Prostate cancer

This policy presents information about prostate cancer research and diagnostic aids. It will be updated as significant new literature is published or if there are important changes in the policy environment.

This policy has been developed by Cancer Council Australia and reviewed internally by the Screening and Immunisation Committee of Cancer Council Australia.

This policy has been externally reviewed by Professor Henry Woo (Urological Surgeon) and Professor Ian Davis (Medical Oncologist/Prostate cancer researcher). It has been approved by Cancer Council’s principal Public Health Committee.

Contact: cancercontrolpolicy@cancer.org.au

Key policy priorities in summary

• Research investment into prostate cancer early detection.
  • Further research into an improved technology to detect aggressive prostate cancer.
• Support general practitioners (GPs) and other health professionals to assist men to make an informed decision on PSA testing.

Prostate cancer was the most commonly diagnosed cancer in Australia with 19,305 new cases diagnosed in 2016.^[1] It is the second most common cause of cancer death among Australian men with 3,264 deaths attributed to prostate cancer in 2018.^[1] Transgender women, male-assigned non-binary people or intersex people can also get prostate cancer if they have a prostate. However, most data available for prostate cancer is reported for males only and therefore statistics used in this chapter will refer to males. The causes of prostate cancer are poorly understood and there are no conclusively established modifiable risk factors associated with prostate cancer. Nor can prostate cancer be detected early through population-level screening interventions that meet the World Health Organisation criteria. However, the high incidence and mortality of prostate cancer have warranted its inclusion in the National Cancer Prevention Policy.

Prostate cancer mortality increases with age at a markedly higher rate than other cancers. For example, prostate cancer deaths double in older age groups (aged 60-69, 70-79 or over 80) compared to a 22% increase in the same age groups for bowel cancer.^[2] The impact of prostate cancer will increase with population ageing and increasing life expectancy.

Testing to assess whether an asymptomatic man may be at risk of developing prostate cancer, using the prostate specific antigen (PSA) blood test is common. The PSA test measures the amount of prostate specific antigen in blood, however, as the test is not cancer-specific, testing asymptomatic people using the PSA test is a complex and controversial issue and the subject of ongoing debate, both in Australia and internationally. The population health benefits of screening for prostate cancer using the PSA test are currently uncertain. There is no other primary test for prostate cancer risk in common use, other than digital rectal examination (DRE), the use of which is not supported in the primary care setting by the Australian clinical practice guidelines. Therefore, there is no population screening program for prostate cancer in Australia or anywhere in the world, with the exception of Lithuania.

While some prostate cancers are aggressive and life-threatening, many grow slowly and do not progress sufficiently during a person’s lifetime to cause any problems. No current test, including the PSA test, can adequately distinguish between these two kinds of prostate cancer. Consequently, while testing of healthy people may offer a longer life to those with aggressive cancers, the consequences of a test may harm people with indolent cancers by exposing them to treatments that cause significant side effects such as urinary incontinence and sexual dysfunction without any compensating benefit.

While the uncertainty persists, current evidence does not support population screening for prostate cancer. Individuals who ask for, or are offered testing, are advised to make an informed decision about whether or not to be tested.