Readers of our blog will know that one of our favourite sports is to report on every new set of PSA testing guidelines that come our way, if only to show how often they change and contradict each other.
Poking fun at PSA is just too easy. This week two major recommendations regarding the pros and cons of PSA testing were released within 48 hours of each other. And as expected – they contradict each other completely.
The Prostate Cancer World Congress met in Melbourne and released a consensus statement regarding testing. This is the expert opinion from world leaders in the field – primarily urologists. The main points they made were:
– Prostate cancer testing is a separate issue from prostate cancer treatment (finding prostate cancer early does not have to involve surgery. Depending on the PSA and then other tests, it could involve just watching to see how quickly everything develops/evolves.)
– A man in his 40s can have a baseline test to determine future risk.
– For men between 50 and 70, regular PSA reduces the risk of prostate cancer spreading by 30% and decreases the risk of dying by 20%. Older men who are expected to live at least 10 more years will probably also benefit from testing.
Fair enough. The experts have spoken and the logic seems reasonable.
But wait! A couple of days later the Australian National Health and Medical Research Council – the chief scientific research body released its recommendations for PSA testing based on a review of the world research and literature. Their advice is that PSA testing has no discernible impact on the risk of dying of prostate cancer but runs a significant risk of leading to overdiagnosis and overtreatment including significant side effects.
The key points they make are:
If 1000 60-year-old men who have a low-risk of prostate cancer get tested annually for 10 years then:
• Two will avoid dying of prostate cancer before age 85.
• 28 will be diagnosed with prostate cancer as a result of the PSA testing, but many of them would never have has symptoms so their test is finding a disease that actually doesn’t matter
• 87 will undergo unnecessary biopsies and 24 will suffer significant side effects as a result.
• 25 will undergo potentially unnecessary treatment, 7-10 of whom will be left impotent or incontinent as a result.
The full NHMRC report can be read at http://consultations.nhmrc.gov.au/files/consultations/drafts/resources/men4apsatestingreportv03190713.pdf
So there we have it – the latest evidence analysed by up to date experts resulting in completely contradictory advice.
What is a patient to do? What, for that matter, is a GP to do?
The truth is – we’re not sure. By all means, talk to your doctor. And we will do our best to tease out the evidence and discuss the pros and cons with you. But don’t expect us to give a clear-cut answer or definitive advice.
We’re not expert enough to do that.