Question
I’ve seen a lot about PSA tests for prostate cancer in the news recently. Is this a test all men should have done regardless of any symptoms?
Answer
Well, this is a curly one! This very question has been hotly debated for the last 20 years! Whilst PSA screening has been shown to reduce death and suffering from aggressive forms of prostate cancer, the concern has been whether the harms of PSA screening might outweigh these benefits.
In the past, this was a very real concern because the next step after an abnormal PSA result was a random prostate biopsy via the rectum. This is now known to be not only highly inaccurate in detecting prostate cancer but carried a significant risk of life-threatening blood infection (septicaemia).
However, in March 2019, the European Association of Urology (EAU) published guidelines, endorsed by our own Urological Society of Australia and New Zealand (USANZ), recommending a non-invasive prostate MRI following an abnormal PSA, and if the MRI is all clear, no biopsy is needed at all. In addition, if the MRI does show a lesion suspicious for cancer, the biopsy is now regularly performed via the skin, avoiding all the infection-causing bacteria of the rectum. Our own research has shown that the infection rate using this approach is near-zero.
Furthermore, most low-grade prostate cancers, which themselves are not harmful, are managed nowadays by active surveillance, rather than radical treatment, like radiotherapy or surgery, which can cause side effects of erectile dysfunction and urinary incontinence.
So just in the last few years, enormous strides have been made towards reducing the harms of PSA testing, making the benefits more apparent. The current NHMRC Guidelines recommend at least a discussion with your GP regarding the pro’s and con’s of PSA testing.
Jeremy Grummet
A/Prof Jeremy Grummet is a Clinical Associate Professor at Monash University, Director of Clinical Research at Alfred Health and supervises PhD, Master of Surgery and BMedSci students on MRI and PSMA PET in prostate cancer diagnosis. He has published on the lack of sepsis in transperineal prostate biopsy, his paper winning the 2015 BJUI Global Prize, and is a member of the EAU Guidelines Prostate Cancer Panel and co-founder of MRI PRO, the online trainer for reading prostate MRI, launched in May 2018.
