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Prostate cancer awareness month

The size of the prostate is often compared to the size of a walnut and we have compiled this guide to the latest thinking in prostate cancer screening. 

Prostate cancer is the most common cancer in Australian men with some 24,217 cases diagnosed in 20221 and some 3500 deaths are attributed to prostate cancer in Australia1.

For patients that decide to screen, there are tests that can spot cancer before obvious symptoms occur, including a blood test that detects what’s called a Prostate Specific Antigen (PSA). 2

For healthcare professionals, find out below if it is the right time to chat to patients about the walnut!

Risk Factors – Local guidelines

Risk Factors – Local guidelines

Consensus-based recommendation for men whose risk of prostate cancer is estimated to be at least 2.5–3 times higher than average due to the presence of risk factors (e.g. a brother diagnosed with prostate cancer, particularly if younger than 60 years at diagnosis), and who decide to undergo testing after being informed of the benefits and harms, offer testing every 2 years from age 45–69 years.4

For men whose risk of prostate cancer is estimated to be at least 9–10 times higher than average due to the presence of risk factors (e.g. father and two brothers diagnosed with prostate cancer), and who decide to undergo testing after being informed of the benefit and harms, offer testing every 2 years from age 40–69 years.4

Screening is not recommended for men unable or unwilling to tolerate treatment.

Informing men of the benefits and harms of testing is a key component of the recommendations regarding PSA testing.4

wallnut2

Need for a conversation

Prostate Cancer Foundation of Australia has developed national evidence-based clinical practice guidelines on PSA testing and early management of test-detected prostate cancer.

Ready to talk prostate?

The decision whether to screen

For men who decide to be tested, it contains guidance on matters such as what age to start testing; how frequently to be tested; when to stop testing; the PSA level which should prompt further investigation; family history; and the role of the digital rectal examination.

By encouraging this dialogue and providing up-to-date medical information, the campaign seeks to raise awareness of the potential protection conferred by prostate cancer screening for at-risk individuals and ensure that PSA testing is accessible to the men most likely to benefit from it.

Screening blood test

A raised PSA level in the blood could be a sign of prostate cancer, and patients should be able to speak with their doctor to discuss how to move forward, and whether they require further tests or annual monitoring.2

Annual screening for prostate cancer could reduce the chance of dying from the disease by around 30%4

While earlier diagnosis based on PSA screening may reduce prostate cancer mortality, efforts to maximise mortality reduction can conversely increase the risk of overdiagnosis in prostate cancer. Indeed, PSA screening is not recommended for all men or for use in national screening programmes, but may be relevant for high-risk individuals.5,6,7

PSA results can inform risk assessments for prostate cancer but they cannot categorically identify cancer or rule it out. There are no specific normal or abnormal levels of PSA in the blood and levels can vary between men and even within the same individual.8

Generally, PSA levels above 3 or 4 ng/ml may indicate a need for further evaluation/referral. 8-10 For example, digital rectal examinations also help to inform a diagnosis of prostate cancer, although biopsy is needed for confirmation, and to grade any cancer found using the Gleason score.6,12 Further staging work-up – for example with computed tomography (CT), magnetic resonance imaging (MRI) or transrectal ultrasound – may be warranted.

Walnut3
Want to continue the conversation?
Download this guide on the latest thinking in prostate cancer screening
Download Guide
  1. Understanding Prostate Cancer Booklet - Cancer Council - https://www.cancer.org.au/assets/pdf/understanding-prostate-cancer-booklet - Accessed September 2021
  2. Prostate cancer in Australia – what do the numbers tell us? -https://www.pcfa.org.au/news-media/news/prostate-cancer-in-australia-what-do-the-numbers-tell-us/ - accessed September 2023
  3. PSA Testing and Early Management of test-detected prostate cancer. Clinical Practice Guidelines. Prostate Cancer Foundation of Australia and Cancer Council Australia. Published: 20 January 2016
  4. Tsodikov A. et al. Ann Intern Med 2017; 167: 449–455.
  5. U.S. Preventive Services Task Force. Final recommendation statement Prostate Cancer Screening.https://www.uspreventiveservicestaskforce.org/uspstf/announcements/final-recommendation-statement-screening-prostate-cancer accessed July 2023
  6. Mottet N et al. EAU-ESTRO-SIOG guidelines on prostate cancer: Part 1: screening, diagnosis and local treatment with curative intent. Eur Urology 2017;71:618–29.
  7. Auvinen A et al. Absolute effect of prostate cancer screening: balance of benefits and harms by center wi hin the European Randomized Study of Prostate Cancer Screening. Clin Cancer Res 2016;22(1):243–9.
  8. National Cancer Institute. Prostate-Specific Antigen (PSA) test. https://www.cancer.gov/types/prostate/psa-fact-sheet accessed July 2022
  9.  Prostate Cancer UK. Prostate Information. about Prostate Cancer. www.prostatecanceruk.org accessed July 2023
  10. Kakehi Y et al. Evidence-based clinical practice guideline for prostate cancer (summary: Japanese Urological Associ-ation, 2016 edition). Int J Urology 2017;24:648–66.
  11. Prostate Cancer Research Foundation. What is PSA? www.prostatecancer-riskcalculator.com/psa-test accessed December 2023
  12. Cancer Council NSW. Staging and prognosis for prostate cancer. April 2020