20 January 2016
For the first time, health professionals have access to evidence-based recommendations for using the prostate specific antigen (PSA) blood test to assess prostate cancer risk and manage test-detected patients, following the publication today (20/01) of new clinical practice guidelines.
The guidelines, PSA Testing and Early Management of Test-detected Prostate Cancer: Guidelines for health professionals, were launched in draft form for consultation more than a year ago. The recommendations have now been approved by the National Health and Medical Research Council (NHMRC).
Developed through a partnership of the Prostate Cancer Foundation of Australia (PCFA) and Cancer Council Australia, the guidelines provide evidence-based recommendations to health professionals involved in localised prostate cancer risk assessment, surveillance and treatment. The recommendations also cover matters such as retesting, active surveillance, watchful waiting and biopsy.
PCFA and Cancer Council Australia said the guidelines aimed to help healthcare professionals navigate the daily professional dilemma of informing men about the risks and benefits of testing, and prevent scenarios where PSA tests are conducted without patient consent.
PCFA Chief Executive Officer, Associate Professor Anthony Lowe, said while the PSA test was not suited for population screening, it remained in widespread use, so there was a need for evidence-based guidelines to maximise the benefits of the test and minimise the harms.
"Contention about the PSA test has made it difficult for health professionals to take a consistent, evidence-based approach to the test," A/Professor Lowe said.
"While the debate has played out, thousands of men have continued to take the test, as it's the only available biomarker to assist doctors in assessing a man's prostate cancer risk.
"The guidelines cut through the contention and provide guidance in relation to an individual man's circumstances and on how to manage a patient if he requests and consents to taking the test.
"The recommendations were developed following a systematic review of the evidence and consensus on its interpretation by a leading team of epidemiologists, urologists, GPs, radiation oncologists, medical oncologists, allied health professionals and consumers."
Cancer Council Australia CEO, Professor Sanchia Aranda, said NHMRC approval was the gold standard in Australia and reflected the rigour applied to the guidelines' development. She said application of the guidelines should result in less over-treatment associated with PSA testing.
"The PSA test is an imprecise test and has potential harms as well as benefits,” Professor Aranda said. "The NHMRC’s Information Document for health professionals, recommended as a companion document to the guidelines, estimates that for every 1000 men aged 60 with no first degree relatives affected by prostate cancer who take the test annually for ten years, two will avoid a prostate cancer death before the age of 85 as a result. Yet 87 men will receive a false-positive PSA test result and have an invasive biopsy that they didn’t require –28 will experience side-effects, including impotence and incontinence, as a result of this biopsy, and one will require hospitalisation.
"Use of the guidelines will hopefully reduce the level of over-treatment and guide improved management of men with early-stage prostate cancer – until we have a better biomarker. With prostate cancer causing the second most cancer deaths in Australian men after lung cancer, and the numbers of death increasing with population ageing, we urgently need more sophisticated risk assessment and early-detection technology."
PCFA and Cancer Council Australia are currently working together to develop a separate decision aid aimed at assisting GPs and individual men discuss on whether the test may be beneficial to them.
PSA Testing and Early Management of Test-detected Prostate Cancer: A guideline for health professionals is recommended for use by all professionals involved in PSA testing and early-stage prostate cancer surveillance, treatment and care. It is available for download at www.pcfa.org.au and wiki.cancer.org.au/PSAguidelines