New prostate cancer guidelines endorsed by RACGP
Evidence-based guidelines launched earlier this year for using the prostate specific antigen (PSA) blood test to assess prostate cancer risk in patients have been endorsed by the Royal Australian College of General Practitioners.
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 were approved by the National Health and Medical Research Council (NHMRC).
The guidelines align with the RACGP view that using either the PSA test or a digital rectal examination is unreliable and not recommended.
According to RACGP President Dr Frank R Jones: “The best way to approach prostate health is for the patient to discuss his concerns with his general practitioner who after careful deliberation, will determine the need for testing or not. In the vast majority of cases it is unnecessary.”
Evidence has found the harm of a false positive outweighs the possible benefit. For every 1000 men aged 55-65 who had an annual PSA screening test, 87 will find out through an invasive biopsy that they have received a false positive. 4 of the 1000 men screened will eventually die of prostate cancer and only one man will be saved through PSA testing.
The new guidelines 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.