Male life expectancy and the battle against prostate cancer

By European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan

In the week that has seen the European Union mark three decades of action against cancer with a ceremony and high-level meeting in Luxembourg, a Prostate Cancer Awareness Day was held in the European Parliament, Brussels today (16 September).

The EU event represented the 30th anniversary of the Council conclusions of 1985, which paved the way for the first action at European level on cancer, and Lydia Mutsch, Luxembourg’s Minister for Health, alongside Vytenis Andriukaitis, the Commissioner for Health and Food Safety, opened the landmark meeting.

Meanwhile, the Brussels-based European Alliance for Personalised Medicine (EAPM), which launched its White Paper on pancreatic cancer earlier in the week, will also launch its own prostate cancer White Paper. This follows-up and complements a Europa Uomo call to action on the disease released in 2013.

In the foreword to the Europa Uomo document, MEP Nessa Childers wrote that: “We need to do more to help men with prostate cancer stay independent and out of hospital for as long as possible, which requires a holistic, personalised approach to care covering both physical and psychosocial symptoms.”

The call to action highlighted the following needs:

• To provide access to free, appropriate early detection for prostate cancer, coupled with supporting information;
• to improve prompt and accurate diagnosis of prostate cancer at all stages of the disease;
• to provide equal access to effective treatments and technology;
• to improve the identification, assessment and treatment of those at risk of dying from prostate cancer;
• to offer a range of management approaches, including active surveillance, to those whose prostate cancer is unlikely to progress, and;
• to empower men and their families in order that they can be involved in decisions about their personalised care plans, whilst providing ongoing information and support.

Today’s meeting was aimed at increasing male life expectancy featured representatives from the European Association of Urology, the European Society for Radiotherapy & Oncology, the European Society for Medical Oncology, the European School of Oncology, the European Men's Health Forum, the European Cancer Patient Coalition, Europa Uomo, as well as EAPM.

EAPM believes that the battle against prostate cancer needs to be fought at EU level. Despite significant advances in treatment, it is a growing problem that has a major impact on men’s health. In 2008 some 70,000 men died of this disease in Europe, which accounts for in the region of 10% of all male cancer deaths. The vast majority (92%) of these deaths occurred in the oldest age group, which is made up of 65-year-olds and over.

Today some 3 million European men are living with prostate cancer and the number will grow due to the EU’s ageing population. There are in the region of 70 new cases per 100,000 men across the European Union each year. But there are significant differences between Member States with, for example, as many as 123 cases per 100,000 in Ireland.

Since the early 1960s there has been a slight growth of prostate cancer incidence, although mortality rates have remained the same. The reason for this is that the majority of prostate cancer cases are slow growing and pose no immediate threat. These days, many men die with the disease rather than as a result of it.

Speaking ahead of the event, Didier Jacqmin of the European Association of Urology (EAU), explained: “Prostate cancers often have no early symptoms. One problem with the disease had been over screening, which identified too many non-life threatening prostate cancer cases. This in turn led to a great deal of unnecessary treatment and brought with it long-term side effects. A result of this has been some Member States deciding against national screening programmes for the disease.”

Overall, the problem of prostate cancer will only worsen, yet poor lifestyles and preventable risk factors account for a high proportion of premature death in men. There is a strong gendered dimension to lifestyle choices and risky behaviours that place men at higher risk of ill health than women.

In all EU Member States it is clear that men who live in poorer social conditions are likely to eat less healthily, take less exercise, are more likely to be overweight and/or obese, drink more alcohol, are more likely to smoke and/or engage in substance misuse, and have more sexual behaviour that puts them at higher risk.

The Alliance’s Didier Jacqmin said: “Research into prostate cancer needs boosting, with platforms for effective collaboration between academia, industry and healthcare systems, as we strive to achieve within EAPM. Because limited resources and patient numbers make it impossible for research to be conducted in all countries, sharing of knowledge and expertise is vital. A better structure of clinical prostate cancer research within the EU could create several centres with sufficient resources to attract and perform early trials of new agents. Meanwhile, personalised medicine certainly has a role to play in future developments.”

EAPM takes the view that the European Commission should allocate long-term funds for research into prostate cancer, with increased investment in research centres, and with advanced databases of biological and clinical data and clinical databases. Patient registries and databases are essential to permit the pooling of data needed to achieve a sufficient sample size for clinical research. Regulations need to be adapted to allow more sharing of patient data and biological materials.

Improved coordination of clinical trials - and of recruitment – is needed, with better access to information for researchers, doctors and patients. New methodologies for clinical research should be accepted, especially relating to small patient populations.

A clear focus on late translational research, particularly into clinical effectiveness, can identify tangible benefits for the health economy in the short- to medium-term.

Patient advocate Ian Banks said: “Empowerment and involvement of patients and patients’ organisations would enrich reflection on how to tackle prostate cancer. They should be allowed to contribute to shaping an adequate comprehensive European response to the disease, and be given access to the information they need to perform this role.”

And Louis Denis, of patient group Europa Uomo, said: “Vital to the aim of all treatments is the eventual reintegration of patients back into the workforce wherever possible. It is important to respect and involve them in decision-making with respect to their lifestyles and rights, not only as patients per se, but as living, breathing human beings.”

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