Rise in prostate cancer raises alarm

A dramatic rise in the number of men being diagnosed with incurable prostate cancer in the US has raised alarm among Australian doctors.
Surgeons from the Urological Society of Australia and New Zealand fear there could be a similar increase in Australia due to a decline in testing for protein marker PSA.
A new study shows the number of men presenting with metastatic prostate cancer has increased dramatically in the US following a decline in PSA testing that coincided with the high profile US Preventative Services Task Force (USPSTF) recommendations against PSA testing for the disease.
There has been a similar drop in testing in Australia following the recommendations that received widespread publicity worldwide, according to the Urological Society.
“While there have not yet been any local studies showing the longer term consequences of a decline in PSA testing in Australian men, we are concerned there are men who may have benefited from testing who either were not offered or did not seek PSA testing as a consequence of confusion about the recommendations both overseas and in Australia,” said the society’s president, Professor Mark Frydenberg.
The study, published in journal Prostate Cancer and Prostatic Diseases, analysed data from more than 1000 US facilities and found of the more than 760,000 men with prostate cancer there was a decline in the incidence of low-risk disease.
However, alarmingly the incidence of metastatic prostate cancer rose between 2004 and 2013 by 72 per cent.
The largest increase, 92 per cent, was seen in men aged 55-69 years, who doctors say are typically thought to benefit most from PSA testing and early definitive treatment.
The study noted, however, the findings could not be explained solely as a consequence of the USPSTF recommendations, as increases in the metastatic prostate cancer began in the years prior to its release.

Prof Frydenberg believes new, world-first consensus guidelines on PSA testing in Australia this year will end uncertainty over the best approach to testing for prostate cancer which is the second most common cause of cancer-related death among men in Australia.
“We believe that while imperfect, the PSA blood test has a very important role to play in preventing prostate cancer deaths,” he said.


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