1. CHAPS - The Men’s Health Charity www.tackleprostate.org PROSTATE CANCER To Screen or Not To Screen - That is the Only Question Chris Booth MBBS, FRCS Emeritus Consultant Urologist Clinical Advisory Board, Tackle Clinical Director, CHAPS Charity chris.booth@chaps.uk.com 1

2. www.tackleprostate.org CHAPS - The Men’s Health Charity 2

3. www.tackleprostate.org CHAPS - The Men’s Health Charity 3

4. SIGNIFICANT PUBLICATIONS www.tackleprostate.org CHAPS - The Men’s Health Charity 2008: BJU Int, 101, 809-16 Tyrol Prostate Cancer Demonstration Project: 25% benefit 2009, ‘12, ‘14: NEJM, NEJM, Lancet ERSPC 2014: BJU Int, 114, 323-25 Guideline of Guidelines 21% benefit 4

5. 2015: European Urol, 68(3), 354-60 Organised PSA Screening V. Opportunistic Testing www.tackleprostate.org CHAPS - The Men’s Health Charity Av. age 66, PSA 4.9 9950/1396(1022)/†79 NNI 139 at 18y NND 13 V. Av. age 68, PSA 8.7 V. 9949/962(361)/†122 (risk reduction 42%) V. NNI 493 at 18y V. NND 23 2016PCRMP: Public Health England Benefits and Risks of PSA Testing Prostate Cancer UK Consensus Statements on PSA Testing in Asymptomatic Men in the UK 5

6. 2016 EUROPA UOMO SCREENING STRATEGY A Strategy for Prostate Cancer Screening In Europe Monique J Roobol www.tackleprostate.org CHAPS - The Men’s Health Charity What Can Be Achieved By Screening? What is Happening in Daily Practice? -Guidelines: compliance V. non-compliance -Controlled V. uncontrolled screening -Informed decision/biopsies/imaging/MDTs/new treatments/active surveillance What is the Way to Go? -US Preventive Services Task Force: NO!! -Controlled screening (± risk assessment?) -Implementation - HOW?? 6

7. US Preventive Services Task Force, 2012 Recommended against screening for all ages www.tackleprostate.org CHAPS - The Men’s Health Charity No urologists No identification of risk (FH, race) Metastatic presentation rising Are we going to go back to the 1980s!? 7

8. Towards Controlled Screening www.tackleprostate.org CHAPS - The Men’s Health Charity Raise awareness of PCa Raise awareness of risk Educate commissioners and providers Introduce baseline testing Introduce risk profiling Ensure imaging before biopsy Standardise best practice 8

9. Implementation Prostatic Assessment Clinic SymptomsScreening No problem No action Urologist Nurse Specialist Drugs Continue ReviewNo Improvement 2/52 Target USN GPSI Urologist Complaint Duration Past History Medication Abdominal examination Rectal examination PSA Watch/Wait Discharge Primary Care Prostate Clinic www.tackleprostate.org CHAPS - The Men’s Health Charity 9

10. www.tackleprostate.org CHAPS - The Men’s Health Charity 10

11. www.tackleprostate.org CHAPS - The Men’s Health Charity 11