Policy context

Prostate Cancer Early Detection Policy

There is currently no organised, population-based screening program for prostate cancer in Australia or anywhere in the world, with the exception of Lithuania. However, individual testing occurs in large numbers, as shown by rates of prostate specific antigen (PSA) testing.^[1] In 2014, 1.3 million men received a Medicare-subsidised PSA test, with an average of 1.2 PSA tests received per patient.^[1] This is not much lower than annual breast and cervical cancer screening rates among target populations.

The risk and benefits of screening asymptomatic men with the PSA test with the aim of detecting prostate cancer early continues to be widely debated.

The joint position of Cancer Council Australia and the Australian Health Ministers’ Advisory Council is that the harm of screening men for prostate cancer with the PSA test on a population basis outweighs the benefit. The Clinical Practice Guidelines: PSA testing and early management of test-detected prostate cancer recommends men considering being tested for prostate cancer with a PSA test make an individual decision after being fully informed about benefits and harms of testing and treatment.^[2] These guidelines have also been endorsed by Royal Australian College of General Practitioners, Urological Society of Australia and New Zealand and Royal College of Pathologists of Australasia. Andrology Australia, the peak body for male reproductive health and associated chronic diseases, also supports informed individual choice instead of population-based screening.^[3]

International recommendations

International guidelines recommend that men make an informed decision about undergoing PSA testing. The American Cancer Society, American Urological Association and US Preventive Services Task Force all recommend men considering a PSA test make an individual decision after being informed of the risks and benefits by their doctor.^[4][5][6] Similarly, the Canadian Urological Association and Canadian Task Force on Preventive Health Care recommend shared decision-making after benefits and harms have been discussed.^[7][8]

The European Association of Urology recommends a baseline serum PSA level should be obtained in men aged 40-45 years and testing interval be individualised based on baseline PSA level.^[9]

References

Australian Institute of Health and Welfare 2017. Cancer in Australia 2017. Canberra: Australian Institute of Health and Welfare; 2017 [cited 2021]. Report No.: CAN 100. Available from: https://www.aihw.gov.au/getmedia/3da1f3c2-30f0-4475-8aed-1f19f8e16d48/20066-cancer-2017.pdf.aspx?inline=true.
Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer. [homepage on the internet] Sydney: Cancer Council Australia; 2015 [cited 2021]. Available from: https://www.cancer.org.au/clinical-guidelines/prostate-cancer/psa-testing.
Andrology Australia. Andrology Australia statement on PSA testing for prostate cancer. Melbourne: Andrology Australia; 2015 Jul Available from: https://www.andrologyaustralia.org/wp-content/uploads/review-early-detection-of-prostate-cancer.pdf.
American Cancer Society. American Cancer Society Recommendations for Prostate Cancer Early Detection. [homepage on the internet] American Cancer Society; 2016 [cited 2021]. Available from: https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html.
American Urological Association. Early Detection of Prostate Cancer 2018. [homepage on the internet] American Urological Association; 2013 [cited 2021; updated 2015]. Available from: https://www.auanet.org/guidelines/guidelines/prostate-cancer-early-detection-guideline.
Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, Davidson KW, et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2018 May 8;319(18):1901-1913 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29801017.
Rendon RA, Mason RJ, Marzouk K, Finelli A, Saad F, So A, et al. Recommendations of the Canadian Urological Association on the screening and early diagnosis of prostate cancer. Can Urol Assoc J 2017 Oct;11(10):298-309 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29381452.
Canadian Task Force on Preventive Health Care. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ 2014 [cited 2021] Available from: https://www.cmaj.ca/content/cmaj/186/16/1225.full.pdf.
Mottet N, Cornford P, Van den Bergh RCN, Briers E, De Santis M, Fanti S, et al. Guidelines on Prostate Cancer. EAU 2020 [cited 2021] Available from: https://uroweb.org/wp-content/uploads/EAU-EANM-ESTRO-ESUR-SIOG-Guidelines-on-Prostate-Cancer-2020v4.pdf.