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

Prostate cancer screening using the prostate-specific antigen (PSA) test has been available to asymptomatic men in Australia since the late 1980s; however, substantial uncertainty still remains over the net benefit of early detection.

Based on the trial evidence available to date,1 routine PSA screening for asymptomatic men is not recommended in Australia;2 however, access to PSA testing is available and publically subsidised in Australia through the Medicare Benefits Schedule. The Royal Australian College of General Practitioners (RACGP) recommends that general practitioners assist men seeking PSA screening to reach informed decisions by weighing the potential benefits of screening against the inconvenience and harms of biopsies resulting from false-positive PSA test results, as well as the side effects of unnecessary surgery and/or radiotherapy for indolent cancers that currently cannot be reliably distinguished from those of a more aggressive nature.2

While debate continues about the interpretation of existing trial data in decisions about the PSA screening of asymptomatic men in general, there is a recognition that the trade-off between…