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Guidelines for preventive activities in general practice 7th edition

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Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

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Prostate cancer

Prostate cancer age range table
Age 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 79 >80
                    Inform patients of risks and benefits 74  

Routine screening for prostate cancer with digital rectal examination (DRE), prostate specific antigen (PSA) or transabdominal ultrasound is not recommended.416-418 Patients should make their own decision about being tested for prostate cancer after being fully informed of the potential benefits, risks and uncertainties of prostate cancer testing (C).419 Where a patient chooses to be tested, both PSA and DRE should be performed.

Prostate cancer risk
Who is at higher risk of prostate cancer? What should be done? How often? Level of evidence and references

Average risk
The risk of developing prostate cancer increases with age. However, because prostate cancer is usually slow growing, men over 75 years of age or with a life expectancy of less than 10 years are at reduced threat of dying from a diagnosis of prostate cancer

Men with uncomplicated lower urinary tract symptoms (LUTS) do not appear to have an increased risk of prostate cancer. The most common cause of LUTS is benign prostate enlargement. Early prostate cancer often does not have symptoms


Inform patients of risks and benefits of screening
Opportunistically
V C 420

High risk

  • Men with one or more first degree relatives diagnosed before the age of 65 years
  • Men with a first degree relative with familial breast cancer (BRAC1 or BRAC2)

Inform patients of risks and benefits of screening
Opportunistically
V C 421,422


Prostate cancer PSA
Not recommended Justification References
PSA While there is currently good evidence that PSA screening can detect early stage prostate cancer when curative treatment can be offered, it can also lead to ‘over detection’, ie. detection of disease which will not impact on the health of a man during his lifetime. There is inconclusive evidence that such early detection can reduce mortality. (There are two large studies currently designed to address this question due to report in the next 5 years.) Testing and treatment for prostate cancer can cause substantial harm, including erectile dysfunction (20–70%) and urinary incontinence (15–30%) 416-418

Strategy

Patients who request testing should be informed about the risks and benefits of testing for prostate cancer and assisted to make their own decision as to whether to go ahead with testing.423 Written material, particularly decision aids, may be useful for this purpose (see the ‘green book’). Responding to patients’ concerns and fulfilling medicolegal responsibilities are considerations in discussion with patients requesting testing.


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© The Royal Australian College of General Practitioners
Printed from www.racgp.org.au/redbook