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PSA Testing for Prostate Cancer in Asymptomatic Men: Information for Health Practitioners submission

ID: 
3
Personal Details
First Name: 
BRUCE
Last Name: 
KYNASTON
Specific Questions
1. What are the potential benefits of PSA testing?: 

Obtaining a diagnosis of prostate cancer if it is present and actually included in the region biopsied.

2. What are the potential harms of PSA testing?: 

If a diagnosis is made, it may not represent the true extent of grade of the disease, due to sampling error.  If cancer is missed (false negative) diagnosis is delayed.

Apprehension may risk a younger man’s making a decision to rush into treatment when managed surveillance would be wiser.  His urologist may have difficulty convincing him.

An older man might understand the wisdom of watchful waiting, but both could have anguish should metastatic disease appear after some ‘inactivity’.

3. How frequent are these benefits and harms?: 

For every 1000 men tested, 2 men will avoid death from prostate cancer before 85 years of age because of PSA testing*. *Estimated using Australian age-specific incidence and mortality rates for prostate cancer by Howard et al. Arch Intern Med 2009;169:1603-1610.

I have not seen this paper but as mortality rates for prostate cancer normally don't include data of men who die with PCa rather than because of it, perhaps then the statement, though true, can be questioned.

Otherwise,   I am in general agreement with this section.

4. What research has been done to study the effectiveness of PSA testing for prostate cancer?: 

No relevant comment, but the review is appreciated.

Longer follow up studies are needed to really evaluate the true answer.

5. Does PSA testing in asymptomatic men reduce their risk of dying from prostate cancer?: 

Well presented.

6. Does PSA testing in asymptomatic men reduce their overall risk of dying?: 

While the information available in inconclusive, but perhaps the ‘jury is still out’ on this matter.

7. Does PSA testing in asymptomatic men reduce their risk of having metastases present at diagnosis of prostate cancer?: 

That appears to be shown to be: Yes.

8. Does PSA testing in asymptomatic men affect the quality of life of men who are diagnosed with prostate cancer?: 

It most certainly does to varying extent.

9. What is a PSA test?: 

 A blood test.  It is affected by age, and a collection of prostatic conditions as well as some ‘lifestyle’ events in the days before the test is taken.

10. How accurate is a PSA test?: 

There are false positives and false negatives.

11. Are there any other screening tests available for prostate cancer?: 

Digital rectal examination may detect abnormalities.

12. How can men prepare for a PSA test?: 

 Yes, by avoiding those ‘lifestyle’ factors shortly before attending for it.

13. What are normal and abnormal PSA test results?: 

 Those that are consistent with the man’s age, and those that are above that.

14. What happens if a man receives a normal PSA test result?: 

He should have a DRE if he wants to be tested.

He should be advised when to be tested again.

Much depends on his age and general health status.

15. What happens if a man receives an abnormal PSA test result?: 

Depending on his age, he could, if elderly, be given his option to be observed and reviewed

or he could be retested and/or referred to a Urologist for advice

16. If a man receives a diagnosis of prostate cancer after an abnormal PSA test, what choices does he have?: 

 This matter is well discussed in the paper.

17. If a man decides not to have a PSA test what risks should he and his family be aware of?: 

If there is no family history of prostate or breast cancer, there is a probability (varying levels of same for age) of acquiring the complaint in later life and having a risk of dying from it.

General Comments
18. Considering the Information Document is for Health Practitioners, do you have any other comments?: 

The present evidence is inconsistent as to whether there is an effect of PSA testing on the risk of dying from prostate cancer.

The review is one of "public health' i.e. 'per 100,000 of population. or similar, and 'personal health' is a different matter.

PSA testing appears to have no discernible effect on the overall risk of dying. ?Meaning it has not 'killed' any, Public Health wise.

However, overall, the evidence shows that PSA testing reduces the risk of having metastases present at diagnosis of prostate cancer.

The Health Practitioner must take time to help the individual if he desires to consider testing as prostate cancer is not uncommon, worse if there is a significant family history of prostate or breast cancer.

Page reviewed: 4 March, 2014