Medical Forum
New prostate cancer screening guidelines are here
New guidelines for prostate cancer testing are here, with men under 50 and over 70 now recommended to have routine testing through their GP.
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Medical Forum
Prostate specific antigen (PSA) testing should now be offered to men aged 45-49, to be repeated within a couple of months if the results are considered high.
While standard PSA testing is recommended every two years for those aged 50-69 and where appropriate for those aged 70 and above. Previously guidelines excluded those over 70.
It is hoped that lowering the screening age may help detect prostate cancer earlier in those considered at high risk of the disease.
Prostate cancer is Australia’s most commonly diagnosed cancer with around 29,000 men expected to be diagnosed this year. Some 4000 are expected to die from the disease.
The guidelines, put together by the Prostate Cancer Foundation of Australia (PCFA) to replace the 2016 guidelines, put a greater emphasis on shared decision making and risk assessment to detect clinically significant prostate cancer earlier while reducing unnecessary tests and treatment.
PCFA said the guidelines position Australia among the world's first countries to transition from an informal model of discretionary testing to a planned, evidence-based approach to opportunistic early detection.
The new guidelines confirm the importance of GPs initiating discussions about prostate cancer and PSA testing with patients, rather than the onus being on patients.
They state that informed discussion of the possible benefits and harms of PSA testing with shared decision making and patient choice is key to good clinical practice.
New screening age recommendations for prostate cancer. Source: PCFA
Updated recommendations across every stage of early detection form part of the guidelines, including risk assessment, PSA testing, use of multiparametric MRI before biopsy, active surveillance and care for priority populations.
They also strengthen recommendations for men with significant family history, inherited genetic risk and other groups at increased risk of developing clinically significant prostate cancer.
Adjunct Professor Peter Heathcote, chair of the guideline expert advisory panel, said modern prostate cancer diagnosis is no longer based on PSA blood tests alone.
“Today's diagnostic pathway incorporates individual risk assessment, shared decision-making, multiparametric MRI before biopsy, targeted biopsy techniques, and active surveillance for men with low-risk disease,” he said.
“These advances allow clinicians to identify clinically significant cancers more accurately while reducing unnecessary biopsies, significantly reducing risks of overtreatment, and ensuring we protect men’s quality of life while managing individual risks.”
Prior to the release of these guidelines, the RACGP raised concerns about a suggestion for Aboriginal and Torres Strait Islander men to be screened from the age of 40, warning of the risks of overdiagnosis and harm to this group.
This concern was addressed and the guidelines now outline that PSA testing recommendations for Aboriginal and Torres Strait Islander men are the same as for the general population.
PCFA chief executive Anne Savage said the next step was ensuring the guidelines were put into clinical practice.
“Evidence only saves lives when it reaches the men who need it. Australian men need to understand their individual risk, know when to have the conversation with their GP, and be supported by clinicians with access to the latest evidence,” she said.
“These guidelines provide Australia with an extraordinary opportunity to reduce deaths from our most commonly diagnosed cancer. Realising that opportunity will require coordinated implementation, clinician education, consumer awareness, and ongoing investment in evidence-based care."