PSA testing guideline approved by NHMRC

Australian clinical practice guidelines on PSA testing and early management of test-detected prostate cancer have been agreed by the National Health and Medical Research Council.

 

In partnership with Cancer Council Australia and a multi-disciplinary expert advisory panel comprising urologists, medical oncologists, radiation oncologists, pathologists, general practitioners, epidemiologists, allied health professionals and consumers, Prostate Cancer Foundation of Australia has developed national evidence-based clinical practice guidelines on PSA testing and early management of test-detected prostate cancer.

 

The guidelines were developed to resolve the controversy surrounding PSA testing for both men and their doctors.

 

The guidelines don't recommend a population screening program for prostate cancer (a program that offers testing to all men of a certain age group) as evidence does not support such a program.

 

For men who decide to be tested it contains guidance on matters such as what age to start testing; how frequently to be tested; when to stop testing; the PSA level which should prompt further investigation; family history; and the role of the digital rectal examination.

 

The main recommendations in the guidelines are:

  • Men who are considering having a PSA test should be offered evidence-based decision support, including the opportunity to discuss the benefits and harms of PSA testing, before making the decision to be tested.

  • Men who are at average risk of prostate cancer who have been informed of the benefits and harms of testing, and who decide to undergo regular testing for prostate cancer, should be offered PSA testing every 2 years from age 50 to 69. Further investigation should be offered if the total PSA concentration is greater than 3ng/mL.

  • Men aged 70 years or older who have been informed of the benefits and harms of testing, and who wish to start or continue regular testing, should be advised that the harms of testing may be greater than the benefits for men of their age.

  • Men who have a father or one brother who has been diagnosed with prostate cancer have 2.5 to 3 times higher than average risk of developing the disease. Such men who have been informed of the benefits and harms of testing, and who decide to undergo regular testing for prostate cancer, should be offered PSA testing every 2 years from age 45 to 69.

  • Men who have 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. Such men who have been informed of the benefits and harms of testing, and who decide to undergo regular testing for prostate cancer, should be offered PSA testing every 2 years from age 40 to 69.

  • Digital rectal examination is not recommended as a routine addition to PSA testing in the primary care setting. Note, however, that on referral to a urologist or other specialist, digital rectal examination remains an important assessment procedure prior to biopsy.

  • Since any mortality benefit from early diagnosis of prostate cancer due to PSA testing is not seen within less than 6 to 7 years from testing, PSA testing is not recommended for men who are unlikely to live another 7 years.

Other recommendations contained in the guideline cover further investigations if the PSA concentration is above 3ng/mL; prostate biopsy and multiparametric MRI; active surveillance; and watchful waiting. The full text of the guideline can be found at www.pcfa.org.au/psa-testing-guidelines.

 

20 January 2016.