Testing
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.This chapter summarises evidence about strategies for prostate-specific antigen (PSA) testing as a tool for early diagnosis of prostate cancer in primary care and makes recommendations applicable to this setting. It makes no recommendations about population screening, and the recommendations in this guideline would not necessarily apply to population screening for prostate cancer using PSA as the screening test.
Developing an effective and acceptable approach for testing to detect early prostate cancer in men attending primary care who do not have symptoms that suggest they might have prostate cancer involves determining:
- whether early diagnosis and treatment of prostate cancer would be likely to benefit the patient
- which methods of decision support for men increase their capacity to make an informed decision whether to undergo PSA testing
- which strategies for PSA testing provide the best balance between the benefits and harms of testing for men without a history of prostate cancer or symptoms that might indicate prostate cancer
- how (if at all) PSA testing strategies developed for men at average risk of prostate cancer should be modified for men at high risk of prostate cancer
- which men would be unlikely to live long enough to benefit from PSA testing
- the role of digital rectal examination (DRE), if any, in association with PSA testing
- which further PSA tests (e.g. free-to-total PSA percentage, PSA velocity, Prostate Health Index) should be offered to improve the chance of detecting clinically important cancer, when the initial PSA test result is below the threshold selected as an indication for biopsy
- which further PSA tests (e.g. free-to-total PSA percentage, PSA velocity, Prostate Health Index, repeated total PSA) should be offered before referring for biopsy, when the initial PSA test result is above the threshold selected as indication for biopsy.
See also Chapter 2 Discussion.