News

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RACGP endorses updated prostate cancer guideline

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An updated guideline for detecting prostate cancer early has included expanded detail on people at higher risk of ‘clinically significant’ cancer, while encouraging ‘active surveillance’ rather than intervention for those at lower risk.
 
The guideline, developed by the Prostate Cancer Foundation of Australia, and endorsed by both the RACGP and the National Health and Medical Research Council, includes the following groups as at higher risk, defined as ‘at least double’ the risk for the overall Australian male population:
 

• Males over 45 with a significant family history of prostate cancer
• Black males over 45 of sub-Saharan African ancestry
• Males over 45 with a confirmed BRCA2 gene mutation

 
Fremantle-based GP Dr Brett Montgomery was the RACGP representative on the steering committee for the guidelines and sat on the expert advisory panel and some topic working groups, including for the prostate specific antigen (PSA) test.
 
‘A lot has changed in the pathway of detecting prostate cancer early and we need a guideline that reflects that,’ he told newsGP
 
‘The first step remains the PSA test, which has its problems.
 
‘It’s not a perfectly specific or sensitive test but what follows downstream from a high PSA has changed over the last decade or so. We still double check the PSA by repeating a high test after one to three months and if it’s persistently high, the next recommended step is a referral to a urologist.’
 
He said the previous recommendation of a biopsy of the prostate gland has now been superseded by an MRI scan to help show whether significant prostate cancer is likely.
 
‘By doing that a lot of men can be spared biopsies that aren’t really necessary,’ he said.
 
The guideline now also states that ‘active surveillance’ is the preferred way of managing men who have been diagnosed with low or very low-risk prostate cancer – an approach Dr Montgomery says is already standard clinical practice among most urologists.
 
The new advice suggests more than 80% of men in this category opt for regular monitoring instead of immediate treatment, ‘helping avoid side effects like incontinence or sexual dysfunction’.
 
It also suggests PSA testing every two years for males aged 50–69 ‘who decide to undergo testing following a discussion of possible benefits and harms’.
 
Dr Montgomery emphasises that the guideline is ‘not a population screening program’.
 
‘The importance of good, informed consent before testing is emphasised again and again in these guidelines,’ he said.
 
‘I don’t think we should be doing PSA tests on men without having a quality conversation first.’
 
He adds that there is ‘more wiggle-room’ for men with high risk factors to consider testing earlier, as well as for PSA tests to continue beyond the age of 70.
 
‘It usually takes many years for lives to be saved from prostate cancer,’ he said.
 
‘We say that life expectancy should be at least seven years if you’re going to do PSA testing in people aged 70 and above.’
 
RACGP President Dr Michael Wright said the updated guidelines are important for GPs, given the decade that has elapsed since their initial release.
 
‘Since that time, we’ve got better evidence about when PSA testing is indicated, when biopsies might be indicated and, importantly, much better information about the use of prostate MRIs,’ he told newsGP.
 
‘It’s good to see these new guidelines clear up some of the uncertainty in the previous guidelines which made GPs unsure about which patients should continue screening.’
 
He said the guideline update means treatment will be better targeted to those who need it.
 
Last week, Federal Health and Ageing Minister Mark Butler also announced $320,000 will go to the RACGP to develop and put in place an education and awareness program for doctors. 
 
Noting GPs as ‘the first point of contact for men considering prostate cancer testing’, the Federal Government said the program ‘will help doctors discuss relevant issues with their patients and support their patients to make informed decisions about testing, considering their individual risk, possible benefits and harms, and their values and preferences’.
 
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, said Dr Montgomery ‘has been a great advocate for the role of GPs in early detection of prostate cancer, ensuring the new guidelines are workable’.
 
‘I am particularly pleased to see that the Government has supported implementation of the guidelines with funding for the RACGP,’ he told newsGP.
 
He said the RACGP’s Red Book will be updated shortly, along with a new decision aid for evidence-informed conversations with men about prostate cancer screening.
 
Draft guidelines were released last year, with the RACGP subsequently providing feedback.
 
Prostate cancer is the most commonly diagnosed cancer in Australia, with around 29,000 men diagnosed in 2025, and accounting for 4000 deaths in the same year according to Cancer Australia.
 
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