Europa Uomo was founded here in Milano in 2004 by Professor Veronesi and Alberto Costa ten years after they founded Europa Donna. So we followed the same scheme, it was easy in the beginning. The purpose was to support men with prostate cancer. So our extended name is really the European Prostate Cancer Collaboration. Under that name we are known as collaborating, indeed, with a number of professional societies in the first place. Second, we have our big sponsors that are the European School of Oncology, the European Association of Urology, the Oncology Centre, Antwerp, and newly the ECPC, the European Cancer Patient Coalition.
One of the reasons is that prostate cancer covers about three million people in Europe. We are now composed of a consortium of about 23 countries but we don’t have enough human resources to cover it all as much as we really would like to do. So we are going to work together because, in my opinion, we have two definite divisions in what they call nowadays personalised treatment. The first one is that I would like to see personalised, as individualised, medical treatment, the scientific part, and personalised holistic treatment as the social part.
The scientific part goes with evidence-based medicine, multidisciplinary certainly, and following strict rules to improve the patients on a scientific basis. On the other hand, medicine is not a complete science, medicine is also an art and that’s the social aspect of the disease. An individual, for me, is a mountain of flesh with DNA and genes and whatever but if you are a person you belong to society, you are a person in a society with your family, with your system. National health systems are very, very different in Europe and so there the treatment we see as multi-professional. We think that for every major physic factor there is always, on the other hand, a psychotherapeutic problem.
It’s not because you don’t express it, like most men don’t, that you don’t have it. Cancer is always an annoying disease but it’s also for the family a fact that it costs money, it’s a financial problem. That you are somewhat rejected with a stigma, it’s a social problem.
So the purpose for us or the members from Europa Donna is not so much the extension of life, because at this moment the peak of prostate cancer in Europe is 75 years and the death peak is 85, it’s very difficult to do better already at the moment. So all of our guys claim they want quality of life, that’s one of their most important requests. So for that sake we feel that patients should be observing and having some representation with official medicine. But when it comes to the personalised care then we should play an important role because it’s not a question. You could say it easily by we say the patient comes first and then his cancer – you treat the patient first.
We are very lucky in prostate cancer, about twenty years ago we could prove that 50% of the newly diagnosed cancers do not need immediate treatment. It took a lot of time to convince a Belgian when he heard the word cancer that he doesn’t need treatment but nowadays people know more about cancer and understand the biology of cancer. They understand, first of all, that we have cancer all the time and that we ourselves cure it. I must say that’s the usual way that cancer is treated – by your own immunological system. The second thing is that when you age up and you have these specific cancers like prostate cancer that are annoyable, a chronic disease, but it takes at least fifteen years to die. If you are treated well then it’s very difficult to die from prostate cancer. The death rate in our ERSPC, the European randomised screening trial, is 2.5% after fifteen years in 168,000 people. It’s always a bet but it’s a good bet. On the other hand, outside in some countries it’s still 16% so there is a lot of work to be done in Eastern Europe, for instance, essentially Eastern Europe. Here in Western Europe, the Nordic countries, it goes.
What are some of the policies on screening?
ERSPC is a screening programme and we started in Antwerp in 1991 with some protocols first to see if it worked. Afterwards it caught on, we got eight countries to participate – Finland, Sweden, the Netherlands, France and Spain and Switzerland. I must say we had our problems because screening for a population always brings over-treatment. It took us fifteen years to discover really that we were over-treating the people. We cured these cancers that were not cancers. So when that came on us at least we had the courage to say that this was the truth.
So we went forward by following this as some type of treatment; it’s now accepted as a treatment.
The great glory came when we had a thirteen year follow-up with a 20% diminution of the mortality and that was published in the big American journal, The New England Journal of Medicine, next to the big American study, PLCO. I don’t remember how many patients they had but anyway the American study was negative and so they decided that the European study never could be better. So they gave the two studies a negative figure, D, that means that in the United States since 2012 they were not allowed to use PSA as a screening method, it was advised against. Now, four years later, alleluia, we are kind of modestly pleased the big United States Preventive Sciences Association confessed that they were wrong, that they think our studies were excellent and that the American study was flawed.
So now it’s a C, which means that everybody again can have the advice to have prostate cancer early detected if he is well informed by the doctor. It’s kind of important because, no matter what I said this morning, prostate cancer does not have symptoms. If you don’t go for it, you’ll never find it. Then the problem is most of the time it’s too late, like in the old days before. So now we are, at this moment in time, checking for the best way to do it by finding as many tumours as necessary to be operated – about 20% - and the others that we can leave in peace. So this is what I call the stratification of the patients.
That’s the most important but, of course, you understand stratifying at 70 is very easy but at 55 if you have to tell the guy that he has a very small cancer and that his chance of having a little cancer is less than 1% still [?? 10:46]. Usually the women insist that he gets his surgery done. The problem is the surgery gives all kinds of complications. So at this time we are living in a new system but at least it’s controlled and so we will get better. But, like I said, improving on 2.4% mortality is almost impossible and we go for quality of life.