A detailed illustration of a European man undergoing a PSA test for prostate cancer screening, showing subtle variations in healthcare settings across different European countries. The background includes medical equipment, data charts, and healthcare professionals, emphasizing public health and preventive care.
The landscape of prostate cancer in Europe is increasingly dominated by opportunistic PSA testing, leading to highly variable incidence rates. A new study assesses prostate cancer’s epidemiological trends from 1980 to 2017 across 26 European countries. The research underscores the importance of controlled screening programs, highlighting the contrast between high incidence and low mortality rates.
Salvatore Vaccarella and his team found that prostate cancer incidence reached peaks in the mid-2000s but declined in several countries thereafter. However, recent years have seen a rise in cases again. “The trends show a 20-fold variation in incidence, yet mortality only varies fivefold,” says Vaccarella. This sharp contrast suggests that a significant portion of diagnosed cancers may not require treatment.
The research emphasizes the potential for overdiagnosis—a situation where prostate cancer is identified but may not pose a risk to the patient’s health in their lifetime. “The risk of overdiagnosis cannot be ignored,” warns Mengmeng Li, co-author of the study. “Prostate cancer screening programs need to be carefully structured to avoid unnecessary treatment.”
Screening Needs Better Design
Vaccarella and his team argue for more robust screening measures across Europe. PSA screening, when done opportunistically, has led to inconsistent results. “Countries implementing unregulated PSA screening have seen varying outcomes, with no clear consensus on whether it effectively reduces mortality,” says Freddie Bray, another co-author. The findings indicate that while some countries report declines in prostate cancer deaths, others show stagnant or rising mortality rates despite increased testing.
A key takeaway from the study is the need for more organized, population-based screening approaches that minimize harm. “Screening policies must be carefully aligned with the specific epidemiological patterns of each country,” suggests Diego Serraino. The team believes that proactive policies are needed to avoid both underdiagnosis and overdiagnosis, ultimately reducing the healthcare burden caused by unnecessary treatments.
Mortality Trends and Future Implications
Despite increasing incidence, the study revealed that mortality rates for prostate cancer have steadily decreased across most European countries. This decline could be attributed to advancements in treatments and earlier detection. However, the researchers warn that mortality reductions do not necessarily justify the aggressive screening practices seen in some regions.
“There’s still much work to be done in determining the balance between early detection and preventing unnecessary interventions,” says Valentina Lorenzoni. As Europe grapples with the need for effective prostate cancer screening, this study offers crucial insights into the benefits and risks of PSA testing.
Citation
Vaccarella S, Li M, Bray F, Kvale R, Serraino D, Lorenzoni V, et al. Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study. BMJ. 2024;386. doi:10.1136/bmj-2023-077738.
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