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New prostate cancer clinical guidelines launched

New prostate cancer clinical guidelines launched - Featured Image

Australian health professionals will now have access to evidence-based recommendations for using the prostate specific antigen (PSA) blood test to assess prostate cancer risk in patients.

The PSA Testing and Early Management of Test-detected Prostate Cancer: Guidelines for health professionals were developed in partnership with the Prostate Cancer Foundation of Australia (PCFA) and Cancer Council Australia and have now been approved by the National Health and Medical Research Council (NHMRC).

PCFA Chief Executive Officer, Associate Professor Anthony Lowe said contention about the PSA test has made it difficult for health professionals to take a consistent, evidence based approach to the test.

“The guidelines cut through the contention and provide guidance in relation to an individual man’s circumstances and on how to manage a patient if he requests and consents to taking the test,” he said.

Related: MJA – Risk assessment to guide prostate cancer screening decisions: a cost-effectiveness analysis

The recommendations include:

  • Men considering a PSA should be given information about the benefits and harms of testing.
  • Men with an average risk who have decided to undergo regular testing after being informed of the benefits and harms should be offered PSA testing every 2 years from age 50-69. If the total PSA concentration is greater than 3ng/mL then further investigation should be offered.
  • Men over 70 who have been informed of the benefits and harms of testing and who wish to start or continue regular testing should be informed that the harms of PSA testing may be greater than the benefits of testing in their age group.
  • Men with a father or one brother who has been diagnosed with prostate cancer has 2.5 – 3 times higher than average risk of developing the disease. If these men have decided to undergo regular testing after being informed of the benefits and harms, they should be offered PSA testing every 2 years from age 45 to 69.
  • Men with a father and two or more brothers who have been diagnosed with prostate cancer have at least 9 to 10 times higher than average risk of developing the disease. If these men have decided to undergo regular testing after being informed of the benefits and harms, they should be offered PSA testing every 2 years from age 40 to 69.
  • In a primary care setting, digital rectal examination is not recommended for asymptomatic men in addition to PSA testing however this may be an important assessment procedure if referred to a urologist or other specialist for further investigation.
  • Mortality benefit due to an early diagnosis of prostate cancer due to PSA testing isn’t seen within less than 6-7 years of testing so PSA testing isn’t recommended for men who are unlikely to live another 7 years (subject to health status).
  • A PSA testing decision aid for men and their doctors is under development by PCFA and Cancer Council Australia.

Other recommendations also include further investigations if the PSA concentration is above 3 ng/mL; prostate biopsy and multiparametric MRI; active surveillance and watchful waiting.

Related: MJA – Can magnetic resonance imaging solve the prostate cancer conundrum?

The report says there is no evidence to support a national PSA screening program to all men of a certain age group.

Cancer Council Australia CEO, Professor Sanchia Aranda says use of the guidelines will hopefully reduce the level of over-treatment.

“The NHMRC’s Information Document for health professionals, recommended as a companion document to the guidelines, estimates that for every 1000 men aged 60 with no first degree relatives affected by prostate cancer who take the test annually for ten years, two will avoid a prostate cancer death before the age of 85 as a result. Yet 87 men will receive a false-positive PSA test result and have an invasive biopsy that they didn’t require –28 will experience side-effects, including impotence and incontinence, as a result of this biopsy, and one will require hospitalisation.”

PSA Testing and Early Management of Test-detected Prostate Cancer: A guideline for health professionals is available for download at www.pcfa.org.au and wiki.cancer.org.au/PSAguidelines.

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