European Prostate Cancer Awareness Day 2019

1. The PSA (Hi)story
Prof.Dr. M.J.Roobol
Erasmus University Medical Center
Rotterdam
The Netherlands

2. Rationale for prostate cancer screening
• 1972: Hanash et al. reported 10 years survival rates of 52% and 4% for
stage A and B disease respectively. (Nowadays M+; two third of men
were diagnosed with stage B).

3. Rationale for prostate cancer screening
• 1972: Hanash et al. reported 10 years survival rates of 52% and 4% for
stage A and B disease respectively. (Nowadays M+; two third of men
were diagnosed with stage B).
• 1984: with the DRE as the only method of diagnosis, 30-35% of men
had bone metastases, and 45-50% had nodal disease [Thompson et al.
1984].

4. 1 out of 2 to 3 PCa
patients died of their
disease in the
pre-screening era
International Journal of Cancer vol. 85, January 2000

5. Then came PSA 1
• The rate of PSA based screening over the last 35 years can be compared
with driving your car from the Netherlands to Italy. It starts with a rather
flat drive in the Netherlands. This represents the rate of PSA screening in
the late 80s.
• Moving with high speed through Germany one gradually climbs to higher
altitudes, i.e the rate of PSA testing in the 90s.
1. Based on: M.J.Roobol: Where we are with screening and risk prediction for prostate cancer in 2016? BJUi: 117: 381

6. Then came PSA and had effect!
• Then the high (but very difficult to drive) summits and
beautiful valleys of Switzerland are there, representing PSA
testing practices in the new millennium and the decline in
metastatic disease and related mortality.
Schröder et al. Lancet 2012 / Eur Urol 2012
Prostatecancermortality

7. PSA testing ?
• Finally we descend to Italy’s Po valley, comparable to especially
PSA testing rates in the US after the recommendations of the
USPSTF
• Followed by an increase of 42% in advanced disease by 2025
Sammon et al. JAMA 2015 and Kelly et al Eur
Urol Focus 2018

8. How to continue?
• The question is what will we do next? Will we take a left turn
and slowly disappear into the sea like Venice?
• Returning to a situation where 1 out of 2 or 3 men died of
prostate cancer?
BBC news 2018 !!!
http://spcsg.ca/reading-material/prostate-cancer-deaths-overtake-breast-cancer/

9. Obvious choice!
• Or will we stop our car, look behind, see the beautiful
landscape and return taking the Gotthard road tunnel,
avoiding spoiling of petrol (i.e. unnecessary PSA testing and
potentially harmful prostate biopsies) and go straight to the
valleys of Switzerland?
To be continued…