PSA testing – from confusion to consensus

Prostate Specific Antigen (PSA) testing has long been the subject of much debate among the medical fraternity leaving men scratching their heads about what they should do. Introduced in 1980, the PSA blood test was billed as a scientific breakthrough and an invaluable tool for detecting prostate cancer early. Over time, PSA testing grew increasingly controversial due to its association with over-diagnosis, unnecessary biopsies, and harmful over-treatment for people with low-risk prostate cancer. The question “to test or not to test” has divided medical groups, resulting in conflicting views and confusion.

Clinical practice guidelines, released last year by Prostate Cancer Foundation of Australia and Cancer Council Australia with direction from The Royal College of Pathologists of Australasia (RCPA), have sought to establish consensus by providing clear, evidence-based recommendations on the use of PSA blood tests. Guidelines now recommend doctors inform men aged 50-69 of the potential benefits and harms of PSA screening, and the decision should be an individual one.

A/Prof Ken Sikaris, a chemical pathologist and leading expert on PSA testing, commented “For men who decide to be tested, PCFA’s clinical practise guidelines contain comprehensive instructions 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 and family history. These guidelines are intended to resolve confusion and ensure greater consistency in testing practices.”

During Prostate Cancer Awareness month, PCFA encourages GPs to familiarize themselves with the Clinical Practise Guidelines on PSA Testing. According to Associate Professor Anthony Lowe, Chief Executive Officer of PCFA: “The guidelines have been introduced to benefit GPs and enable them to have informed conversations with patients who decide to be tested. We believe that this framework will improve patient outcomes and provide assistance to GPs in explaining to men the role of active surveillance for prostate cancer.”

While some prostate cancers are aggressive, most are not, and appropriate treatment requires careful consideration of the patient’s risk profile. Additional prostate cancer markers through blood, urine and tissue samples help doctors to better identify which patients would likely benefit from treatment and who should forego it.

Recent findings published this month in the Annals of Internal Medicine, have further contributed to the PSA testing debate. Researchers concluded that PSA testing does help save lives from prostate cancer and is linked to as much as a 32% decrease in prostate cancer deaths, compared to men who aren’t tested.[1]

The findings may give more men and their doctors confidence that PSA testing is a safe and effective way to assess prostate cancer risk, which could potentially prolong their lives.

[1] http://time.com/4927356/psa-test-prostate-cancer/