Do you need the test?
Why do you need to read this?
Confusion prevails about prostate cancer and PSA testing – who needs one, why it’s not necessary for everybody, and what you should do about it.
Our aim is to help men make an informed decision about PSA testing.
While screening programs for breast, cervical and bowel cancers can save lives, the case for PSA testing for prostate cancer is not clear cut. While it probably does prevent some prostate cancer deaths, it can also lead to overdiagnosis, needless treatment and significant negative physical and psychological impacts for men and their loved ones.
But do not choose to ignore further checks becuse of this confusion. Get a second opinion. Remember that the disease may be too late to control if you start getting symptoms. In other words, don’t use the confusion as an excuse to not do anything.
Prostate Cancer in Australia
Prostate cancer is an important public health issue. Every year 1.3 million men worldwide are diagnosed with prostate cancer. Australia has one of the highest incidence rates internationally, with 1 man in every 7 Australian men likely to be diagnosed during their lifetime. While survival rates for prostate cancer are high (over 95% of men survive to at least five years), it remains the most commonly diagnosed cancer in Australian men. With the growing Australian population and increasing life expectancy, the number of men diagnosed will continue to increase. There are over 200,000 Australian men currently living with a diagnosis of prostate cancer and this year 20,000 more Australian men will be diagnosed and 3500 will die of the disease.
What is a PSA test?
Prostate-specific antigen, or PSA, is a protein produced by both normal and cancerous cells of the prostate gland. The PSA test is a blood test that measures levels of PSA in the blood, given as nanograms of PSA per millilitre (ng/mL) of blood.
An elevated PSA level can be indicative of prostate cancer, but it can also be caused by a number of benign conditions which are not cancerous.
What else do you need to know?
PSA testing may lead to fewer people dying from the disease and developing advanced prostate cancer; but it can also lead to the diagnosis and treatment of prostate cancers that may not be harmful (this is called over-diagnosis). Men should not use this as an excuse to avoid getting tested or you may be too late to prevent the cancer getting into your system (metastasis).
Testing may also include a digital rectal examination, a CT bone scan and, maybe, an MRI scan or a PSMA-PET scan. There is a great guide for newly diagnosed men which outlines all the information you need.
If you are diagnosed, it’s important to discuss your options with your GP and doctors. Treatment for prostate cancer can cause unwanted side effects. When you are first diagnosed, you tend to be thunderstruck and don’t ask the necessary questions. If you need more answers, get back to your practitioner or even get a second opinion. It’s worth it.
Evidence shows that for men in Australia who have PSA testing every two years from 50 to 69 years of age, more men will experience over-diagnosis than will avoid dying from prostate cancer or being diagnosed with advanced prostate cancer.
For more information about treatment, call the Prostate Cancer Foundation of Australia on 1800 22 00 99 or go to www.pcfa.org.au. Also, our support group has men who are going through different treatment programs and may be able to show you how they managed their journey. Use the contact information shown for the group in this web site.
Key questions to ask
The information below tells you how likely it is that a man having PSA tests every two years from age 50 will experience the benefits or harms of PSA testing.
Key Questions |
Have PSA testing (every 2 years from 50 to 69 years of age) |
|---|---|
| What are my chances of dying from prostate cancer? | 4 out of 1000 men die from prostate cancer. |
| What are my chances of being diagnosed with advanced prostate cancer? | 1 out of 1000 men are diagnosed with advanced prostate cancer. |
| What are my chances of being diagnosed and treated for a prostate cancer that would not have caused harm? | 25 out of 1000 men are diagnosed and put on active surveillance or treated for a prostate cancer that would not have caused harm (over-diagnosis). This should not be an excuse to avoid getting tested. |
| What are the chances I will have a false positive test result that leads to extra testing? | 93 out of 1000 men have a false positive result and extra testing, when they do not have cancer. The latest PSMA testing is overcoming this. |
| What are the chances I will develop unwanted side effects if I am treated for prostate cancer? | About 20% of men who have a radical prostatectomy have long-term inabilty to hold their urine but there treaments to overcome this. About 70% of men who have a radical prostatectomy have long-term difficulty getting an erection; About 50% of men who have radiation therapy have long-term difficulty getting an erection; About 17% of men who have radiation therapy have long-term bowel problems (including bowel urgency and loss of bowel control) but modern radiation techniques have largely overcome these.1 |
| Can I expect to live long enough (about 7 years or more) to benefit from PSA testing? | Healthy Australian men age 50 to 69 have better than a 94% chance of living another seven years; but men with some health conditions and older men may be less likely to live this long. |
| What do I need to do after making my choice? | If you choose to start PSA testing, you should consider another PSA test every 2 years after the first (as per Australian guidelines). Every time you consider having a PSA test you should consider your chances of living another seven years. |