PhD defence S. (Sebastiaan) Remmers

Brief summary of the doctoral thesis:

Prostate cancer is one of the most frequently diagnosed cancers. A randomized controlled trial showed that early detection by using a blood test (i.e., PSA-based screening) decreases disease-specific mortality. In the thesis, we have shown that - as a consequence of early detection - men are on average one year earlier a prostate cancer patient compared to those who did not receive the screening test. However, once men are diagnosed, they live longer without experiencing progression. This demonstrates that PSA-based screening is able to reduce the burden of the disease.

In addition, we have shown that there is a multitude of tools available for the detection of prostate cancer in the diagnostic pathway. Referral for prostate biopsies can be based on a single PSA test, but also be based on so-called multivariable prediction models. These multivariable prediction models combine multiple relevant clinical factors into an individualized probabilitity. We have shown that not all models should be used in a setting where the model has not been developed. In addition, we have shown that developments in pathological grading system contribute to an improvement of diagnostic and prognostic risk prediction.