Fostering Innovation to Improve Prostate Cancer Care in Europe
By Chris Bangma, Professor and Chairman department of Urology, Erasmus University Medical Centre, Rotterdam, the Netherlands
Europe has a privileged position when it comes to prostate cancer research and treatment. Not only when looking at the variability of the incidence of prostate cancer over the countries within the union, that shows a higher incidence in the north compared to the south of Europe. Also when we look at the results of the epidemiological research performed over the last two decades. Population based screening proved that early detection of prostate cancer, even when performed with simple protocols that stratified men for biopsies based on their serum PSA only, reduce the cancer mortality with at least 20%.
Even better, it reduces the number of men with metastatic disease with 40%, which means a tremendous benefit in quality of life for men in Europe, next to a reduction of health care costs. While we are starting to appreciate the advantage of this privileged position, Europe can work on making individualised screening available to every citizen. Those men who understand the currently available balanced study information well, will be able to pick up the responsibility for their own health, and may choose for screening for prostate cancer based on their individual risk assessment. Patient organisations may support the distribution of adequate information in the various European languages by new mobile technology, improving E-health by their network under the umbrella of Europa Uomo.
So prostate cancer can be recognised early, resulting in cure, but we need this personalised approach. Prostate cancer may be diagnosed with better methods, but we need better stratification upfront of men with harmless indolent cancers in contrast with aggressive cancers. Europe has the frontline industries in imaging and marker technology to support this development. While MRI and ultrasonography are becoming better, their fusion is more than 1+1=2. It enhances the above mentioned stratification, reducing overdiagnosis of harmless cancers.
Further development of objective parameters within images might eliminate the problem of standardisation between centres and manufacturers across Europe. As the EU is also home base of industries developing proteomic and genomic markers, stimulation of marker research will provide chances for products with world wide implementation. Homing a number of biorepositories with long follow-up (registries have been raised in academic institutions as well as in pharmaceutical companies), Europe might support the fast validation of candidate markers for stratification of patients for screening and treatment in clinical networks, and test those prospectively in small cohorts distributed from north to south, and from west to east.
Prostate cancer can be cured, but experts are needed. In various European countries Prostate Units have been intiated that guarantee better quality based on multidisciplinary approaches in which professionals are audited on a daily base by their counterparts. Urologists, radiotherapists, oncologists, and nursing specialists decide on the best management of cancer patients when building on the expertise of dedicated pathologists, radiologists, and clinical chemists. While minimal treatment volumes can be accomplished, care will never be far from the patients’ home, as prostate cancer remains a high frequent disease for the decades to come. Umbrella organisations will play a major role to accomplish the networks of the best that perform research next to treatment.
Which are the likely facts and challenges? 1 of 10 European men are facing prostate cancer during their life: we can do better.
200,000 men are diagnosed annualy in the EU with indolent cancers: we can reduce that and avoid overtreatment.
30% of men treated with curative intent face serious side effects: we may focus treatment.
Treatments for metastatic disease are invented but slowly validated: we can speed it up by designing new study endpoints that allow for drug reimbursements.
Most of all: we can involve European men to build the databases and repositories that are needed to make these developments. When motivated to participate in open access biobanks for biodata, images, and biomaterials we involve our most important stakeholders to provide the tools for succesful and leading European research.