PhD defence I.I. (Ivo) de Vos

Below is a brief summary of the dissertation: 

This thesis emphasizes the value of long-term data in the fight against prostate cancer and advocates for personalized, risk-based strategies instead of one-size-fits-all approaches. The >20-year findings from the ERSPC study show that PSA-based screening can significantly reduce prostate cancer mortality and metastasis, but only when it is implemented in a structured, repeated, and age-appropriate manner. Nowadays, screening is often performed opportunistically, leading to overdiagnosis and overtreatment. There is an urgent call for the implementation of organized screening pathways that integrate multivariable risk calculators, biomarkers, and MRI to identify the men most likely to benefit. For active surveillance, the 15-year data from the PRIAS study confirm the safety of this approach for men with low-risk prostate cancer. However, overtreatment remains an issue, often due to unjustified transitions to definitive treatments driven by anxiety, rigid protocols, or changing diagnostics. The study supports two strategies to reduce overtreatment: expanding the inclusion criteria for active surveillance and implementing dynamic, personalized follow-up schedules based on risk models. These approaches not only reduce the burden of surveillance but also improve adherence and patient quality of life.