Update on kidney cancer screening

How can we improve survival from kidney cancer? “In my opinion, we need to treat high-risk localised diseased better with drugs around the time of surgery, and critically, to detect it earlier,” said Prof. Grant Stewart (GB) while presenting results from the Yorkshire Kidney Screening Trial, as well as future research plans. The latter explored the feasibility of adding abdominal non-contrast CT to screen for kidney cancer and other abdominal pathology to the chest CT offered within lung cancer screening.”

His results illustrated that from the 4,019 who accepted the scan, 5.3% of participants were found to have serious findings involving one or more organ systems. Only 18 participants needed to be screened to detect one serious finding, showcasing the efficiency of this programme. Ninety-three to identify a suspicious renal lesion, and 402 to confirm one case of renal cancer histologically. (Stewart G et al. European Urology, May 2025)

According to Prof. Stewart, the next step is to test whether abdomen screening can stage shift disease and/or improve disease specific survival. Starting this week, this will be evaluated in a randomised trial, piloted first in the ‘live’ Lung Cancer Screening Programme – TACTICAL1 (Targeted Abdominal CT in Conjunction with Lung screen). This feasibility study adds a non-contrast abdominal CT scan to the Targeted Lung Health Check thorax CT in high lung cancer risk ever-smokers aged 55-60 years.

Rehabilitating PSA screening in North America

According to Prof. Laurence Klotz (CA), “The US and Canadian national guidelines are a mess”, both being inconsistent, as well as outdated, with conflicting interests between methodologists and clinicians. In his lecture, he shared details of his work with the ‘Canadian Coalition for Responsible Health Care Guidelines’, a group formed in 2022 to improve guidelines in Canada.

As a result, the Canadian Task Force responsible for writing the guidelines was ‘paused’ by the Ministry of Health this year, with plans to move towards a more agile ‘living guidelines’ approach. Prof. Klotz stressed the importance of involving colleagues from other specialities to ensure expert representation on guidelines panels.

In his opinion, future PCa screening considerations include how to use PSA optimally – specifically, what upper threshold should prompt further testing and what lower threshold to stop testing, including intervals. He recommends a national screening programme for men at risk, restricting testing to only men who will benefit. The outcome will result in less overdiagnosis and morbidity from treatment, as well as fewer biopsies and missed significant cancers.

Whole body-MRI screening for healthy people: A tool for the future?

“Without the right clinical question, even the best technology is useless,” stated Prof. Konrad Stock (DE) as he opened the discussion on the innovative use of whole body MRI (WB-MRI) as a screening tool in healthy people. He emphasised that different cancer types need different strategies for effective detection.

Prof. Giuseppe Petralia (IT) presented on the pros and cons of using WB-MRI as a cancer screening tool in healthy individuals, detailing both its clinical effectiveness and the ethical considerations. He cited findings from his paper on “Oncology relevant findings reporting and data systems (ONCO-RAD): Guidelines for the acquisition, interpretation, and reporting of whole-body MRI for cancer screening.

According to Prof. Petralia, there is no evidence of its cost-effectiveness, raising questions about who pays for it, and who ultimately benefits – such as high-risk groups for cancers that do not currently have screening programmes (e.g., urinary bladder, kidney, pancreas, liver, non-Hodgkin Lymphoma [NHL]).

“The survival benefit of WB-MRI has not yet been measured, but its use is increasing. Studies report up to 99% abnormal findings, with cancer detected in 1-2% of cases. The main challenge is to minimise harm and avoid over-investigation for the majority, while ensuring optimal management for those with confirmed cancer through expert, multi-organ evaluations”.

Prof. Petralia also elaborated on ethical concerns, particularly around the growing direct-to-consumer WB-MRI market, which bypass traditional physician gatekeeping. Their marketing often emphasises potential benefits and minimises limitations. “It is an unregulated industry with no centralised registry or data on companies operating in this space.” He also stated that there are concerns around a truly informed consent from patients.

You can watch the full presentation at the EMUC25 Resource Centre

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The experts gave their view on the continued use of PSA as a screening tool and the current state (and future potential) of imaging or biomarker-based alternatives.

The 11th edition of the European Multidisciplinary Meeting on Urological Cancers is taking place in Vienna on 15-17 November. It was preceded by the 8th Meeting of the EAU Section of Urological Imaging and other supplementary meetings on the 14th. EMUC19 is a collaboration of the European Society for Medical Oncology (ESMO), the European Society for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU).

A case for timely detection

Prof. Chris Bangma (Rotterdam, NL), urologist, co-chaired the session on early detection and the 40 years of PSA. He suggested that the audience use the coffee break after the session to celebrate the milestone. Its discovery in 1979 had a huge impact on the medical profession, patients and governments alike.

As an illustration of how far we’ve come (and perhaps as a warning if PSA testing is recklessly abandoned) Prof. Roobol (Rotterdam, NL) painted a picture of prostate cancer diagnosis and treatment in the 1970s and 80s. Patients were diagnosed at a point where the cancer had spread to bones and only one in 2-3 patients survived. Following a huge rise in PSA testing in the early 2000s, there followed a reflective period and fear of overdiagnosis. “But stopping PSA testing is not the way to go,” warned Roobol, fearing a return to mortality levels of the 1980s.

“We have to preserve the achievements of recent decades and work on preventing the excesses. In two words: Risk Assessment.” Roobol proposed an approach for 2019 and beyond that started with baseline PSA, then risk stratification, imaging, further risk stratification, biopsy, and then treatment  (including active surveillance) if required.

Earlier in the session, Prof. Hein Van Poppel lamented the recent decline in PSA screening and the associated increase in mortality in several Western European countries. “This could be prevented with early detection and appropriate treatment.” Van Poppel warned the audience for what he termed “anti-PSA propaganda” and the discouragement of PSA use. He concluded that effective use of supplementary tools and technologies like new biomarkers and MRI can avoid overdiagnosis and overtreatment.

Crucially, Van Poppel argued that Europe’s adult male population “needs to be informed” directly, thereby increasing awareness of PSA testing and the importance of early detection. The EAU is also working in a wider coalition of experts and patient organisations to lobby the European Commission to recommend population-based screening and hopefully change national guidelines. This is part of a longer strategy that was outlined at the EAU’s National Societies Meeting earlier this year and further detailed in an opinion piece on behalf of the EAU.

Van Poppel also hailed EMUC as a major achievement, a real multidisciplinary meeting that reflected the reality that urinary cancers no longer belong to a single specialty.

A voice to be heard

The morning’s session progressed to include the current state and (near-)future potential of various early detection options including MRI (specifically PI-RADS), the grading system used by pathologists, and biomarkers and genomics. A lot of discussions took place in between the talks, covering topics like certification for hypothetical prostate imaging centres, and the role of artificial intelligence in risk stratification.

One discussion focused on the needs of patients and their experiences with their GPs: Dr. Erik Briers (Hasselt, BE) who was in the audience and identified himself as a prostate cancer patient mentioned the “own way of thinking” that general practitioners had when it came to their patients and prostate cancer.

“They feel that they have to protect men from overdiagnosis and overtreatment. But actually, men want to know about their prostate cancer when it is still curable. It might help to adjust the training of GPs, they have to learn that urologists and other disciplines are not out to take our prostates. They want to help us in the best possible way, and our doctors should not be afraid to refer us to a specialist.”

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