13 March 2014
Australia's leading health research body has released comprehensive information about the benefits and harms associated with having a PSA blood test for detection of early prostate cancer in men with no symptoms.
The National Health and Medical Research Council (NHMRC) document is intended to inform discussions doctors have with their male patients about whether to have a PSA (prostate specific antigen) test and what the consequences might be.
The latest NHMRC documents cover the statistical benefits and harms of testing, which vary with age and family history of the disease, but it stops short of offering any specific recommendations about decision-making.
Benefits of the test include reassurance, early detection, and prompt treatment if necessary.
The document outlines potential harms associated with having the test and how often these harms occur. Harms include false positive results, where the test result suggests cancer when no cancer is present. That can lead to further investigations which are unnecessary, such as an invasive prostate biopsy, potentially causing psychological and physical harm.
PSA testing can also lead to over diagnosis, the NHRMC says, where cancer is diagnosed but it is unlikely to cause serious harm in a man's lifetime. The treatments and interventions he receives can negatively impact his life by causing more harm than the cancer itself.
"The decision of whether or not to undertake a PSA test should weigh up the potential benefits of detecting prostate cancer early, against the uncertainties of PSA testing and the risk that detection and treatment may be unnecessary and may adversely affect quality of life," the report cautions.
This latest document comes ahead of national evidence-based guidelines on PSA testing which are expected to provide more clarity for men and their doctors.
PCFA is working in partnership with Cancer Council Australia, RACGP, epidemiologists and public health experts and other medical colleges to develop the guidelines anticipated for release in 2014.
PSA Testing for prostate cancer in Asymptomatic Men: information for health practitioner
http://www.nhmrc.gov.au/guidelines/publications/men4
Prostate-Specific Antigen (PSA) testing in asymptomatic men: evidence evaluation report 2013
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/men4a_psa_evidence_report_130820.pdf
BOX: Examples of benefits and harms of PSA testing
Among 1000 Australian men aged over 60 who have an annual PSA test for the next 10 years and have no first-degree relative affected by prostate cancer:
Two will avoid death from prostate cancer before age 85 years because of PSA testing.
Two will avoid metastatic prostate cancer before age 85 years because of PSA testing.
87 men will have a false positive test result that leads to biopsy when they don’t have prostate cancer.
28 men will experience side effects from a biopsy that they consider a moderate or major problem requiring them to seek healthcare and one will be admitted to hospital for complications.
28 men will have prostate cancer diagnosed by PSA testing and many of these men would have remained asymptomatic their whole life (i.e. over-diagnosed).
25 men will choose to undergo treatment including surgery and radiotherapy because of uncertainty about which cancer needs to be treated and many of these men would do well without the treatment.
Source: Prostate-Specific Antigen (PSA) testing in asymptomatic men: Evidence Evaluation Report 2013, NHMRC
