As the world struggles to recover from the Covid pandemic and restore critical health services, including cancer services, now is the time to prioritise prostate cancer care for all those who need it.
COVID-19 has exposed deep inequalities in healthcare that must be urgently addressed. Many of these existed before COVID but were made worse by the strain on healthcare systems across Europe. One of these, and an issue I feel passionately about, is prostate cancer, which policymakers must ensure does not return to the escalating situation pre-pandemic.
The impact of coronavirus has been devastating for many cancer patients,1 including those with prostate cancer. Research shows that nearly 61% of European oncology centres were forced to reduce activity at the peak of the pandemic2, resulting in delays and cancellation of cancer treatment. Furthermore, COVID-19 has prevented many from seeking that all-important early medical advice.
We know that prostate cancer mortality and ‘too-late’ diagnoses are on the rise.3 This picture is likely to be exacerbated further as the impact of the COVID-19 pandemic on broader access to screening, diagnosis, treatment, and cancer care becomes fully understood. Of huge concern is that an estimated 100 million screening tests for all cancers were not performed as a result of the pandemic, with clinicians seeing 1.5 million fewer cancer patients in the first year, according to recent data from the European Cancer Organisation.1
This has left around one million cancer patients potentially undiagnosed,1 with prostate cancer screening alone down 74% compared with the pre-COVID period.4 This, says the European Cancer Organisation, is already leading to later cancer diagnoses,1 lower overall survival, and more complex and costly prostate cancer care.
Lack of awareness of prostate cancer
Prostate cancer is the most frequently diagnosed male cancer in Europe, accounting for some 24% of all new male cancers annually.5 In some countries like Sweden, it has become the number one cause of male cancer death and in many EU Member States, it ranks number two after lung cancer.6 Across Europe, 10% of all male cancer deaths are due to prostate cancer.6 However, less than half (48%) of men in the region are aware of either prostate cancer risks or the potential for screening using prostate-specific antigen (PSA) tests.7
This highlights the barriers to early detection and awareness-raising among the healthy male population. Early detection is a challenge, but it is possible today through an easy risk stratification to avoid overdiagnosis (and overtreatment) in men with a suspicious PSA level.8
Moreover, due to access issues, some of the largest differences between countries in cancer medicines uptake are seen in medicines for prostate cancer. This means that the prostate cancer care and treatment necessary to secure the best possible outcomes – longer and more comfortable lives despite the disease – are not always available to prostate cancer patients.9
What needs to change?
In 2020, the Let’s Talk Prostate Cancer expert group, which represents key prostate cancer stakeholder organisations, launched the Digital Atlas, a resource hub that provides up-to-date analysis and information on screening, diagnosis, and treatment across some European states. It also offers toolkits and other resources for awareness-raising among health practitioners and the general public.
As part of the process of recovering from, and re-evaluating our health systems after the pandemic, we must take steps to ensure that going forward, those affected by prostate cancer in Europe receive the right treatment at the right time.
As mortality and ‘too-late’ diagnoses3 for prostate cancer increase even in wealthier areas of the world – and inequalities in access to prevention, treatment and care persist9 – it is more important than ever that policymakers work together to make better prostate cancer care a reality for all affected citizens.
The recent amendments to Europe’s Beating Cancer Plan (EBCP), and a renewed focus on EU health policy as a result of the pandemic, are a unique opportunity for us to ensure prostate cancer care is prioritised at an EU and national level.
Encouraging signals for prostate cancer care
While it is encouraging that, in December 2021, the final amendment to the EBCP on early detection was voted on unanimously by all Members of the European Parliament (MEPs) and that it specifically encourages EU Member States to consider early detection of prostate cancer,10 greater focus should be paid to ensuring this is implemented as a priority and that there is access to specialist multi-disciplinary teams for patients alongside a greater focus on screening to help save lives.
This is why the Let’s Talk Prostate Cancer Expert Group is calling for urgent action and prioritisation of prostate cancer by European Union countries and their national policymakers at this pivotal moment. We have outlined five key actions to help improve prostate cancer care, awareness, and outcomes, calling for:11
- Prioritisation – the final report of the European Parliament’s Beating Cancer Committee to recommend specific actions on prostate cancer, including organised PSA testing for risk-based early detection, and to recommend commissioning a report on the progress of national cancer plans;
- Awareness – campaigns and education programmes to be supported by policymakers to educate individuals about their risk, timely detection methods and treatment options;
- Healthcare inequalities – European, national, and regional policymakers to fund research into the inequalities that affect people with prostate cancer, including socio-economic, ethnic, national, and regional factors;
- Access – Member States to improve timely access to high-quality multidisciplinary and multi-professional prostate cancer services at every stage of the treatment and care pathway; and
- Health system organisation – innovations in prostate cancer care developed during the COVID-19 pandemic should be prioritised by national governments, such as the increased role for primary care professionals in the provision of care.
Implementing specific and measurable actions on prostate cancer is one of our strongest opportunities to help address the deepening inequalities in cancer care, which have been further exacerbated by COVID-19. If we collectively take urgent action now, we can improve the health outcomes for countless men across Europe and help to provide them with the care and quality of life they deserve.
About the author
Professor Dr Hendrik Van Poppel is Chair of the Policy Office of the European Association of Urology, Co-Chair of the European Cancer Organisation Inequalities Network and a member of the expert group for the Let’s Talk Prostate Cancer (LTPC) initiative. This article was initiated by and developed in collaboration with Astellas Pharma Europe Ltd, which organises and funds Let’s Talk Prostate Cancer.
1 European Cancer Organisation. Covid-19 and cancer data intelligence. Available at: https://www.europeancancer.org/timetoact/impact/data-intelligence. Last accessed March 2022
2 European Society of Medical Oncology (Sept 2020). COVID-19 pandemic halts cancer care and damaged oncologists’ wellbeing. Available at: https://www.esmo.org/newsroom/press-office/esmo2020-covid-pandemic-halts-cancer-care-oncologist-wellbeing. Last accessed March 2022
3 European Association of Urology (3 February 2021) Europe’s Beating Cancer Plan brings hope for better prostate cancer outcomes. Available at: https://epad.uroweb.org/europes-beating-cancer-plan-brings-hope-better-prostate-cancer-outcomes/. Last accessed March 2022
4 Alkatout I, Biebl M, Momenimovahed Z, et al. (2021) Has COVID-19 Affected Cancer Screening Programs? A Systematic Review. Front. Oncol. 11:675038. https://www.frontiersin.org/articles/10.3389/fonc.2021.675038/full. Last accessed March 2022
5 Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10(2):63-89. Available at: https://pubmed.ncbi.nlm.nih.gov/31068988/. Last accessed March 2022
6 Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018;103:356-387. Available at: https://pubmed.ncbi.nlm.nih.gov/30100160/. Last accessed March 2022
7 European Association of Urology, White paper on Prostate Cancer, Recommendations of the EU cancer plan to tackle prostate cancer 2020. Available at: https://uroweb.org/wp-content/uploads/EAU_PCa-WhitePaper-FINAL-VERSION.pdf. Last accessed March 2022
8 Van Poppel H, Roobol MJ, Chapple CR, et al. Prostate-specific antigen testing as part of a risk-adapted early detection strategy for prostate cancer: European Association of Urology Position and Recommendations for 2021. Eur. Urol. 2021; 80: 703-711. Available at: https://www.sciencedirect.com/science/article/pii/S0302283821019278?via%3Dihub. Last accessed March 2022
9 Hofmarcher, T., Brådvik, G., Svedman, C., et al. Comparator report on cancer in Europe 2019 – disease burden, costs and access to medicines. IHE Report 2019:7. Available at: https://www.efpia.eu/media/580501/comparator-report-on-cancer.pdf. Last accessed March 2022
10 European Association of Urology (December 2021). Amendment to EU Cancer Plan encourages EU member states to consider early detection of prostate cancer. Available at: https://uroweb.org/amendment-to-eu-cancer-plan-encourages-eu-member-states-to-consider-early-detection-of-prostate-cancer/. Last accessed March 2022
11 Let’s Talk Prostate Cancer, Call to Action document, 2020. Available at: https://www.letstalkprostatecancer.com/resources/Final%20LTPC%20Call%20to%20Action.pdf. Last accessed March 2022
Professor Dr Hendrik van Poppel
Chair of the Policy Office
European Association of Urology