NATIONAL: The Prostate Cancer Foundation of Australia (PCFA) is calling for government to fund a review of the prostate cancer screening guidelines as the latest data reveals more men are now being diagnosed with late-stage cancers than in 20171.
Prostate cancer is the most common male cancer in Australia, killing nine men each day.
The Prostate Cancer Outcomes Registry for Australian and New Zealand men annual report 2020 (PCOR-ANZ) looks at data over four years from 2015-2018.
There is a screening blood test that can be offered to men by their GP, the Prostate Specific Antigen (PSA) test, and current guidelines2 state a PSA level of 3 or above should be followed up.
The PCOR report shows that 32 per cent of men diagnosed with prostate cancer have a PSA level of 10 or above at point of diagnosis.
For men diagnosed with prostate cancer, 38 per cent are diagnosed with high/very high-risk disease or cancer that has already spread. This has increased from 34 per cent in 2017.
Once prostate cancer has spread it is not curable, but treatments are available to manage it. Early detection is the best way to prevent advanced disease, which is why screening via the PSA test is available for asymptomatic men.
A two-yearly PSA test is suggested for men aged 50 and above, or 40 and above for those with a family history of prostate cancer.
Right now, the test is not being uniformly recommended by GPs and PCFA says updated guidelines are essential to improve understanding and utilisation of the test.
PCFA’s CEO, Professor Jeff Dunn AO, said the funding would be used to create new Consumer and Clinical Guidelines for testing:
“Australia’s current guidelines were published in 2016 and remain highly controversial and poorly understood by the majority of Australians. Research by the Prostate Cancer Foundation of Australia has found that about 75 per cent of Australians do not know the guidelines, an alarmingly high level of unawareness that impedes early detection and diminishes population-wide survival prospects.
“Without a doubt, investment in a revised set of Consumer and Clinical Practice Guidelines for PSA Testing and a public health education campaign to communicate the guidelines would save many lives each year.”
The PSA testing guidelines are now five years old and there have been advances during that time, not only in the testing but in how men with a high PSA result are followed up.
Leading urologist, Adjunct Professor Peter Heathcote said a review was urgently needed:
“It’s important for patients and general practitioners to be aware that medical opinion has moved on significantly when it comes to screening and diagnosis of prostate cancer. The two large European screening trials continue to show increasing benefit of PSA screening over time, and clearly demonstrate that PSA screening saves lives. With the latest medical imaging techniques and improved active surveillance protocols, we now have fewer men having unnecessary biopsies, or being over-diagnosed or unnecessarily treated for low-risk cancers.”
Prostate cancer patient and former Lieutenant Commander in the Navy Reserve, John Boland (71), was 64 when he was diagnosed with prostate cancer in December 2014.
“I had been having regular PSA tests with my GP and she became worried when my PSA level doubled from three to six within 12 months. I was referred to a urologist and after a PET scan and an MRI guided biopsy I was diagnosed with prostate cancer. By the time I was referred for surgery to have my prostate removed in January 2015 my PSA had gone up to 8,” he said.
“When I was having the scan I asked them what would have happened if I had waited another six months and I was told I wouldn’t have lived another five years.”
Mr Boland underwent operations to remove his prostate and lymph nodes in 2015, but in 2019 discovered the cancer had returned and underwent radiation treatment. In 2020 he began Prostate-Specific Membrane Antigen therapy and hormone treatment and continues his prostate cancer battle today.
“The effects of prostate cancer on your life can be devastating, but outcomes are so much better when the cancer is caught early. It affects the whole family, and even more so as my wife was going through breast cancer at the same time. It’s so important that men know about the PSA test and that they have a four times higher risk of prostate cancer if another male relative has been diagnosed,” said Mr Boland.
According to the PCOR report, men over 70 face significantly higher risk of being diagnosed with metastatic disease.
For those aged 70-74, 7 per cent are diagnosed with metastatic disease and 13 per cent of men aged 75 and over are diagnosed with metastatic disease. For men over 75, 60 per cent are diagnosed with high/very high-risk disease, regionally advanced, or metastatic disease.
“Now that we are all living longer our attitude to age is also different. Men with few comorbidities and generally in good health at the age of 70, could have 10 or 20 healthy years of life ahead so screening protocols should reflect this,” A/Prof Heathcote said.