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Red Book

Early detection of cancers

Prostate cancer

Guidelines for preventive activities in general practice
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Not recommended as a preventive activity


Screening of asymptomatic (low-risk) men for prostate cancer by prostate specific antigen (PSA) testing is not recommended because the benefits have not clearly been shown to outweigh the harms.1 This remains the case following recent large trials.1 Therefore, GPs have no obligation to offer prostate cancer screening to asymptomatic men.

Some men may have individual concerns about prostate cancer and may put a higher value on the possible benefits of prostate cancer screening. This requires specific discussion to address the benefits and harms (from overdiagnosis and overtreatment) of prostate cancer screening.2 The Royal Australian College of General Practitioners (RACGP) has produced a patient decision aid that may assist this discussion

If after an informed process, perhaps using a decision aid, a man still requests prostate cancer screening, a PSA blood test is acceptable.3 Digital rectal examination (DRE) is no longer recommended as it is insufficiently sensitive to detect prostate cancers early enough.4

Clinicians should not test for asymptomatic prostate cancer (eg by adding the PSA test to a battery of other tests) without counselling about possible harms as well as possible benefits, and obtaining informed consent.


Strategy

Patients who request testing should be informed about the risks and benefits of tests for prostate cancer, and should be assisted to make their own decision using an acceptable decision aid.16

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