PSA – Should I have my prostate level checked?

Increasingly, a large part of what we do in Family Medicine is screening. This involves offering tests or investigations to otherwise well people to investigate if they have any underlying unknown medical conditions or if they are at risk of developing them. A simple example is checking your cholesterol, a test that allows your doctor to predict if you are at an increased risk of developing heart disease or stroke.

Cervical screening (formally pap test), breast screening and bowel cancer screening are part of the national cancer screening program and offered to all persons of a certain age and gender on a regular basis.

Other tests, bone density tests for osteoporosis, skin cancer checks, diabetes testing and more are usually offered in the context of a consultation with your doctor and most people avail of these tests on a regular or semi-regular basis. This is consistent with advice from the college of general practice and most national guidelines.
There has been some controversy around prostate screening in the past, and most people now recommend a discussion with your doctor about the benefits of undertaking screening before proceeding.

So what’s the deal with prostate cancer anyway?

•  The prostate is a small golf ball sized gland that rests under your bladder. It is important for the maturation and health of sperm and produces the fluid in which sperm can travel.
• Prostate cancer is the second most commonly diagnosed cancer in Australian men (after skin cancer).
• Prostate cancer is the second most common cause of cancer death in Australian men and the sixth most common cause of death overall.
• Despite this, thankfully prostate cancer has one of the highest rates of 5 year survival after diagnosis.

What is prostate screening?

• Well, that’s the easy part really – To screen for prostate cancer all you need is a blood test ordered by your doctor.
• This can easily be included with any routine blood tests that you might already undertake every couple of years.
• Doing a physical prostate examination or digital rectal examination is no longer part of routine screening of asymptomatic men.

But do I need screening? Won’t I just know if my prostate is playing up?

• Well – maybe, but probably not.
• As we age, the prostate enlarges and can cause compression of the urethra leading to problems passing urine. This process is termed Benign Prostatic Hypertrophy
• BPH) and often not related to a cancer.
• Early prostate cancer does not usually cause symptoms.
• That said, if you have any symptoms affecting your urinary flow, it is strongly recommended that you consult your doctor soon to have this properly assessed.

This seems pretty easy and straight forward. Surely a test is only a good thing. So why is there controversy?

• The primary reason for this is the risk of over-diagnosis, and therefore over-treatment.
• There is some concern that what appears like a simple routine blood test may open the door to anxiety around a cancer diagnosis and may lead to further testing without leading to improved outcomes for the patient.
• Depending on your age and family history, studies have found that for certain men the harms of routine testing may actually outweigh any benefits.

So why have a test at all?

• The counter argument to this point is that PSA testing is the only reliable way to detect early prostate cancer in otherwise well men, and earlier diagnosis leads to better outcomes and lives saved.

So what do the experts say?

• Australian guidelines recommend that men WITH a family history should be offered screening from 40 or 45 depending on the strength of the family history.
• Men WITHOUT a family should be offered screening from 50.
• Most guidelines recommend that you stop screening after 70.
• If you have a family history of breast or ovarian cancer or any related genetic mutations in your family, you should definitely speak to your doctor about having prostate screening.

So, should I have a test then?

• Yes. Probably. At some stage.
• Chat to your doctor about what is best for your individual circumstances.

Is there anything I can do to reduce the risk of a false positive test?

• Avoid anything that aggravates your prostate for 48 hours prior to your blood test.
• This includes high level physical exertion, cycling, sex or ejaculation.

Is there anywhere else I should look for advice on this topic? Any bedtime reading?

prostate-cancer-screening-infosheetpdf.pdf (racgp.org.au)

Prostate cancer | Causes, Symptoms & Treatments | Cancer Council

Info – PSA Testing

The purpose of this blog is to address some of the confusion that patients may face around whether they should or shouldn’t have a blood test to check for prostate cancer. This blog was written to provide some context and additional substance to clinical advice that we offer to our patients during routine consultations. The following texts were used to support this advice:

PSA-Testing-Guidelines-Overview.pdf (prostate.org.au)
prostate-cancer-screening-infosheetpdf.pdf (racgp.org.au)
Prostate cancer | Causes, Symptoms & Treatments | Cancer Council
Info – PSA Testing