USANZ statement on PCFA clinical practice guidelines on PSA-testing
USANZ is pleased to endorse the recently released clinical practice guidelines on PSA-testing (http://www.prostate.org.au/awareness/for-healthcare-professionals/clinical-practice-guidelines-on-psa-testing/), developed by a multidisciplinary expert advisory group under the leadership of the PCFA, and approved by the NHMRC. USANZ recognises the controversy associated with PSA-testing for the early detection of prostate cancer, and feels that these consensus guidelines will be helpful in appropriate management for men at risk of prostate cancer, leading to minimisation of potential harms while preserving potential benefits.
USANZ welcomes the following evidence-based recommendations on PSA-testing from the guidelines:
- Offer evidence-based decisional support to men considering whether or not to have a PSA test, including the opportunity to discuss the benefits and harms of PSA testing before making the decision.
- For men at average risk of prostate cancer who have been informed of the benefits and harms of testing and who decide to undergo regular testing for prostate cancer, offer PSA testing every 2 years from age 50 to age 69, and offer further investigation if total PSA is greater than 3.0 ng/mL.
USANZ makes the following suggestions for consideration:
- We acknowledge the evidence base surrounding the omission of DRE as a routine mandatory adjunct to PSA-testing risks. As there is a risk of missing a small proportion of prostate cancers, we would suggest that GPs confident in performing DRE are still encouraged to continue to do so.
- The percentile ranges recommended for use in men aged <50years are most useful if considered with the associated PSA levels, namely:
Evidence surrounding prostate cancer imaging and the selection criteria for active surveillance are rapidly changing areas, and we would encourage PCFA and Cancer Australia to review these areas of the guidelines frequently. As the level of evidence in the guidelines surrounding selection for active surveillance is low and the criteria proposed in the guidelines are considerably broader than other guidelines (e.g. EAU) and established surveillance protocols (e.g. PRIAS) we would suggest that the decision to select a patient for active surveillance only occur after careful specialist counselling of patients by urologist, radiation or medical oncologists.
- 75th percentile: 1.0 ng/ml
- 90th percentile: 1.5 ng/ml
- 95th percentile: 2.0 ng/ml