The Urological Society of Australia and New Zealand (USANZ) hopes that the results of a recently published UK study of prostate cancer screening using the blood test for prostate-specific antigen (PSA) does not deter men from having the test altogether. The CAP study, published in the Journal of the American Medical Association (JAMA) showed that offering a single PSA test for population-wide screening of men for prostate cancer did not improve survival outcomes over 10 years of follow-up, despite detecting more cancers.
“The results from this study were not surprising – previous trials of population-wide PSA screening have also shown limited impact on survival. The problem is that many of the cancers detected by a population-based approach are of low stage and grade, and it is now well understood that these cancers rarely turn out to be lethal. Therefore, most such cancers are now managed by surveillance rather than upfront treatment,” says Professor Shomik Sengupta, USANZ UroOncology Advisory Group Leader.
“However, some prostate cancers continue to be a significant health problem – with more than 3000 deaths across Australia and New Zealand annually and a great many more who suffer painful metastatic disease and need treatments with serious side effects such as castration or chemotherapy. The PSA test remains the best test currently available for the early detection of those prostate cancers that lead to these outcomes” says Professor Sengupta.
The most important steps to minimising the potential harms of PSA testing, while still benefiting from early detection for those that need it, follow on after the test. Imaging the prostate using MRI scans and targeted biopsies of identified abnormalities help increase the detection of significant cancers and reduce the overdiagnosis of indolent cancers. The transperineal approach to prostate biopsy helps minimise the risk of infectious complications. Finally, surveillance of low-risk cancers helps avoid overtreatment and treatment-related side-effects. Currently, USANZ urologists lead the way in all these areas of prostate cancer management.
The Consensus Guidelines developed in 2016 by a multi-disciplinary panel led by the Prostate Cancer Foundation of Australia provide a robust framework for the appropriate clinical use of PSA-testing for the early detection of prostate cancer. USANZ urges men to discuss PSA-testing with their GPs to make an informed decision.