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On PSA Testing

http://www.australiandoctor.com.au/opinions/guest-view/why-do-doctors-keep-silent-about-their-own-prostat

Simon Chapman’s ebook: Let-sleeping-dogs-lie

http://www.australiandoctor.com.au/news/latest-news/nhrmc-finally-releases-its-psa-advice

For every 1000 low-risk, 60-year-old men tested annually over a decade:

  • Two will avoid dying of prostate cancer before age 85
  • Two will avoid metastatic prostate cancer before age 85
  • 87 will have a false-positive test leading to an unnecessary biopsy, and 28 will suffer significant side effects as a result
  • 28 will be “overdiagnosed” with a prostate cancer that would likely otherwise have remained asymptomatic
  • 25 will be “overtreated”, 7-10 of whom will be left impotent or incontinent as a result
  • PSA testing has “no discernible effect” on overall mortality

The figures are largely unchanged from a draft version released last

Not sure what to say about PSA testing?

David Brill 6 comments

The NHMRC has finalised its PSA testing advice for doctors, in what is claimed to be the best summary of the evidence to date.

Released Tuesday, the document provides a backgrounder for GPs to discuss both the benefits and harms of PSA testing with asymptomatic men.

Following an extensive literature review, with input spanning general practice, urology and oncology, the guide provides a list of statistics to use in conversation with patients (see below box).

Professor Ian Olver (pictured), a member of the NHMRC’s expert advisory group, said the group was “as confident as we can be” in the figures.

“We’re trying to say that the reason this can’t be promoted as a population test for everyone is that there are benefits and risks that have to be balanced. Every man has to decide where that balance lies for him,” said Professor Olver, CEO of the Cancer Council Australia.

“We’re providing an evidence-based tool for practitioners to be able to have that discussion.”

For every 1000 low-risk, 60-year-old men tested annually over a decade:

  • Two will avoid dying of prostate cancer before age 85
  • Two will avoid metastatic prostate cancer before age 85
  • 87 will have a false-positive test leading to an unnecessary biopsy, and 28 will suffer significant side effects as a result
  • 28 will be “overdiagnosed” with a prostate cancer that would likely otherwise have remained asymptomatic
  • 25 will be “overtreated”, 7-10 of whom will be left impotent or incontinent as a result
  • PSA testing has “no discernible effect” on overall mortality

The figures are largely unchanged from a draft version released last year, although the NHMRC has now stressed that the document “is not a substitute for relevant clinical practice guidelines and therefore does not contain recommendations”.

Meanwhile, GPs will have to wait until December for full consensus clinical practice guidelines, which are currently being developed by the Cancer Council Australia and Prostate Cancer Foundation of Australia.

These guidelines also have broad, multidisciplinary representation, and it is hoped they will provide some resolution to a debate that has divided Australia’s medical colleges in recent years.