The Prostate Cancer Foundation of Australia and Cancer Council Australia have released new draft guidelines for health professionals on PSA testing. They’re now open for consultation, so may still change before they’re finalised.
We know that the PSA test isn’t perfect and that prostate cancer diagnosis is nowhere near where it should be. These draft guidelines don’t change that. And they don’t recommend nationwide screening. But they do give doctors in Australia the kind of clarity around best practice for PSA testing (in men with no symptoms of prostate cancer). And that is something we want doctors and men in the UK to have.
So what is it that doctors Down Under should soon be clear on?
For a start, Australian doctors have now been given clear guidance on repeated PSA tests – which doctors here don’t have. The draft Australian guidelines recommend that men between 50 and 69 years old, who are interested in regular testing for prostate cancer, and have talked through the pros and cons of this with their doctor, should be offered repeat PSA tests every two years.
The guidelines also give doctors a best course of action for looking after men at higher than average risk of prostate cancer (Black men and men with a family history of prostate cancer). If men in this category want to be tested for prostate cancer, they can start having PSA tests from age 45.
What the guidelines have to say about digital rectal examinations (DRE) is also interesting. They say that DRE shouldn’t be a routine part of first-line testing for prostate cancer by GPs if men have no symptoms. It’s still recommended, but only to be carried out by specialist clinicians for men who are referred for biopsy. This is different in the UK, where the guidance for GPs assumes they will also carry out a DRE, but isn’t very clear on best practice.
The Prostate Cancer Foundation of Australia and Cancer Council Australia have also come to a point on the highly controversial question of using a man’s first PSA test for comparison in these guidelines. They say that although men should be able to have repeat PSA tests, the first test should not be used as a comparison (or baseline) to see how much PSA levels have changed over time.
This has been a sticking point for prostate cancer policy makers around the world recently, with more back and forth than the Wimbledon Final about whether it would be beneficial or not. So far, there have been no straight answers coming out of the UK. And it’s time that changed. That’s why we’re going to be leading a project in early 2015, with the help of health professionals and other experts, to develop a clinical consensus on that very question.
We aren’t saying that we want the Australian recommendations to be implemented in the UK – it’ll take us a bit of time to know what would be best practice here. But we are saying it’s great that these new draft guidelines show it’s possible take some of the uncertainty out of PSA testing for both men and doctors. If the final guidelines stay looking as the draft does now, men in Australia will soon know exactly what to expect when they go to their doctor to ask for a PSA test. Men in the UK deserve the same certainty.
So it’s good news that the UK National Screening Committee is planning to update the Prostate Cancer Risk Management Programme (PCRMP), which tells UK GPs what to do when a man asks for a PSA test. As they do, we’ll be pushing for it to equip men and GPs to make an informed choice about whether to have a PSA test and, if so, how often – Australian style.