prostate cancer (Schröder et al, NEJM 2009).
Based on the results of the European Randomised Study for Screening
of Prostate Cancer (ERSPC), the EAU has formulated a position statement
regarding prostate cancer screening in Europe, and the subsequent
actions to be taken by health professionals and health authorities.
In summary, the ERSPC reports on a relative prostate cancer mortality
reduction of at least 20% by PSA-based population screening in 162,000
asymptomatic men aged 55-69 years.
For every prostate cancer death prevented, 1,410 men have to undergo
screening, while 48 are needed to be treated in excess of the control
group population to save one prostate cancer death.
Results of the PLCO (Prostate, Lung, Colon and Ovary) US randomised
study of screening were also published in the same issue of the NEJM
(Andriole et al, NEJM 2009) and to date show no significant
effect of screening on mortality from the disease, but suffered from a
significant level of contamination in the control arm. The study
The EAU adopts the conclusions of the ERSPC study and recognizes the
benefit of screening in terms of mortality reduction, as well as the
adverse effects of overdiagnosis and overtreatment of prostate cancers
which could be quantified for the first time in the setting of a
randomized screening study. Further publication of relevant data is
awaited from the ERSPC group in due course to inform the debate.
In the interest of men’s health in Europe and elsewhere, the EAU
formulates the following statements:
- Prostate cancer is a major health problem, and one of the
main causes of male cancer deaths. However, current published data
are insufficient to recommend the adoption of population screening
for prostate cancer as a public health policy due to the large
overtreatment effect. Before screening is considered by national
health authorities, the level of current opportunistic screening,
overdiagnosis, overtreatment, quality of life, costs, and
cost-effectiveness should be taken into account.
- Overdiagnosis of prostate cancer leads potentially to
significant overtreatment. Health professionals, especially
urologists, should avoid overtreatment by developing safe methods of
cancer surveillance/monitoring without invasive therapy. Invasive
therapies should be tailored to patients’ needs and the prognosis of
- Current screening algorithms are insufficient due to a
lack of specificity and lack of selectivity for aggressive cancers
which require treatment. The development of novel diagnostic and
prognostic markers and imaging modalities is needed urgently to
enhance the predictive value of screening tools.
- In the absence of population screening, the EAU advises
men who consider screening by PSA testing and prostate biopsy to
obtain information on the risks and benefits of screening and
individual risk assessment.
- The EAU and the ERSPC study group represent essential
European stakeholders to further develop health strategies for
prostate cancer screening.
- The EAU promotes the quality of care for prostate cancer
patients in Europe in collaboration with the patient support
organization Europa Uomo (www.europa-uomo.org) through the
development of information support and guidelines.
- The EAU wishes to support and foster research needed to
develop reliable active surveillance protocols for low-risk prostate
cancers, prognostic markers, and targeted therapies in order to
deliver optimal patient care.
For further information
The EAU website: www.uroweb.org
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