Life Limiting Prostate Cancer

In February 2021, the European Commission (EC) announced the EU Cancer plan, to tackle Cancer across Europe, from prevention, to screening and diagnosis, to treatment and palliation. One of the more sensitive goals was the expansion of screening from Breast, Cervical and Colorectal cancers, to include Lung, Stomach and Prostate. This was not greeted across Europe with enthusiasm in all countries, as it would require significant resources and place a major strain on a number of healthcare systems across the EU. In order to inform a European early detection / screening program, further information and research is required. Previous screening programs in prostate cancer have been established around the world without patient engagement, and led to poor outcomes, over-treatment and screening was therefore generally not recommended. The European Association of Urology has led a successfully application (known as PRAISE-U) involving 25 countries across Europe who over a total of 6 work packages in 3 years will provide the much needed information to inform a successful screening program. Work package 4, involves the establishment of national pilot programs in 5 countries, and Ireland, through the Irish Society of Urology (ISU) has been invited to establish a research screening program.

The ISU, the National Screening Service (NSS) and the National Cancer Control Program (NCCP) have developed an innovative prostate cancer screening pilot program, known as Prostate Check that is being funded by the EC through PRAISE-U . The program will involve doctors (both GPs and Urologists), Irish men (aged 50-70 years) and their families. Feedback from all involved will inform the design of a future PSA based risk-stratified national screening system. The Irish data collected will be fed to the PRAISE-U Investigators (based in Erasmus University in Rotterdam) who will put together a European wide report to the European Commission by April 2026. The Irish proposal brings together two partners, firstly an academic hub in University College Dublin (UCD), and secondly the Health Service Executive (HSE). Men aged 50-70 years will be randomly identified from the Screening service, and will be invited to the pilot, giving their consent if they wish to be involved and for their data to be collected (via the website prostatecheck.ie). Partnering with a test provider, a home based PSA blood testing kit will be sent to the patient, who will perform a finger prick blood sample and return the sample for PSA testing in the mail to the laboratory. This means that GP practices will no longer be burdened with blood testing and referrals. All the data will be stored securely in UCD. All of the pilot programs will follow the EAU algorithm (Image 1). Men with high PSA readings will be seen automatically in the successful Rapid Access Prostate Clinics (RAPC) for MRI imaging, possible biopsy and treatment if needed. This data, and feedback from doctors, patients and families will all be analysed centrally by the EAU Investigators. In essence we will have Irish data, on Irish men assessing a novel home PSA testing system as a potential screening method in our commonest male cancer. We will learn from the experience of other European countries, and they from ours. Other work packages are examining the current status of screening across Europe, the needs of countries and the design and implementation of a screening protocol through knowledge sharing.