Preface
Guidelines developed in partnership with
This resource has been developed, reviewed or revised more than five years ago. It may no longer reflect current evidence or best practice.
Published: 2015
National Health and Medical Research Council 
These guidelines (recommendations) in the web-version of this guideline were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 2 November 2015 under section 14A of the National Health and Medical Research Council Act 1992 In approving the guidelines (recommendations), NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of five years. NHMRC is satisfied that the guidelines (recommendations) are systematically derived, based on the identification and synthesis of the best available scientific evidence, and developed for health professionals practising in an Australian health care setting.
This publication reflects the views of the authors and not necessarily the views of the Australian Government.Prostate cancer has emerged as the second-most important cause of cancer death in Australian men. This has encouraged increasing efforts to diagnose potentially fatal prostate cancer while still confined to the prostate, as this offers the best opportunity for treatment to eradicate it.
Measurement of prostate-specific antigen (PSA) in serum has largely replaced the traditional method of detecting prostate cancer early, the digital rectal examination. However, while PSA testing is widely used, there is still debate over whether it offers men net benefit. PSA is specific to the prostate but not for cancer. Consequently, establishing PSA levels that will detect most cancers without prompting too many unnecessary biopsies is challenging. A marker that is specific for cancer would be ideal, but none has yet been found. Moreover, if a specific marker is identified, the problem remains that indolent cancers would be better not found. Gleason grade can predict cancer behaviour, but it is not perfect either and its assessment requires a prostate biopsy.
Yet it remains that prostate cancer kills men. Notwithstanding the problems of PSA testing, men still seek testing in the hope of avoiding death from prostate cancer.
In developing these guidelines, we have used systematic methods to determine from extensive, relevant scientific literature how PSA can be best used to find prostate cancer early, and how the next steps in decision-making about care can maximise the potential benefits and minimise the potential harms from PSA testing. These guidelines have been purpose-developed for Australia, occasionally drawing on existing evidence-based guidelines such as those developed by the UK National Collaborating Centre for Cancer. Consensus and clarity have emerged in most areas; in others, promising approaches to management have been identified that need further study before they can be accepted as the standard of care.
We are indebted to Prostate Cancer Foundation of Australia, Cancer Council Australia, members of the Expert Advisory Panel, subcommittee, systematic reviewers and all other contributors. All made vital contributions to developing these guidelines.
Professor Villis Marshall AC
Chair, Expert Advisory Panel
Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer