Study shows increase in metastatic prostate cancers after drop in PSA testing rates
MEDIA RELEASE | 20 July 2016
A new study shows the number of men presenting with metastatic prostate cancer has increased dramatically in the United States following a decline in PSA testing that coincided with the high profile US Preventative Services Task Force (USPSTF) recommendations against PSA testing for the disease.
There has been a similar drop in testing in Australia following the recommendations that received widespread publicity worldwide.
“While there have not yet been any local studies showing the longer term consequences of a decline in PSA testing in Australian men, we are concerned there are men who may have benefited from testing who either were not offered or did not seek PSA testing as a consequence of confusion about the recommendations both overseas and in Australia,” said President of the Urological Society of Australia and New Zealand, Professor Mark Frydenberg.
The study, Increasing incidence of metastatic prostate cancer in the United States (2004 – 2013), published today in Prostate Cancer and Prostatic Diseases sought to analyse the relationship between relaxed screening in the US population and increases in yearly incidence of metastatic prostatic cancer.
The study followed data from more than 1000 US facilities. Of 767,550 men with prostate cancer there was a decline in the incidence of low-risk disease, while the incidence of metastatic prostate cancer rose between 2004 and 2013 by 72%, with the largest increase (92%) seen in men aged 55 – 69 years who are typically thought to benefit most from PSA testing and early definitive treatment.
The study noted, however, the findings could not be explained solely as a consequence of the USPSTF recommendations, as increases in the metastatic prostate cancer began in the years prior to its release (2008 and 2011).
Professor Frydenberg believes new, world-first consensus guidelines on PSA testing in Australia this year will end uncertainty over the best approach to testing for prostate cancer which is the second most common cause of cancer-related death among men in Australia.
“We believe that while imperfect, the PSA blood test has a very important role to play in preventing prostate cancer deaths,” says Professor Frydenberg.
While the USPSTF recommended no PSA testing for men, the new Australian guidelines support testing after information is provided to men about the risks and benefits. “The aim of the new guidelines is to ensure the PSA is used strategically to ensure men who are unlikely to benefit aren’t unnecessarily tested or treated while ensuring those men who are at risk of life-threatening disease aren’t missed.
The Guidelines were developed by an expert advisory panel that included GPs, epidemiologists, urologists, oncologists, consumers, psychologists, pathologists and public health experts.
“These guidelines should help Australian men feel confident they are receiving consistent advice and clinical care based on the most contemporary, peer-reviewed evidence.
“This is about testing the right men at the right time, and ensuring those men who are diagnosed with prostate cancer are given appropriate treatment according to their individual risk profile. The guidelines also help ensure men avoid over-treatment, and subsequent side effects,” says Professor Frydenberg.
The guidelines, Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer, were facilitated by Cancer Council Australia and the Prostate Cancer Foundation of Australia and have been endorsed by the NHMRC.
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