Final amendments are being made to Australia’s first national clinical guidelines for the early detection of prostate cancer.
The Prostate Cancer Foundation of Australia (PCFA) has said Australia is set to become the first country in the world to introduce such guidelines, with feedback on a draft document currently being worked through.
The 2025 document is designed to supersede the 2016 Clinical Practice Guidelines for PSA (prostate-specific antigen) testing
The updated guidelines shift the focus from an opportunistic testing program to an organised testing program; and from a focus on PSA testing to a focus on early detection.
RELATED: New treatments changing life after prostate cancer
Key changes from the previous document include a world-first recommendation to offer a baseline PSA test to interested men at the age of 40 and earlier and more frequent testing for certain demographic groups of men, including Aboriginal and Torres Strait Islander men.
Among the submissions informing the final guidelines is one from the RACGP.
The college wrote it had “major concerns with the recommendation to start screening at age 40 for all Aboriginal and Torres Strait Islander men,” and asked for this to be changed in line with non-Indigenous men to 50 years of age.
It referred to the RACGP and NACCHO national guideline to preventive healthcare for Aboriginal and Torres Strait Islander people (the National guide), which recommends screening for Aboriginal and Torres Strait Islander men from age 40 only if they are at increased risk, for example, they have close family member with cancer diagnosed before the age of 60.
The RACGP’s submission said there was no suggestion that Aboriginal and Torres Strait Islander men were at higher risk of developing prostate cancer than non-Indigenous men but rather variations in access to, and engagement with, the health system is a likely reason for the differences in prostate cancer outcomes.
“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,” the submission said.
Dr Brett Montgomery, the College’s representative on the steering committee for the guidelines, acknowledged there was a need for the new guidelines because much has changed over the last decade in the diagnosis of prostate cancer.
RELATED: Getting the data right on prostate cancer
He said many GPs can encounter difficulties in having meaningful conversations about the topic with patients.
“I think that many GPs have found it challenging to counsel patients about early detection of prostate cancer,” Dr Montgomery said.
“A problem in the past has been that only a tiny proportion of participants have their life saved through early detection.”
Overdiagnosis concerns
The RACGP’s submission has suggested the document clearly outline the “nuances of the potential mortality benefit of prostate cancer screening”.
“The potential mortality benefit is still unclear, but needs to be communicated to patients,” the submission reads.
“For every 1000 people getting tested, we see about one life being saved after 11 years, two after 16 years, and perhaps four after 25 years and 14 after 40 years,” Dr Montgomery added.
The College also called for the financial cost as a result of overdiagnosis to both the health system and to patients be included in the guidelines.
“This addition will clarify to readers that careful consideration needs to be made between the GP and patient to reduce the risk of a variety of harms from both potential advanced disease and potential overdiagnosis,” the submission reads.
Dr Montgomery said the guidance about who and how often PSA testing should be offered, and how to interpret the results, would be particularly useful for GPs.
The guideline strongly recommends GPs initiate conversations about PSA testing and offer two-yearly testing to all men aged 50–69.
It reverses the 2016 stance against testing men over 70, instead recommending testing based on clinical assessment.
Earlier and more frequent testing for men at higher risk, including those with a family history or of sub-Saharan ancestry is recommended for men starting at age 40.
The draft guidelines also reinforce that digital rectal examinations are no longer recommended in primary care, removing a major barrier to testing for many men.
The public consultation period for the draft guidelines closed in late May and the PCFA said the final draft guidelines will be submitted to Australia’s National Health and Medical Research Council this week for review and endorsement.
PCFA chief executive Anna Savage said she expected the Council to formally approve the new guidelines in August, with a phased implementation process likely to begin immediately after that.
Want more news, clinicals, features and guest columns delivered straight to you? Subscribe for free to WA’s only independent magazine for medical practitioners.
Want to submit an article? Email editor@mforum.com.au