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RACGP reacts to overhauled prostate cancer guidelines
With significant changes to early detection proposed, potentially altering the way GPs screen and treat patients, the college has aired its views on the guide.
The draft guidelines were released for feedback by the PCFA in April 2025.
An overhauled set of clinical guidelines could change the way prostate cancer is screened for and detected in Australia – in response, a new RACGP submission has revealed the college’s views on the plan and how it will work within general practice.
It comes after the draft Guidelines for the Early Detection of Prostate Cancer in Australia were put out to consultation earlier this year from the Prostate Cancer Foundation of Australia (PCFA).
The plan aims to reassess the balance of harms and benefits of baseline prostate-specific antigen (PSA) screening, emphasising a structured approach to offering all men the chance to engage in shared decision-making.
Key changes in the proposed guidelines include offering males who are not at a higher risk or from a priority population, but who are interested in their prostate health, an initial PSA test from age 40.
It also includes 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.
In response, the RACGP has recommended the inclusion of PSA cut off limits for individual patient groups, saying these need to be emphasised.
‘This clarifies to readers that cutoffs are different depending on the testing situation,’ the submission says.
While the RACGP commended the PCFA on its ‘hard work in updating these important and valuable clinical guidelines’, it has also flagged concerns with a ‘world-first recommendation’ to offer a baseline PSA test to all interested men at age 40.
‘It is important men of this age are fully informed and undertake a shared decision-making process with their GP,’ the submission said.
‘This is particularly the case given men of this age at average risk may be at higher risk of overdiagnosis and harms, so they need to think very carefully before undertaking testing.
‘The PCFA needs to make it clear this is not a recommendation for testing to be routinely proactively offered to men in their 40s, but is meant to allow GPs some flexibility on start age for highly intrinsically motivated younger men, and emphasise this is a consensus recommendation.’
The guidelines also recommend a national public education campaign focused on understanding risk factors and early detection.
However, ‘the RACGP recommends men are asked to speak with their GP about their individual risk factors and about the benefits and potential harms of screening’, the college’s submission said.
‘We recommend any promotion of testing for men interested in prostate health be careful – particularly if they are at average risk and are at higher risk of harms from overdiagnosis.
‘Incautious promotion may have the effect of making testing appear routine for men in their 40s.’
It is also recommended that earlier and more frequent testing for men at higher risk, including those with a family history or of sub-Saharan ancestry, start at age 40, and for Aboriginal and Torres Strait Islander men to be tested every two years from age 40.
However, ‘more unintentional harms’ could result from screening all Aboriginal and Torres Strait Islander men for prostate cancer from the age of 40, says the RACGP.
The college has instead called for screening to start from the age of 50 for all Aboriginal and Torres Strait Islander men, in line with non-Indigenous men and the National guide to preventive healthcare for Aboriginal and Torres Strait Islander people.
The submission said the evidence cited by the PCFA in its draft guidelines ‘shows no significant difference in the age of diagnosis or spread of disease at diagnosis in Aboriginal and Torres Strait Islander men’.
‘Therefore, while they are a priority population, the RACGP is concerned this approach may lead to more unintentional harms for Aboriginal and Torres Strait Islander men, such as false positive PSA tests and overdiagnosis,’ it said.
The submission also noted that the addition of a summary list of the potential harms from overdiagnosis and treatment to the guidelines would provide GPs with key information to share with patients as part of the decision-making process.
‘GPs undertaking a careful shared decision-making process with asymptomatic men is a crucial part of the GP role,’ it said.
‘Patients often like to know the likelihood of side effects or harms before making a decision.
This should include information such as rates of impotence, rates of incontinence, number of interventions to save a life over 11 years, 16 years, etc.’
Another key recommendation in the submission is the development of a national registry for prostate cancer screening after shared decision-making, in line with other Australian screening programs.
This would capture the information of patients, ensuring that even if they saw multiple providers, or changed doctors, they would receive recalls and reminders for screenings when necessary.
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