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EAU 2021 | Novel MRI approach for prostate cancer screening

Peter Albers, MD, University of Düsseldorf, Düsseldorf, Germany, share his views on the future of screening for prostate cancer in Europe, commenting on existing risk-adapted screening tools and highlighting the use of bi-parametric MRI as a screening tool. This bi-parametric MRI approach demonstrated the potential to detect clinically relevant cancer at a low median PSA of 1.24 ng/ml. Prof. Albers also talks on data from the large, prospective PROBASE trial of risk-adapted PSA screening in men. This interview took place at the virtual European Association of Urology (EAU) Virtual Meeting 2021.

Transcript (edited for clarity)

The future of screening is already ongoing with the simple risk reduction of starting age, so in PSA value at baseline in younger ages. Second, the calculation of your personal risk, like family history, ethnicity, and your personal investigations like PSA and digital rectal examinations. We already have risk calculators like the PLCO risk calculator or the ESPC risk calculator from Rotterdam.

So, we can already adjust our screening beginning and the screening frequency on the clinical risks...

The future of screening is already ongoing with the simple risk reduction of starting age, so in PSA value at baseline in younger ages. Second, the calculation of your personal risk, like family history, ethnicity, and your personal investigations like PSA and digital rectal examinations. We already have risk calculators like the PLCO risk calculator or the ESPC risk calculator from Rotterdam.

So, we can already adjust our screening beginning and the screening frequency on the clinical risks. The breakthrough with this EAU meeting now and the following New England Journal of Medicine publication tomorrow is that MRI as a new imaging tool, a specialized MRI, which is a multiparametric MRI of the prostate together with the PSA test can lead or leads to a less higher frequency of indolent cancers detected. So, the specificity of screening is much higher, and the detection rate of aggressive cancer is not lower. So, this actually is the message, what we all hoped to be is now level one evidence.

And this will be now the future of screening and the EAU has developed under the guidance of Hein Van Poppel, an algorithm already that works today based on all these data, including PSA, including risk calculators and including modern imaging to burn down the group of men that really need high frequent screening to perhaps only 10%. And this is proven to avoid biopsies in half of all patients or half of all men that undergo screening.

So, these are the future developments. A lot of studies are to come. So, I’m the principal investigator of the largest screening trial, which is based on the baseline PSA at 45. This trial is called Probase trial is run, this is running in Germany. Another trial is Pro Screen from Finland. Both screening trials are based on this modern strategy of including H-adapted PSA and the modern imaging techniques. And there are a number of other trials worldwide that will, are recruiting at the moment, will be finished in the next years, showing that the combination of several risk factors is able to determine a group that needs screening and, much more importantly, I guess, about 80 to 90% of all men will have the good message that at age 50, they don’t need high-frequency screening because they have a very low risk of developing prostate cancer in the next 25 years.

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