GU Cancers 2019 | The benefits of active surveillance and PSA screening

Hendrik Van Poppel

There has been an increase in prostate cancer mortality that may be related to a reduction of PSA screening in the medical community. Hendrik Van Poppel, MD, PhD, of the University Hospitals Leuven, Leuven, Belgium, discusses how the reintroduction of PSA screening may be a positive step forward and also mentions the benefits of the active surveillance of prostate cancer patients, such as the avoidance of unnecessary radical prostatectomy. This interview was recorded at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA.

Transcript (edited for clarity):

We have indeed made a position paper on PSA screening. You know that since the task force in the United States has discouraged PSA screening, there has been less PSAs taken. And we have seen that the decline in prostate cancer mortality that has been ongoing for years has now stopped, and the mortality of prostate cancer increases.

The fact is that, 15 years ago when I had a prostate cancer patient on a biopsy, whatever the Gleason grade or the aggressivity of the tumor was, we treated him. We have realized afterwards that we have treated a number of patients with radical prostatectomy or with radiation treatment that did not deserve it because their tumor is not aggressive enough to ever bother them or shorten their life or their quality of life.

This is where active surveillance comes into the aim where low-risk prostate cancer patients that we can identify today, much better than years ago, we offer them no treatment, we just follow them. Active surveillance means, active surveillance. It’s something active. He needs to have a new checkup, a new PSA taken, an MRI which is of great help in selecting active surveillance patients, in selecting where we take the biopsy and to follow these patients conservatively. Looking at the tumor, is it growing? Do we need to do something? Because active surveillance does not mean we will never treat him. We do not treat him today. It might well be that we treat him in two years or in four years.

And in the end, 35% of active surveillance patients get active treatment in the end. But not at the time that it’s not needed. I have done more 3,000 radical prostatectomies in my life and I’m sure I have to admit that at least 200, 250 patients, I’ve done a radical prostatectomy on that did not need it at the time I did it. 30% of them would have had radical prostatectomy in the years to come but I certainly over treated prostate cancer very much.

The argument about PSA screening, that needs to be reintroduced because the mortality of prostate cancer, true prostate cancer, male patients die from prostate cancer because we do not detect them early enough. Now we have active surveillance so this means we can with PSA maybe detect cancer but we realize it does not to be treated. Active surveillance in this new setting of reintroducing PSA screening is extremely important.

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