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GPs will offer prostate cancer checks every two years to men aged between 50 and 69 under a major overhaul of national guidelines designed to detect Australia’s most common cancer earlier.
High-risk groups, including men with the BRCA2 gene variant and with a family history of the disease, will be offered screening from the age of 45.
In a significant shift, new clinical guidelines from the Prostate Cancer Foundation of Australia recommend for the first time that men with low-grade prostate cancer manage their condition through “active surveillance”. This approach monitors the disease with regular blood tests and scans rather than resorting to surgery or radiation.
It is also now advised that men aged 70 and over should undergo prostate cancer testing every two years if their life expectancy is more than seven years.
Previously, it was not generally recommended that men in this older cohort were routinely tested for the disease due to the risks of overdiagnosis and the potential harms of intervention.
Professor Jeff Dunn, chair of the Prostate Cancer Foundation of Australia’s guidelines steering committee, said the update was long overdue and followed a decade of technological advancements and evolving attitudes about ageing.
“Because we’re all living longer and many of us are healthier, it’s important to include men 70 and over,” he said.
“It provides a pathway to include men who are fit and well and still interested in prostate health to be included in the diagnostic process.”
Autopsy studies have revealed that about 60 per cent of men in their 60s have signs of prostate cancer. A recent paper described early stages of the disease as “perhaps a normal aspect of ageing”.
Prostate cancer is the most commonly detected cancer in Australia, with almost 29,000 men diagnosed with the disease every year. About 4000 Australians die from the disease each year.
The overhaul, which was endorsed by the National Health and Medical Research Council, urges men with high prostate-specific antigen (PSA) levels to undergo an MRI scan before any biopsy to reduce unnecessary and invasive testing.
Dunn said detailed MRI scans allowed clinicians to visualise suspected cancers, helping patients avoid unnecessary biopsies.
High-risk people, who are now advised to get prostate cancer checks every two years from age 45, include men who have a brother with prostate cancer, a father diagnosed before the age of 65, a second-degree relative (such as an uncle or grandfather) who died from prostate cancer, or a BRCA2 mutation, as well as those who are black or have sub-Saharan ancestry.
Urological Society of Australia and New Zealand president Damien Bolton welcomed the changes, noting that more than 80 per cent of men with low-grade prostate cancer were now being monitored closely without treatment.
“The key thing to avoid in prostate cancer management is overtreatment,” Bolton said. “Overtreatment of clinically insignificant disease achieves no benefit and can result in complications.”
These complications include erectile dysfunction and infection.
Under the old 2016 guidelines, it was recommended that men aged 50 to 69 initiate a conversation with their doctor about PSA testing, which is a quick blood test.
The new guidelines state that GPs should be the ones initiating this discussion.
“It’s good news,” said Professor Declan Murphy, a urologist and director of genitourinary oncology at Peter Mac.
“We see a huge shift towards encouraging GPs to be proactive about having a conversation with men about assessing their prostate cancer risk, rather than relying on men to turn up and ask about it.”
Mike Watson wishes this guidance had been in place in the years before he was diagnosed with aggressive prostate cancer in 2021.
His GP never brought up PSA testings during his annual check-ups. It wasn’t until Watson watched a television news segment about the benefits of early detection that he decided to get screened at the age of 59.
Watson, who lives in Melbourne’s south-east, said his doctor questioned why he would need a test if he had no symptoms.
“I was in shock,” Watson said of his PSA test results and eventual diagnosis. “There’s a lot of emotional turmoil that you go through when you get a diagnosis, especially of a high-grade cancer. You automatically think worst-case scenario.”
Watson had robotic surgery to remove his prostate, 33 sessions of radiation treatment and six months of hormone therapy. He is now cancer-free.
The now-64-year-old believes that if he had been offered testing throughout his 50s, his cancer would have been detected earlier, and he would have avoided such invasive treatment.
The Royal Australian College of General Practitioners has endorsed the guidelines.
The federal government has provided $320,000 to the college so that it can develop and implement an education and awareness program for doctors.
Australia is a world leader in prostate cancer detection and treatment, and the five-year survival rate for the disease sits at 95 per cent.
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Henrietta Cook is a senior reporter covering health for The Age. Henrietta joined The Age in 2012 and has previously covered state politics, education and consumer affairs. Email her via henrietta.cook@theage.com.au or henrietta.cook@protonmail.comConnect via X, Facebook or email.From our partners
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