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Diagnosis of Prostate Cancer: Population-Based Early Detection, Risk Stratification and...
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Diagnosis of Prostate Cancer: Population-Based Early Detection, Risk Stratification and Imaging

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: 5 April 2025 | Viewed by 4339

Special Issue Editor

Prof. Dr. Monique J. Roobol

E-Mail Website
Guest Editor
Department of Urology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
Interests: epidemiology; urological oncology; individual risk prediction; nomograms; decision making; biomarkers; screening; modeling

Special Issue Information

Dear Colleagues,

The effect of screening on disease-specific mortality was studied in the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening trial. Elevated PSA levels were followed the performance of systematic sextant prostate biopsy (a one-size-fits-all strategy). We had to wait for almost two decades before the data of these trials became mature enough to publish the first results. Those results showed us that screening indeed could allow patients to avoid suffering and dying from prostate cancer, but at the same time fueled a strong debate on harms and benefit.  The poor balance between harms and benefit initiated a tsunami of studies into ways of improving this. Nowadays, this is a continuously ongoing process with a focus on an individual risk-based screening algorithm that preserves the benefits from the purely PSA-based screening algorithms.

On the 20th of September 2022, after three decades of research, the European Commission added prostate, lung, and gastric cancer to the list to be screened for, in addition to cervical, colorectal, and breast cancer. This gives the green light to implement high-quality prostate cancer screening programmes throughout Europe.

In this Special Issue, we will focus on what actually constitutes a good of quality program and will discuss several approaches to and the results of implementation. Additionally, the views of patients will be highlighted.

Prof. Dr. Monique J. Roobol
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prostate cancer
  • early detection
  • PSA
  • algorithm
  • risk stratification
  • MRI
  • biomarkers
  • mortality
  • patient-reported outcomes

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Published Papers (3 papers)

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Research

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15 pages, 3056 KiB  
Article
Investigating Efficient Risk-Stratified Pathways for the Early Detection of Clinically Significant Prostate Cancer
by Juan Morote, Ángel Borque-Fernando, Luis M. Esteban, Ana Celma, Miriam Campistol, Berta Miró, Olga Méndez and Enrique Trilla
J. Pers. Med. 2024, 14(2), 130; https://doi.org/10.3390/jpm14020130 - 23 Jan 2024
Cited by 2 | Viewed by 1243
Abstract
Risk-stratified pathways (RSPs) are recommended by the European Association of Uro-logy (EAU) to improve the early detection of clinically significant prostate cancer (csPCa). RSPs can reduce magnetic resonance imaging (MRI) demand, prostate biopsies, and the over-detection of insignificant PCa (iPCa). Our goal is [...] Read more.
Risk-stratified pathways (RSPs) are recommended by the European Association of Uro-logy (EAU) to improve the early detection of clinically significant prostate cancer (csPCa). RSPs can reduce magnetic resonance imaging (MRI) demand, prostate biopsies, and the over-detection of insignificant PCa (iPCa). Our goal is to analyze the efficacy and cost-effectiveness of several RSPs by using sequential stratifications from the serum prostate-specific antigen level and digital rectal examination, the Barcelona risk calculators (BCN-RCs), MRI, and Proclarix™. In a cohort of 567 men with a serum PSA level above 3.0 ng/mL who underwent multiparametric MRI (mpMRI) and targeted and/or systematic biopsies, the risk of csPCa was retrospectively assessed using Proclarix™ and BCN-RCs 1 and 2. Six RSPs were compared with those recommended by the EAU that, stratifying men from MRI, avoided 16.7% of prostate biopsies with a prostate imaging–reporting and data system score of <3, with 2.6% of csPCa cases remaining undetected. The most effective RSP avoided mpMRI exams in men with a serum PSA level of >10 ng/mL and suspicious DRE, following stratifications from BCN-RC 1, mpMRI, and Proclarix™. The demand for mpMRI decreased by 19.9%, prostate biopsies by 19.8%, and over-detection of iPCa by 22.7%, while 2.6% of csPCa remained undetected as in the recommended RSP. Cost-effectiveness remained when the Proclarix™ price was assumed to be below EUR 200. Full article
(This article belongs to the Special Issue Diagnosis of Prostate Cancer: Population-Based Early Detection, Risk Stratification and Imaging)
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13 pages, 1598 KiB  
Article
Navigating through the Controversies and Emerging Paradigms in Early Detection of Prostate Cancer: Bridging the Gap from Classic RCTs to Modern Population-Based Pilot Programs
by Juan Gómez Rivas, Renée C. A. Leenen, Lionne D. F. Venderbos, Jozien Helleman, Irene de la Parra, Vera Vasilyeva, Jesús Moreno-Sierra, Partha Basu, Arunah Chandran, Roderick C. N. van den Bergh, Sarah Collen, Hein Van Poppel, Monique J. Roobol, Katharina Beyer and on behalf of the PRAISE-U Consortium
J. Pers. Med. 2023, 13(12), 1677; https://doi.org/10.3390/jpm13121677 - 1 Dec 2023
Cited by 4 | Viewed by 1824
Abstract
Over the last three decades, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening have steered the conversation around the early detection of prostate cancer. These two randomized trials assessed the [...] Read more.
Over the last three decades, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US-based Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening have steered the conversation around the early detection of prostate cancer. These two randomized trials assessed the effect of screening on prostate cancer disease-specific mortality. Elevated PSA levels were followed by a systematic sextant prostate biopsy. Standard repeat testing intervals were applied. After controversies from 2009 to 2016 due to contradicting results of the two trials, the results aligned in 2016 and showed that early PSA detection reduces prostate cancer-specific mortality. However, overdiagnosis rates of up to 50% were reported, and this sparked an intense debate on harms and benefits for almost 20 years. The balance between harms and benefits is highly debated and has initiated further research to investigate new ways of early detection. In the meantime, the knowledge and tools for the diagnostic algorithm improved. This is a continuously ongoing effort which focuses on individual risk-based screening algorithms that preserve the benefits of the purely PSA-based screening algorithms, while reducing the side effects. An important push towards investigating new techniques for early detection came from the European Commission on the 20th of September 2022. The European Commission published its updated recommendation to investigate prostate, lung, and gastric cancer early detection programs. This opened a new window of opportunity to move away from the trial setting to population-based early detection settings. With this review, we aim to review 30 years of historical evidence of prostate cancer screening, which led to the initiation of the ‘The Prostate Cancer Awareness and Initiative for Screening in the European Union’ (PRAISE-U) project, which aims to encourage the early detection and diagnosis of PCa through customized and risk-based screening programs. Full article
(This article belongs to the Special Issue Diagnosis of Prostate Cancer: Population-Based Early Detection, Risk Stratification and Imaging)
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Review

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6 pages, 197 KiB  
Review
Prostate Cancer Screening in Young Men
by Maxime De Vrieze, Rouvier Al-Monajjed, Matthias Boschheidgen and Peter Albers
J. Pers. Med. 2024, 14(8), 818; https://doi.org/10.3390/jpm14080818 - 31 Jul 2024
Viewed by 793
Abstract
Background: Prostate cancer (PCa) screening strategies are being developed and evaluated in several countries. However, most of the evidence regarding PCa screening has been generated in study populations aged 50 and older. Aims: This study summarizes findings of a screening trial in younger [...] Read more.
Background: Prostate cancer (PCa) screening strategies are being developed and evaluated in several countries. However, most of the evidence regarding PCa screening has been generated in study populations aged 50 and older. Aims: This study summarizes findings of a screening trial in younger men and discuss those findings in the context of other screening trials. Methods: Non-systematic review. Results: Screening of 45-year-old men resulted in a low PCa detection rate. Nonetheless, almost 70% of screen-detected PCa at this age was clinically significant. In young men ISUP GG 1 screen-detected cancers warrant rigorous follow-up. A baseline, midlife prostate-specific antigen (PSA) value at age 45 may safely exclude the vast majority of men from further screening investigations for at least 5 years. At age 45, a confirmatory PSA value reduces the number of subsequent tests almost by half. Sequential magnetic resonance imaging (MRI) as a reflex test subsequent to an elevated PSA ≥ 3 ng/mL needs further investigation in young men. Conclusions: Screening in young men needs to be carefully investigated in order to avoid overscreening and overdiagnosis. Full article
(This article belongs to the Special Issue Diagnosis of Prostate Cancer: Population-Based Early Detection, Risk Stratification and Imaging)
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