Prostate cancer screening

We are fortunate in Australia to have effective screening programmes for breast cancer (mammogram every two years from age 50-74 years), cervical cancer (cervical screening test aged 25-74 years) and bowel cancer (stool tests every 1-2 years from age 50-74). These programmes are effective because they can detect cancers early, and if these cancers are found early, they can be cured in many cases. Furthermore, the screening processes are relatively simple, and if the screening test is positive, the next step to confirm or exclude a diagnosis is also relatively simple and has a low rate of complications.

This is not the situation with prostate cancer.

Recently the Royal Australian College of General Practitioners (RACGP) and the Urological Society of Australia and New Zealand (USANZ) declared that there is no evidence to support mass screening of men who have an average risk of prostate cancer. The available “screening” tests include the prostate specific antigen blood test (PSA), and the digital rectal examination (DRE).

The PSA has a high rate of false positive results (where the test is positive in a man without cancer), as well as a significant rate of false negative results (where the test is negative in a man with cancer). The DRE will often not detect a significant cancer, and so can give false reassurance. If a “screening test” is positive, the next step to confirm or exclude a cancer is a prostate biopsy. This is associated with significant complications such as pain or infection (recent advances in MRI may lead to safer tests in this situation).

Some men might like to consider screening with PSA after a discussion about the potential benefits and harms (note that DRE is no longer considered a useful screening test). In this case, the RACGP and the USANZ recommend a PSA test every two years for men from the age of 50 to 69 years, with further investigations if the PSA is elevated. The guidelines indicate that for men aged 70 or older, starting or continuing screening may result in more harm than benefit.

Remember, these guidelines apply to men with average risk of cancer. If your risk is above average (for example if a close relative has prostate cancer), then discuss screening with your GP. If you have symptoms related to your bladder, discuss this with your GP. Most common bladder symptoms are not indicators of prostate cancer, but still must be fully assessed.

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About the author

Dr David King MBBS
Dr King graduated from Sydney University and has been a well regarded General Practitioner on the Central Coast for over 35 years.. He recently joined the team at Your Family Doctors at Erina. Medical interests include chronic disease management, mental health and minor skin surgery.

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