Guidelines on PCa screening Nicolas Mottet, Chairman EAU PCa Guidelines Panel

1. Guidelines on Prostate cancer screening
N. Mottet
St Etienne France

2. Prostate Cancer
NOT an indolent disease
2nd / 3rd cause of cancer death
Late clinical symptoms
“Controversies” limiting the message

3. Difficulty
Dying with a PCa / Dying from a PCa

4. EAU guidelines
Endorsed by all EU member states scientific organisation
And many others (altogether: 50 national urological associations)
Fully published
Updated yearly

5. EAU guidelines 2017
Evidence based (peer reviewed fully published papers)
Mainly systematic revue
Really multidisciplinary: 5 urologists, 3 radiotherapists,
2 medical oncologists, 1 pathologist, 1 radiologist,
1 patient representative

6. EAU guidelines
Years of follow-up N needed to screen N needed to treat
9 1,410 48
11 979 35
13 781 27
ERSPC Schroeder Lancet 2014
PLCO trial: “control” arm at least as screened (if not more) as
the “screened” arm Shoag. N Engl J med 2016
Numbers below those in breast cancer
(Lancet 2012)
Combined: screening reduces PCa mortality
Tsodikov. Ann Int med 2017

7. EAU guidelines
Still a question: diagnosis of “insignificant PCa”
Knowing what happens is the only way to decide what to do
Diagnosis does not mean treatment
Diagnosis means: knowing what is present
Leading to optimal decision
General principle in Oncology: better outcome if early disease

8. EAU guidelines

9. EAU guidelines
Early diagnosis: only way to find "early" aggressive lesions
Cutting the link between diagnosis / treatment
only way to decrease overtreatment while maintaining
survival benefit associated with early diagnosis