PhD defence R. (Renée) Hogenhout

Below is a brief summary about the dissertation:

Two decades of research have learned us that PSA-based screening reduces metastatic disease stages and prostate cancer-specific mortality, but also results in a significant amount of overdiagnosis and subsequent overtreatment. Many tools that break the link between PSA and immediate prostate biopsy have been developed to reduce this overdiagnosis and further improve the quality of life of screened men. The most important ones are prediction models (i.e. risk calculators) and prostate MRI. These tools can be deployed in a variety of ways. The most suitable strategy will differ per country depending on issues like disease incidence, life expectancy, resource availability, and healthcare systems. Within the Dutch healthcare system, risk stratification in a primary healthcare setting can reduce many unnecessary referrals to the secondary healthcare setting which might fit within a possible future organised early prostate cancer detection programme. Subsequent biopsy procedures needed can be best performed via the transperineal route instead of the transrectal route to reduce infectious complications and antibiotic consumption. Once being diagnosed with prostate cancer, it is important to remain critical in whom to treat as patients to avoid overtreatment, especially in the current MRI-era in which improved prostate sampling induces a risk-inflation. Guidelines can assist in such treatment decisions. By clear, structured presentation, or integration of these guidelines into the electronic health record, their adaptation might be accelerated possibly resulting in a further reduction in overtreatment.