Key policy priorities
Resources (including decision making tools) for health professionals to assist men with making an informed decision on prostate specific antigen (PSA) testing have been developed. While there are national evidence-informed consensus guidelines to guide the use of PSA testing in Australia, the impact of the guidelines have not been evaluated adequately. More research is required to improve early detection of prostate cancer and health professionals should be supported to help men make informed decisions on PSA testing.
Research investment into prostate cancer early detection
The PSA test is not suitable for population-based screening for prostate cancer as it is a non-specific test. While elevated levels of PSA can be caused by prostate cancer, they can also be caused by other conditions. An improved screening or diagnostic test is needed which can detect aggressive prostate cancers and offer a mortality benefit. Biomarkers can be used to predict the course of prostate cancer. BRCA1 and BRCA2 mutations have been associated with an increased risk of prostate cancer progression and decreased overall survival. Emerging research suggests that ANO7 is a promising biomarker to predict prostate cancer aggressiveness as high expression of ANO7 is associated with increased prostate cancer mortality. Further research into biomarkers associated with prostate cancer mortality is needed to assist with optimising prostate cancer early detection.
Although prostate cancer is subject to a high level of research funding in relation to disease burden and other cancers in Australia, it is unknown how much of that funding is allocated to improved early detection technology. Highlighting the significant limitations of current early detection technology would assist in prioritising research investment towards improved technologies.
Support GPs and other health professionals to assist men to make an informed decision on PSA testing
Responsibility for advising men about PSA testing lies mostly with GPs who face difficulties with explaining the complex risks, benefits and uncertainties about the PSA test while balancing conflicting viewpoints and unclear medico-legal risks. GPs and other relevant health professionals should be supported and resourced to enable them to adequately inform men of the benefits and risks of PSA testing for prostate cancer, thus enabling men to make an informed decision. Evaluations of GP education workshops have shown that as participants’ knowledge about PSA testing and level of understanding increased, they were more likely to initiate discussions with patients about the risks and benefits of the test, and they were more confident in doing so. The use of current resources, developed by the National Health and Medical Research Council for health practitioners, should be promoted to assist in shared decision-making. Educating and providing resources and decision aids to GPs and other health professionals will improve care for men considering PSA testing for prostate cancer.
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- Metcalfe R, Russell R, McAvoy B, Tse J, Sutherland G, Hoey L. Promoting shared decision making and informed choice for the early detection of prostate cancer: development and evaluation of a GP education program. Cancer Forum 2006 Mar;30(1):38-42 Available from: http://www.cancerforum.org.au/File/2006/March/CF06Mar_38-42.pdf.