The European Study of Screening for Prostate Cancer (ERSPC)
The ERSPC is the world's biggest study of screening of prostate cancer. It involves up to 260,000 men, 220,000 of them in the age group 55-75 years old. Professor Chris Bangma, Director of the ERSPC and Chairman of the urology department at the Erasmus Medical Centre, Rotterdam (headquarters of the ERSPC) explains the study's background and aims
It is being driven by eight European countries and all participants are, like me, members of the Board that is directing this enormous enterprise. The ERSPC aims to answer a pivotal question – whether early screening of prostate cancer in a symptomatic man will benefit the survival of prostate cancer. The answer on this is of course of great interest to all kinds of governments and national institutes in order to advise on screening in the future. We plan to deliver the answer on this very complicated question in about two years’ time.
The current drive is to use active surveillance which actually is a treatment modality that has not been used very much in the past. The reason why we are doing this is because, so far, we have found in the ERSPC that a large number of men diagnosed early with prostate cancer appear to have very small cancers that, under the microscope, do not seem to be aggressive and are actually harmless.
They have the features of those cancers that accidentally are found when people die of other causes, when the microscope looks into their prostate. So we call these indolent cancers, or minimal cancers and they would never harm a patient’s life. We would more or less prefer not to detect them in a screening study because, of course, knowing he has cancer would affect
a man’s well-being. So, active surveillance is the method to follow up patients thought to have an indolent cancer, by regular checks of their blood and also the tissue of their prostate, to find out whether these suggested small cancers are actually growing. If so, then we advise radiation therapy or surgery immediately we find that the cancer could be harmful to life.
The number of these indolent cancers is found in 50% of the general population, and we think that by active surveillance we at least can protect 30% of men against treatment or surgery or radiotherapy that might influence their quality of life.
Why is it important to identify groups? Well, we want to go into targeted therapy. Every treatment has side effects – when you talk about radiotherapy or surgery – and, as said, we would like to protect the men who do not need that therapy. The second reason obviously is that treating a patient with radiotherapy or surgery is very costly, and we would like to use the money that can be spared by offering active surveillance to those people that are being treated, those who actually need it.
The PRIAS Project, which stands for Prostate Cancer Research International Active Surveillance, is a combination of words that (only) indicate that it is a tool or a study that can be used to serve active surveillance to the people. We are making use of a web-based tool to follow up and monitor advisers of patients who have the indolent disease. This is a free instrument, accessible to everybody, patients as well as physicians, and it is very easy to use, and can be offered in such a way that patients and families can look into active surveillance, what it is, what it means and whether they want to follow that.
Why is EU funding needed? The project actually aims to spread information on active surveillance as a treatment option among European men in their national languages – offering them a way out when they have small indolent cancers. We are doing this very much supported by the help from patients’ organisations, which come under the umbrella of Europa Uomo, which is active in 17 to 20 European countries.
The second aim may be even more important – the further development of the prediction of those men who need targeted therapy, intensive therapy, but also, on the other end, indicating better those men with no disease. We are trying to do this with the development of new markers, biomarkers. We have started this already with the P Mark Project, so with the European Consortium active in designing these markers, but we want to improve
on that. The third partner is the European Association of Neurologists, because we need that association in order to spread guidelines for active surveillance and tell the news and about improvements to the neurological profession. Last but not least, on this unique platform of stakeholders in Europe, we also have been able to interest the marker industries, which, of course, are pivotal in the development in bringing forward markers that are valuable for all these patients in Europe.