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First look at early detection prostate cancer draft guidelines
Currently out for consultation, the new guidelines reflect significant changes to the screening process.
The question of testing remains a nuanced, individual clinical discussion.
Draft clinical guidelines for the early detection of prostate cancer are now out, outlining updated testing recommendations that target high-risk groups.
The guidelines have been released for feedback by the Prostate Cancer Foundation of Australia (PCFA) and include significant input from GP experts.
Designed for health professionals including GPs and urologists, they will replace the 2016 Clinical Guidelines for prostate-specific antigen (PSA) Testing.
Key changes in the proposed guidelines include:
- A ‘strong recommendation’ for GPs to initiate conversations about PSA testing and potential benefits and harms, and offer testing every two years to all males aged 50–69
- Advice to offer males not at a higher risk or from a priority population ‘who are interested in their prostate health’ an initial PSA test from age 40
- A recommendation to test males aged over 70 based on clinical assessment, including life expectancy
- A recommendation for earlier testing for males at higher risk, including those with a family history, those of sub-Saharan ancestry
- A recommendation for testing Aboriginal and Torres Strait Islander males, starting at age 40 in recognition of their ‘significantly’ higher mortality risk
- Reinforcement that digital rectal examinations are no longer recommended as screening tests in asymptomatic males in primary care
- For males requiring further investigation on the basis of their PSA, an multiparametric MRI (mpMRI) is recommended as the next diagnostic test to determine if a biopsy is needed
Some of these changes are already common clinical practice.
The guidelines define higher risk as those at ‘high risk of clinically significant prostate cancer or prostate cancer mortality rather than any prostate cancer’.
Fremantle-based GP Dr Brett Montgomery is the RACGP representative on the steering committee for the guidelines, as well as sitting on the expert advisory panel.
‘In terms of the role of MRI, biopsies, new evidence, and more use of active surveillance of males diagnosed with cancer, I think everyone agrees it was time for an update,’ he told
newsGP.
‘Compared to the time of the last guidelines, there is less risk of people being harmed by prostate cancer screening.
‘There’s more clarity in these guidelines on how to discuss risks and benefits at different age ranges, and how to interpret PSA results.’
Dr Montgomery says the question of testing remains a nuanced, individual clinical discussion.
‘Different people will have different values about the trade-offs between benefits and risks, and it often takes a long time for the benefits of prostate screening to become evident,’ he said.
‘It is still a topic that deserves careful discussion about pros and cons and reaching a shared decision with our patients.’
An update to the RACGP patient information sheet, ‘Should I have prostate cancer screening?’ is also currently underway, which will reflect updated guidance in the RACGP’s Red Book for preventive activities in general practice. It is due to be published later this year.
Dr Montgomery also drew attention to the clinical decision-making flowcharts now included in the new guidelines.
‘It starts with figuring out what sort of risk category your patient is in,’ he said. ‘They’re really good, at-a-glance flowcharts which I think will work well for busy GPs.’
He urged GPs to read the draft guidelines and submit their feedback.
‘An update is welcome and it’s good the RACGP and GPs were able to be a part of developing these guidelines,’ he said.
‘I absolutely would encourage GPs to have a look and submit any comments as we work our way through this period of public consultation.’
While mortality rates for prostate cancer have dropped in Australia –
estimated at around 33 deaths per 100,000 males per year by the Australian Institute of Health and Welfare in 2024 – the number is increasing due to an expanding and ageing population.
Anne Savage, PCFA chief executive, said information gleaned from the consultation would inform the final draft, which is expected to go to the National Health and Medical Research Council for approval later this year.
‘Every voice matters — from general practitioners to patients, partners, family members and carers,’ she said.
The guidelines are
open for consultation until 25 May.
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