This week, Dr Tom Shannon discussed the latest PSA testing guidelines with us. He also covered digital rectal examination and MRI Prostate. Dr Shannon is a Urologist working in The Prostate Clinic in Nedlands and Midland. Dr Shannon completed specialty training in WA with post fellowship training in the UK and US. His areas of special interest include Prostate cancer, MRI Prostate, Robotic Surgery, Greenlight laser TURP and Laparoscopic Urology and vasectomy.
PSA Testing Consensus Now Exists
Prostate cancer represents a significant health burden for men, both in years of life lost, and years of health. It is more common and more deadly than breast cancer in Australia.
In Jan 2016 the long awaited Australian guidelines for the management of localised prostate cancer were released. These have been endorsed by the Cancer Council, NH&MRC, PCFA, Andrology Australia, Urological Society, College of Pathologists and importantly the RACGP.
The guidelines now make it much simpler to manage PSA testing in general practice by removing confusion for doctors. The evidence-based guidelines were created over a 3 year period by a multidisciplinary group and represent and up to date approach of the current evidence.
The guidelines give recommendations for men based on risk and age;
50 – 69 years old – test men of average risk every 2 yrs
For men 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, offer PSA testing every 2 years from age 50 to age 69, and offer further investigation if total PSA is greater than 3.0 ng/ml
Less than 50 years old and concerned – Start at 45
For men younger than 50 years who are concerned about their risk for prostate cancer, have been informed of the benefits and harms of testing, and who wish to undergo regular testing for prostate cancer, offer testing every 2 years from age 45 to age 69 years
Higher Risk – start at 45
For men whose risk of prostate cancer is estimated to be at least 2.5–3 times higher than average due to the presence of risk factors (e.g. a brother diagnosed with prostate cancer, particularly if younger than 60 years at diagnosis), and who decide to undergo testing after being informed of the benefits and harms, offer testing every 2 years from age 45–69 years.
Much Higher Risk – start at 40
For men whose risk of prostate cancer is estimated to be at least 9–10 times higher than average due to the presence of risk factors (e.g. father and two brothers diagnosed with prostate cancer), and who decide to undergo testing after being informed of the benefits and harms, offer testing every 2 years from age 40–69 years.
Older Men – Stop when less than 7 yrs life expectancy
Since any mortality benefit from early diagnosis of prostate cancer due to PSA testing is not seen within less than 6–7 years from testing, PSA testing is not recommended for men who are unlikely to live another 7 years.
In asymptomatic men interested in undergoing testing for early diagnosis of prostate cancer, digital rectal examination is not recommended as a routine addition to PSA testing in the primary care setting
MRI – Don’t use it in general practice
Multiparametric MRI should be used only in centres with experienced radiologists appropriately trained in the use of multiparametric MRI to aid urologists in the management of individual patients The recommendations for multiparametric MRI apply only to its use in patients who have already undergone biopsy. Primary healthcare professionals should not order multiparametric MRI in the initial investigation of suspected prostate cancer in men with raised PSA levels.
For a more detailed discussion of these guidelines, please visit Dr Shannon’s Facebook page at www.facebook.com/theprostateclinicperth or website. Referring doctors are free to contact the clinic directly or email Dr Shannon with queries at firstname.lastname@example.org for timely advice.
We would like to thank Dr Shannon for taking the time to put together this very useful summary article. Users are welcome to leave comments below.