News

03-11-2014

Should we routinely check a PSA level ( prostate specific antigen) in men as part of a regular health review?

Medical Colleges in Australia have been divided in recent years, with new trial evidence suggesting survival advantages. GPs and men will have to wait to December for a full consensus Clinical Practice Guidelines to be released. These are currently being developed by the cancer Council Australia and Prostate Cancer Foundation of Australia.

The reason that PSA is not promoted as a population test for everyone is because the benefits and risks must be balanced and every man has to decide where the balance lies for him.

A PSA test measures the level of prostate specific antigen in the blood and can help diagnose prostate disease. PSA is a protein made in the prostate gland and low levels are normally present in the blood, usually increasing with age. A raised level in the blood indicates a change in the prostate, such as inflammation, infection, growth or cancer. Studies have also shown that there is a small risk of prostate cancer even with PSA levels expected for age.

National Health and Medical Research Council ( NHMRC) cancer experts continue to maintain that there is not enough evidence to back population screening. The NHMRC finalised PSA testing advice for doctors in March 2014

For every 1000 low risk, 60yr old men tested per year over 10 years:

 

  • Two will avoid dying of prostate cancer before 85yrs old
  • Two will avoid metastatic prostate cancer before 85yrs old - 87 will have a false-positive test leading to a biopsy, and 28 will suffer side-effects as a result
  • 28 will be over-diagnosed with a prostate cancer that would have remained asymptomatic
  • 25 will be over-treated, 7-10 will be left impotent or incontinent as a result
  • PSA testing had " no obvious effect" on overall mortality

There remains questions about the value of PSA as a test for prostate cancer, and current advice is to weigh up the individual factors for each man .

References; nhmrc.gov.au

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