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Clinical guidelines

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people Second edition

Early detection of prostate cancer

Author Dr Nadia Lusis 
Expert reviewers Professor Bruce Armstrong

Background

After lung cancer, prostate cancer is the second most common cancer diagnosed in Aboriginal men.3 The age standardised incidence of prostate cancer in Aboriginal men was estimated to be 55% less than for non-Aboriginal men, with a corresponding mortality rate that was 26% lower. Missing data on Indigenous status was estimated to be 18%.4 

Factors that may increase the relative risk of prostate cancer are:

  • two or more relatives affected
  • lower age at diagnosis of relative(s)
  • one first degree relative with prostate cancer (brother higher risk then father)
  • one second degree relative with prostate cancer (smaller increase in risk than first degree relative).

Being a carrier of BRAC1 or BRCA2 mutations also increases risk.89,90

Screening for prostate cancer

Neither the blood prostate specific antigen (PSA) test nor digital rectal examination (DRE) is currently recommended for population screening for prostate cancer in Australia. Men who are concerned about their risk of prostate cancer, should discuss screening with their doctor. Doctors should help such men to make a fully informed decision whether or not to commence regular PSA screening. If a decision is made to commence an individual screening program, starting from 50 years of age is generally considered appropriate, with an interval of 1–2 years between PSA tests. The balance of benefits of early detection of prostate cancer and its harms (particularly the side effects of investigation of an elevated PSA and treatment, and the possibility of unnecessary treatment for cancers that would never have been diagnosed except for PSA screening) remain a subject of debate.91–100

Recommendations: Prostate cancer prevention and detection
Preventive intervention typeWho is at risk?What should be done?How often?Level/strength of evidence
Screening Men at average risk The decision to conduct prostate specific antigen (PSA) testing and digital rectal examination (DRE) should be individualised as population based screening is not recommended Opportunistic IIID91–100
Men at potentially higher risk due to family history Opportunistic IID89,90

Resources

The early detection of prostate cancer in general practice: GP/patient show card
www.cancerqld.org.au/ content/Document/The%20Early%20Detection%20of%20Prostate%20Cancer.pdf

Let sleeping dogs lie? What men should know before getting tested for prostate cancer
http://ses.library.usyd.edu.au/ bitstream/2123/6835/3/Let-sleeping-dogs-lie.pdf.

References

  1. Australian Bureau of Statistics & Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2008, ABS cat no. 4704.0. Canberra: ABS, 2008. Cited October 2011. Available at www.aihw.gov.au/ publications/index.cfm/title/10583.
  2. Australian Institute of Health and Welfare & Australasian Association of Cancer Registries. Cancer in Australia: an overview,2010. Cat. no. CAN 56. Canberra: AIHW,2010 cited 2011 October 10. Available at www.aihw.gov.au/ publications/can/ca08/ca08.pdf.
  3. Zeegers MPA, Jellema A, Ostrer H. Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: a meta-analysis. Cancer 2003;97(8):1894–903.
  4. Liede A, Karlan BY, Narod SA. Cancer risks for male carriers of germline mutations in BRCA1 or BRCA2: a review of the literature. J Cancer Res Clin Oncol 2004;22(4):735–42.
  5. Djulbegovic M, Beyth RJ, Neuberger MM, et al. Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials. BMJ 341:c4543.
  6. Ilic D, O’Connor D, Green S, Wilt T. Screening for prostate cancer. Cochrane Database Syst Rev 2006;Jul 19;(3):CD004720.
  7. US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2008;149:185–91.
  8. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360(13):1320–8.
  9. Andriole GL, Grubb RL, Buys SS, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009;360(13):1310–9.
  10. Cancer Council Australia. Position statement: Prostate cancer screening. Sydney: Cancer Council Australia, 2008. Cited October 2011. Available at www.cancer.org.au/File/ PolicyPublications/Position_statements/PS-Prostate_cancer_screening_Apr08.pdf.
  11. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice (red book), 7th edn. Melbourne: RACGP, 2009. Cited October 2011. Available at www.racgp.org.au/your-practice/guidelines/redbook/
  12. Andrology Australia. Andrology Australia statement on PSA testing for prostate cancer. Andrology Australia, 2009. Cited October 2011. Available at www.andrologyaustralia.org/ docs/AndrologyAustralia_PSAposition_webversion_140509.pdf.
  13. NHS Cancer Screening Programmes. About the Prostate Cancer Risk Management Programme. London: NHS Cancer Screening Programmes, 2010. Cited October 2011. Available at www.cancerscreening.nhs.uk/ prostate/about-pcrm.html.
  14. New Zealand Guidelines Group. Update of evidence for prostate-specific antigen (PSA) testing in asymptomatic men. NZGG, 2009. Cited October 2011. Available at www.nzgg.org.nz/ library_resources/57_psa_testing.
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