Get in the Mo about prostate cancer

More than 3000 Australian men lose their lives to prostate cancer each year, and more men die of prostate cancer than women die of breast cancer, according to the Prostate Cancer Foundation of Australia.

Despite previous controversy surrounding prostate cancer screening, diagnoses are increasing in accuracy - and should allay patient concerns regarding overdiagnosis and overtreatment, according to Queensland-based Urologist Dr Timothy Nathan.

The prostate cancer screening controversy largely stemmed from the 2016 American ProtecT trial, “which did not show a benefit for screenings, but this was a flawed study,” Nathan said.

“Better studies [show] a 30 to 40 per cent reduction in prostate cancer mortality in screened men,” he said, referring to The European Randomised Study of Screening for Prostate Cancer, published in 2009, and the Swedish Göteborg Randomised Prostate Cancer Screening Trial - which concluded in 2014.

Times have changed

PSA is a protein produced by both normal and malignant cells of the prostate gland, and which can be detected in the blood. The PSA test measures the level of PSA in the blood.

“A high PSA result used to be followed by an untargeted biopsy - where you could either miss the cancer, or find a non-aggressive cancer, causing anxiety for the patient,” Nathan said.

“Now that we are [increasingly] accurate in picking out more aggressive cancers with more advanced MRI scanning and targeted biopsies, concerns about [unnecessarily] treating non-aggressive, low-grade cancers [should be allayed]. In non-aggressive prostate cancer, we can just monitor patient closely with what we call active surveillance rather than offering treatment.”

When to get a PSA test

The age to begin PSA testing depends on the individual’s risk, Nathan said.

“The main risk factor for prostate cancer is a family history. If a man has one or more first-degree relative, a brother or father with prostate cancer, I would recommend [annual] PSA testing from age 40. For men with no risk factors, PSA testing is only needed from age 50, every two years.  

“After age 70, PSA screenings can be discontinued because the benefits of treatment are less beyond that age.

“A high PSA doesn’t necessarily mean you have prostate cancer,” Nathan said. “It could just indicate inflammation in the prostate, prostatitis, which can occur after bike riding, intercourse, or a urinary tract infection. In some men this inflammation causes a transit PSA rise.”

PSA levels are re-tested two to four weeks after an elevated PSA test. If PSA is still high, further testing with MRI imaging can determine whether this is due to a tumour, inflammation or another condition, Nathan said.

“Prostate cancer screening does save lives. Any physical symptoms and signs of prostate cancer only develop in the advanced stages, so the aim is to find it during the early stages and have the chance to cure it.

“If aggressive prostate cancer is picked up early, the prognosis is usually excellent with a combination of surgery, radiotherapy or both, with a 15-year survival rate in over 80 to 90 percent of men for some tumours,” Nathan said.