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Patients with Metastatic and Castration Resistant Prostate Cancer in Europe

Submitted by on 06 Oct 2011 – 15:05

Patients with Metastatic and Castration Resistant Prostate Cancer in Europe Professor Dr. med. A. Heidenreich, Chairman and Director,Department of Urology, Director EURO Prostate Center Aachen

Prostate cancer is the most common solid cancer in European men with an incidence of 214 in 100,000 men. About 68,000 men die due to prostate cancer annually. Despite intensified screening measures, still about 15% of men are identified with metastatic PCA at the time of the first diagnosis. Approximately 30% to 50% of patients will develop PSA progression following local therapy with curative intent and these men will develop metastatic disease over time. Although there are many innovative therapeutic developments with regard to effective treatment such as MDV3100, abiraterone, Tak-700, cabazitaxel to name a few, a significant gap exists between medical improvement on the one hand and the real medical care of patients with advanced prostate cancer.

Despite the routine publication and distribution of European Guidelines on Diagnosis and Treatment of Prostate Cancer among the members of the European Association of Urology (EAU) there are highly significant intra- and interregional differences with regard to the recommended standards of therapy. Whereas the majority of men receive some type of androgen deprivation therapy (ADT), only 50% of European urologists use ADT as recommended by the EAU guidelines. Once patients progress during ADT systemic chemotherapy with docetaxel represents the first line treatment of choice. Again, there is a high discrepancy between European countries and up to 30% of prostate cancer patients never have received chemotherapy until they finally die due to prostate cancer.

Besides these basically intolerable differences in standards, guideline recommended therapy, a significant rank growth of so-called alternative treatment options offered to the patients can be observed. Most of these options have never been validated in clinical trials. In addition, a substantial number of patients undergo expensive, not validated imaging studies prior to and during systemic therapy to apparently assess treatment response. In Germany, the costs for non-evidence based diagnosis and treatment adds up to more than 5 million € as a recent study of our group has shown.

I am firmly convinced that is one of the most important duties for active uro-oncologists involved in the management of advanced prostate cancer to harmonize diagnosis and treatment among European countries. In order to realize this future goal, intensive research into health care provision has to be initiated with the use of  several options which have been currently activated by the EUA guideline panel on prostate cancer and which have to be supported by European politicians:

  • standardized documentation of diagnostic measures in men with progressing prostate cancer after androgen deprivation therapy according to a validated questionnaire among European urologists
  • standardized documentation of initiated treatments and treatment responses in men with progressing prostate cancer after androgen deprivation therapy according to a validated questionnaire among European urologists
  • inclusion of the national patient support groups to distribute the questionnaire among their members
  • identification of the most promising diagnostic and therapeutic measures

I would be more than delighted to discuss these significant discrepancies in the treatment of men with advanced prostate cancer among European countries and to develop a consensus with regard to the most optimal solution of this significant problem in European health care provision.