Document 19104

In brief
Latest news
The Healthy Male
Practice Nurse Men’s Health Education
Practice nurses are becoming more
widely recognised as an integral part
of delivering health information within
general practice. Andrology Australia has
been working with the Australian Practice
Nurses Association (APNA) to identify
if a need exists for the development
of a men’s health education program
developed specifically for practice nurses.
A Men’s Health Education Survey was
distributed to members of the APNA
to determine the information and
education needs of practice nurses when
engaging men in general practice.
Feedback from the survey showed that
the majority of practice nurses had never
undertaken professional education on
male reproductive health topics such as
erectile dysfunction and prostate disease.
who have an interest in men’s health, are
members of the APNA and have links with
their local Division of General Practice.
The survey results established a need
for the development of a men’s health
education program specifically targeted
toward practice nurses, with 78 per cent
of the respondents indicating that they
would like further education on men’s
health issues within general practice.
The reference group will guide and
develop a practical education program
for practice nurses to deliver current
evidence-based men’s health education
specific to practice nurses across
Australia, including rural areas. The
initial aim of the reference group is to
develop a pilot education program in a
format suitable to practice nurse needs
and preferred methods of education.
To address the need for Practice Nurse
Education on men’s health issues, an
Andrology Australia Practice Nurse
Education Reference Group has been
established. The reference group includes
practice nurses from across Australia
Evaluation of the pilot will help
determine areas of improvement for
a broader roll-out nation-wide.
Research round-up
Public Knowledge of Benefits of Prostate Cancer Screening in Europe
A recent study1 surveyed 10,228 people
across nine European countries to
establish the extent of the public’s
knowledge of the benefits of screening
for breast and prostate cancer, to find
out whether decisions about testing
are likely to be informed. With respect
to prostate cancer screening, the
study explored whether the public’s
knowledge of the benefits is realistic,
which sources are used for health
information, and if the number of times
men used the information sources
impacts their level of understanding.
The male participants were given a
multiple choice question to estimate the
number of lives saved by screening after
ten years, if 1000 men aged 50 and older
had PSA testing every two years. Only
11 per cent of the men surveyed made
reasonable estimates (that the number
of prostate cancer deaths prevented
for every 1000 men screened was less
than or equal to one). The remaining
89 per cent either over-estimated the
benefit or didn’t know. The estimates
made by men aged between 50 and
69 were no more correct than those
made by men in young age groups.
Family or friends were the most used
source of health information, followed
by experts (doctors and pharmacists),
general media, and lastly healthspecific resources (including health
organisation pamphlets, reference
books, health insurance, Internet).
The number of times a man used the
sources of information didn’t increase
his understanding of the real benefits
of screening, but was often related to
an overestimation of the benefit.
To ensure men can make informed
and rational decisions about whether
to have PSA testing, they must be
aware of the benefits of populationscreening (or lack of). An Australian
study2 has shown that resources that
help patient decision-making used
in general practice can increase the
doctor’s knowledge and confidence in
discussing testing with men; such as the
PSA Decision Card: ‘The Early Detection
of Prostate Cancer in General Practice:
Supporting Patient Choice’. Available
from: www.andrologyaustralia.org/
docs/PSAdecisioncard20041007.pdf)
1 Gigerenzer G et al. Public Knowledge of Benefits
of Breast and Prostate Cancer Screening in Europe.
JNCI 2009; 101: 1216-1220
2 Steginga S et al. Shared decision-making and
informed choice for the early detection of prostate
cancer in primary care. BJU 2005; 96: 1209-1210
New resources on the
Andrology Australia website:
Andrology Australia is pleased
to be able to include two new
booklets on the website www.
andrologyaustralia.org for download.
The first booklet, ‘Maintaining your
well-being: Information on depression
and anxiety for men with prostate
cancer and their partners’ was
developed by beyondblue: the national
depression initiative in partnership
with the PCFA. The booklet provides
information on common reactions
to a diagnosis of prostate cancer, the
cancer journey, helpful strategies to
deal with prostate cancer, signs of
distress, including depression and
anxiety, and how to seek help for
depression and anxiety. Hard copies
are also available from the beyondblue
website (www.beyondblue.org.au) or the
beyondblue info line (1300 22 46 36).
The second booklet now available to
download is the ‘Boys and Puberty:
almost everything boys will ever need
to know about body changes and other
stuff!’. Produced by the Government of
Western Australia, Department of Health.
Farewell to Board Member,
Professor Doreen Rosenthal AO
Andrology Australia bids a sad farewell
to Professor Doreen Rosenthal AO from
the Advisory Board. We thank Doreen
for her invaluable contribution to the
ongoing success of the Andrology
Australia program and wish her all
the best in her future endeavours.
PCA3 testing for prostate cancer
A recent study examined whether the level
of prostate cancer antigen 3 (PCA3) in
the urine following a DRE (Digital Rectal
Examination) can be used to help guide
the decision to perform a repeat biopsy to
confirm prostate cancer after a raised PSA.
The study suggested possible benefit of
using this urine test in addition to the
current PSA test and DRE. The study
also explored whether PCA3 could act
as an indicator of the clinical stage and
aggressiveness of prostate cancer.
Many researchers are looking for new
markers of prostate cancer. At this stage,
PCA3 is still an experimental test and
does not have a place in the routine
assessment of prostate disease. There are
only a few published studies on PCA3 and
diagnostic, cutoff values are not clear
and have limited reproducibility. There
is no evidence to suggest that the PCA3
test is better than the current testing
of PSA and/or DRE in the detection
or exclusion of prostate cancer.
While the Internet provides men with
access to information about new
prostate markers for prostate cancer,
PCA3 is not currently approved for use in
Australia by the TGA (Therapeutic Goods
Administration). While some doctors may
offer the technology, as it is not covered
by the Medicare Benefits Schedule, there
may be significant costs to a patient
without any rebates being available.
Given the lack of robust evidence, the
PCA3 test would potentially raise more
doubts than current PSA testing methods
and subsequently may increase the rate
of biopsies, rather than decrease it.
If you are concerned about prostate
cancer, talk to your doctor about the
pros and cons of testing using currently
available and well-validated methods.
Change of Address
For any future correspondence, please
note that our address has changed to:
Public Consultation on draft Clinical Practice Guidelines for the
management of Locally Advanced and Metastatic Prostate Cancer
The Australian Cancer Network is inviting public submissions on its draft Clinical Practice Guidelines for the
Management of Locally Advanced and Metastatic Prostate Cancer. The guidelines address the management of locally
advanced and metastatic prostate cancer including clinical, psychosocial and palliative aspects of the disease.
The draft document and directions on how to make a submission can be viewed and downloaded from
the ACN website at www.cancer.org.au/clinical_guidelines. Submissions close 5 October 2009.
Andrology Australia
Monash Institute of Medical Research
PO Box 5418, Clayton,
Victoria, Australia 3168
Professor Doreen Rosenthal AO and
Andrology Australia CEO, Dr Carol Holden
Newsletter of Andrology Australia
Australian Centre of Excellence in
Male Reproductive Health
Editor: Sarah Camille
Postal Address:
Andrology Australia
Monash Institute of Medical Research
PO Box 5418, Clayton,
Victoria, Australia, 3168
Andrology Australia is supported by a
grant from The Australian Government
Department of Health and Ageing.
2
Community education
Supporting the Lions
Australian Prostate Cancer
Website
2
Upcoming events
Merv’s Have a Crack Day
Telephone:
1300 303 878
3
Focus on
PSA testing: What everyman
(and health professional)
needs to know
Facsimile:
+ 61 3 9594 7156
Email:
[email protected]
Population-screening for Prostate Cancer
using the PSA Test
Contents
Street Address:
27-31 Wright Street,
Clayton Victoria 3168
Internet:
www.andrologyaustralia.org
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
Issue 32 – Spring 2009
5
Professional education
Practice Nurse Men’s Health
Education
5
Research round-up
Public Knowledge of
Benefits of Prostate Cancer
Screening in Europe
6
In brief
6
Latest news
Andrology Australia is administered by
Monash Institute of Medical Research
Prostate cancer testing is a complex and
controversial topic of discussion amongst the
community, health professionals, professional
societies and policy makers. The debate is
due to a current lack of evidence on the
effectiveness of PSA (prostate specific antigen)
testing as a population-screening method for
reducing deaths of men with prostate cancer.
Even without a current recommendation
for population-wide screening for prostate
cancer, PSA testing is widespread in
Australia: estimates suggest that more
than 50 per cent of Australian men over
the age of 50 have had a PSA test1.
The anticipated and recently released interim
results of two large-scale randomised controlled
trials in the USA2 and Europe3 were hoped
to provide more definite answers on the
pros and cons of population-screening for
prostate cancer. Unfortunately, their results
differed and their interpretation was made
difficult by the differing study methods. So
what do the results mean for men considering
having PSA testing and their doctors?
In an effort to interpret the results, two
commentary papers with an Australian
perspective have been released4 5.
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DISCLAIMER
This newsletter is provided as
an information service.
Information contained in this newsletter is
based on current medical evidence but should
not take the place of proper medical advice
from a qualified health professional. The
services of a qualified medical practitioner
should be sought before applying the
information to particular circumstances.
From the Director
Professional education
Due to the uncertainty of the results, neither
paper recommends population-screening.
Instead, men should be informed on the current
evidence-base regarding PSA testing, including
the benefits and limitations of testing, and the
common and significant risks of detection and
treatment (such as erectile dysfunction and
urinary problems). If the well-informed man
chooses to have a PSA test, he should be given
one. To ensure that men are well informed,
both papers call for more evidence and point
to the need for more understanding of the
benefits (in essence, the extent to which deaths
can be prevented) versus harms (in essence,
the burdens of invasive testing and treatment
side-effects) that flow from routine PSA testing.
Both papers conclude that the current
data suggests that a population-screening
program using PSA testing would result in
over-diagnosis of low grade tumours with
over-treatment resulting in significant and
unwarranted side-effects. Furthermore it is
suggested that testing should only be applied
to men with an anticipated life-expectancy
of more than seven years making populationscreening inappropriate for many elderly men.
1 Holden CA et al. Men in Australia Telephone Survey (MATeS):
a national survey of the reproductive health and concerns of
middle-aged and older Australian men. Lancet 2005; 366: 218-224.
2 Andriole GL et al (2009). Mortality Results from a Randomized
Prostate-Cancer Screening Trial. N Engl J Med. 360: 1310-1319
3 Schroder FH et al. Screening and Prostate-Cancer Mortality
in a Randomized European Study (2009). N Engl J Med. 360
1320-1328 Andriole GL et al (2009). Mortality Results from a
Randomized Prostate-Cancer Screening Trial. N Engl J Med. 360:
1310-1319
4 Barratt A et al. Screening for prostate cancer: explaining new
trial results and their implications to patients. MJA 2009; 191:
226-229
5 Smith et al. Evidence-based uncertainty: recent trial results on
prostate-specific antigen testing and prostate cancer mortality.
MJA 2009; 191: 199-200
In response to the results of the overseas trials,
Andrology Australia provided its position on the
debate about PSA testing for prostate cancer
in the last newsletter; with an ‘Andrology
Australia Statement on PSA Testing for Prostate
Cancer’. Since then, Andrology Australia has
received much feedback from men asking
“What do the findings mean for me?”
Male is PSA testing from the viewpoint of an
individual man considering testing, and aims
to communicate the current evidence-base to
men, the community and health professionals.
It translates the evidence-base into information
relevant for discussion between a man and
his doctor when considering whether to have
a PSA test, and lists additional resources
that can help to guide the discussion.
With a lack of conclusive evidence about
population-screening, and the recommendation
for men to make informed decisions on
whether to have a PSA test/DRE (Digital
Rectal Examination), it is important that
professional societies and health professionals
provide a consistent and coherent message
on PSA testing to avoid confusion in men
considering being tested for prostate cancer.
The 'Focus On' for this edition of The Healthy
We hope this edition of our newsletter
helps clarify and guide discussions
between men and their doctor in regard
to this important health issue.
Professor Rob McLachlan
Community education
Supporting the Lions Australian Prostate Cancer Website
The Lions Australian Prostate Cancer
website was established in 2000 by the
education committee of the Australian
Prostate Cancer Collaboration (APCC).
The website was developed in response to
a needs assessment survey of men with
prostate cancer, which was done with
the help of the Association of Prostate
Cancer Support Groups (now the
Support and Advocacy Committee of the
Prostate Cancer Foundation of Australia).
Development funding was kindly
provided by Lions Australia, and the
website was supported in kind by the
Repatriation General Hospital as the
developer of much of the original
content. The site received a Public Health
Association of Australasia Award in 2001.
The site assists men affected by prostate
cancer and their families by providing
information on prostate cancer
and treatment options, educational
resources and stories and experiences.
It also has an online helpline. The
site attracts 400,000 hits and 45,000
visitor sessions per month. Since its
development, the content of the site
has been contributed to and updated
by the education committee of the
APCC, which includes representatives of
the Cancer Councils across Australia.
provides men and their families
with accurate and evidence-based
information on prostate cancer.
We look forward to an ongoing
collaboration with Lions Australia and
continuing to provide accessible sources
of information on prostate cancer.
In continuing to support the quality
and evidence-based prostate cancer
education activities and information
developed by the Australian Prostate
Cancer Collaboration, which will cease
operations in 2009, Andrology Australia
is pleased to take on the management
of the Lions Australian Prostate Cancer
website (www.prostatehealth.org.au).
Focus on: PSA testing: What everyman (and health professional) needs to know
Author: Professor RA 'Frank' Gardiner
Although there is limited evidence that PSA testing reduces the
risk of death from prostate cancer, there has been a noticeable
change recently with more men now asking for information
about being tested.
What is a PSA test and when is it used?
Andrology Australia will continue to
work with the education committee
of the Australian Prostate Cancer
Collaboration and Lions Australia
to ensure that the content of
the site is kept up to date and
Prostate Specific Antigen (PSA) is a protein made mainly in the
prostate and is normally found in low levels in a man’s blood
stream. A PSA test measures the level of PSA in the blood and
may help to diagnose prostate disease. A high PSA in the blood
almost always means that something is wrong with the prostate,
but not necessarily prostate cancer.
A high PSA may be found in men who have prostatitis
(infection or inflammation of the prostate), benign prostatic
hyperplasia (BPH known as prostate enlargement), or least
commonly, prostate cancer.
Why is the decision to have a PSA test a complex one?
Merv’s Have a Crack Day Update
The first group of cricketing legends
have been confirmed. Merv's great
mates and fellow Aussie legends Ian
Healy, David Boon, Damien Fleming and
Rodney Hogg are all starters, and will be
joined by an eclectic mix of Australia’s
other sporting code and entertainment
celebrities yet to be announced.
The latest celebrity cricketer to be
announced boasts one of the longest
bowling run ups in the history of cricket
at 42km. Australian Olympic Champion
Steve Monaghetti has confirmed his
attendance on the day and support of
the importance of raising awareness
of men’s health. The event will be
officially opened by and participated
in by cricket lover and men’s health
advocate, the Governor of Victoria,
Professor David de Kretser AC who is
also Patron of Andrology Australia.
Andrology Australia also welcomes
and is proud to announce ‘Diadora’ as
the official merchandise and apparel
event sponsor. Diadora is a leading
Italian sports brand and it’s licence
in Australia is owned by Overland
Group (Australasia) Pty Ltd.
STAGE ONE:
The unique opportunity to register
a team for the event or secure
the limited categories of event
sponsorship available will soon close.
Register your interest today on the
Merv’s Have a Crack website at
www.mervshaveacrackday.com.au
A single PSA test is not a reliable sign of prostate cancer on its
own. Once a decision is made to be tested for prostate cancer,
a man starts on a ‘testing journey’ made up of three stages that
can continue for the rest of his life. If the additional stages
are not discussed with a man prior to his decision to have
the first PSA test and he receives an abnormal PSA result, the
additional stages can be highly unexpected and may cause
psychological distress.
The decision to have a PSA test should be made with the
understanding of all possible outcomes; including the physical
and psychological side-effects that can come with further testing,
prostate cancer diagnosis and its various treatment options, which
may include erectile dysfunction and continence problems.
For men diagnosed with prostate cancer, there are three treatment
possibilities: i) curative intent (radical prostatectomy or radiation
therapy); ii) commencement of androgen deprivation therapy
(ADT) following monitoring (watchful waiting) and iii) active
surveillance (which includes further biopsies). Monitoring may
be measuring PSA (+/- DRE) with a view to commencing ADT at
some later date or by active surveillance (involving PSA, DRE and
further biopsies). An increasing number of men diagnosed with
prostate cancer are proceeding to active surveillance for what is
considered to be cancer with a low-risk of progression; with the
option of radical prostatectomy or radiation therapy reserved
for those men whose cancers subsequently show evidence of
progressing as revealed by intense monitoring.
A cancer diagnosis is complicated by the fact that in about 1 in 4
men prostate cancer may act in an aggressive fashion (e.g. spread
to lymph nodes and to bone which may have already occurred at
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To ensure men are able to make informed decisions about
whether to be tested for prostate cancer, it is important
that evidence-based information about the current state of
knowledge about PSA testing is provided to men, the community
and health professionals in a form that they can easily
understand; including the physical and psychological impact the
decision and diagnosis may have.
Upcoming events
Time is passing
quickly and
momentum
is gathering
for the first
Andrology
Australia Merv’s
Have a Crack
Day event on
December 11,
2009. There has been a tremendous
amount of interest in teams registering
and companies securing their place
in sponsoring the event, which will
become an annual and coveted fixture
on Melbourne’s sporting calendar.
More sponsorship opportunities and
teams are available, but are filling up
fast, so register your interest today at
www.mervshaveacrackday.com.au.
Prostate cancer ‘Testing Journey’
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presentation but may not be demonstrable with imaging tests),
while in another 1 in 4 men the cancer remains indolent (e.g.
remaining localised to the prostate). At this stage there is no
useful marker to identify which cancers will behave in an indolent
or an aggressive fashion.
> PSA levels rise as a normal part of ageing as the prostate tends
to grow larger so the ‘normal’ levels (or reference range) of PSA
must be adjusted for a man’s age. Even when the PSA level is
within the normal range for that age group, a PSA velocity (the
time it takes for PSA levels to increase, such as a doubling over
12 months) trigger further investigation by your doctor
> Increases in single PSA levels taken at age 40 years (cut-off
0.6 ng/ml) and 50 years (cut-off 1.5 ng/ml) may suggest an
increased risk of prostate cancer over the next 10-20 years
> The combination of a DRE with a PSA improves detection rates.
However a DRE only allows a doctor to feel that part of the
prostate immediately in front of the rectum (back passage) but
not the other areas of the prostate that could also be affected
by cancer
> An abnormal PSA/DRE needs further assessment by a urologist
(specialist) to confirm if this is due to a growing cancer or a
non-cancerous problem such as prostatitis (inflammation due to
infection) or benign prostatic hyperplasia (BPH)
> The limitations of PSA testing should be discussed with your
doctor; including the inability of the PSA test to confirm
prostate cancer or to detect how advanced the cancer is and
how quickly it is progressing
> A normal PSA test (combined with a negative DRE) reduces the
chance that prostate cancer is present but does not exclude it
completely
> There is no level of PSA that identifies whether a man does or
does not have prostate cancer
What if I have a family history of prostate cancer?
Men with a strong family history of prostate cancer (whether a
grandfather, father, brother, uncle or cousin with the disease) are
at a greater risk of cancer and should think about being tested
from 40 years of age. On average, hereditary prostate cancer may
develop six years earlier than non-hereditary prostate cancer.
A history of breast cancer in female family members can also be
linked with a higher risk of prostate cancer in men. It is important
to discuss any family history of disease with your doctor.
What if I’m a health professional talking to my
patients about prostate cancer testing?
One in eight men diagnosed with prostate cancer will die of the
disease with this number varying depending on age and Gleason
score of disease at diagnosis, with younger men diagnosed with
more advanced cancer more likely to die from the disease (as
there are fewer competing causes of death or co-morbidities, such
as cardiovascular disease which is increasingly common as men
become older.)
Being tested for prostate cancer should be a shared decisionmaking discussion between a man and his doctor, and should only
happen if a man is properly informed of the potential gains and
risks of testing and then agrees to proceed with testing. It is not
appropriate to order a PSA test without a patient’s knowledge
or as part of a suite of blood tests unless the patient has been
adequately informed.
What if I’m a man thinking about prostate cancer testing?
It is essential that any health professional ordering and discussing
PSA testing is up-to-date with the scientific evidence and ensures
that balanced evidence-based information and resources are
provided to the patient before a decision is made.
Men should be aware that there is debate about the potential
gains and risks from PSA testing and prostate cancer treatment
options. If you are considering having your first PSA test/DRE,
you should discuss the following with your doctor and use the
resources listed to help guide the discussion:
A man seeking PSA testing should be given access to written or
web-based, relevant material which is evidence-based (when this
is available), is easy to read and understand, and is endorsed by
reputable professional bodies. Any information provided should be
given in a way that respects the man’s education level, personal
circumstances, language skills and culture, and is sensitive to the
man’s values and personal preferences. It should not be assumed
that patients requesting PSA testing are adequately informed.
Health practitioners should recognise that an abnormal PSA
test followed by a biopsy, that shows even low-risk cancer, may
have the potential to cause anxiety and distress for some men.
However, providing information and support is likely to help men
to maintain a good quality of life without psychosocial stress,
even if there is a cancer diagnosis. Such support is particularly
important through all stages of testing and treatment.
Referral to a urologist is essential for assessment of an abnormal
PSA result including a low free/total PSA ratio, or a rapidly rising
PSA. Early referral to a urologist is recommended for consideration
of transrectal ultrasound (TRUS)-guided biopsy. The urologist must
provide full information about the possible TRUS findings, risks
and subsequent management options to the man and his doctor.
What health information and resources are available
on PSA testing?
Current resources which provide information based on the current
evidence available include:
> Andrology Australia website (www.andrologyaustralia.org)
> Fingertip Urology (www.bjui.org/FingertipUrology.aspx)
Topic: ‘Whether to test for Prostate Cancer’
(including PSA Decision Card)
Topic ‘Pertinent Points in Prostate Cancer’ Appendix 2:
Age-related ranges for Caucasian and Asian men
> Lions Australian Prostate Cancer website
(www.prostatehealth.org.au)
> PSA Decision Card: ‘The Early Detection of Prostate Cancer in
General Practice: Supporting Patient Choice’. Available from:
www.andrologyaustralia.org/docs/PSAdecisioncard20041007.pdf
Where do we go from here?
Newer and more specific prostate cancer markers are needed
before an effective population-wide prostate cancer screening
program can be trialled, recommended or implemented. The key
challenge for any prostate cancer population-screening program
is to identify men with aggressive cancer, and to intervene early
and effectively.
There is no current recommendation for population-wide
screening for prostate cancer in Australia by government or
professional societies, including the Urological Society of Australia
and New Zealand and the Cancer Councils of Australia. This lack
of recommendation is due to the lack of evidence.
Until such evidence is available, targeted testing of informed
individuals is considered appropriate practice. PSA testing
combined with DRE is currently considered to be the most suitable
method of identifying men at risk of having prostate cancer.
A full list of references for this article is available by emailing
[email protected]
Community education
Supporting the Lions Australian Prostate Cancer Website
The Lions Australian Prostate Cancer
website was established in 2000 by the
education committee of the Australian
Prostate Cancer Collaboration (APCC).
The website was developed in response to
a needs assessment survey of men with
prostate cancer, which was done with
the help of the Association of Prostate
Cancer Support Groups (now the
Support and Advocacy Committee of the
Prostate Cancer Foundation of Australia).
Development funding was kindly
provided by Lions Australia, and the
website was supported in kind by the
Repatriation General Hospital as the
developer of much of the original
content. The site received a Public Health
Association of Australasia Award in 2001.
The site assists men affected by prostate
cancer and their families by providing
information on prostate cancer
and treatment options, educational
resources and stories and experiences.
It also has an online helpline. The
site attracts 400,000 hits and 45,000
visitor sessions per month. Since its
development, the content of the site
has been contributed to and updated
by the education committee of the
APCC, which includes representatives of
the Cancer Councils across Australia.
provides men and their families
with accurate and evidence-based
information on prostate cancer.
We look forward to an ongoing
collaboration with Lions Australia and
continuing to provide accessible sources
of information on prostate cancer.
In continuing to support the quality
and evidence-based prostate cancer
education activities and information
developed by the Australian Prostate
Cancer Collaboration, which will cease
operations in 2009, Andrology Australia
is pleased to take on the management
of the Lions Australian Prostate Cancer
website (www.prostatehealth.org.au).
Focus on: PSA testing: What everyman (and health professional) needs to know
Author: Professor RA 'Frank' Gardiner
Although there is limited evidence that PSA testing reduces the
risk of death from prostate cancer, there has been a noticeable
change recently with more men now asking for information
about being tested.
What is a PSA test and when is it used?
Andrology Australia will continue to
work with the education committee
of the Australian Prostate Cancer
Collaboration and Lions Australia
to ensure that the content of
the site is kept up to date and
Prostate Specific Antigen (PSA) is a protein made mainly in the
prostate and is normally found in low levels in a man’s blood
stream. A PSA test measures the level of PSA in the blood and
may help to diagnose prostate disease. A high PSA in the blood
almost always means that something is wrong with the prostate,
but not necessarily prostate cancer.
A high PSA may be found in men who have prostatitis
(infection or inflammation of the prostate), benign prostatic
hyperplasia (BPH known as prostate enlargement), or least
commonly, prostate cancer.
Why is the decision to have a PSA test a complex one?
Merv’s Have a Crack Day Update
The first group of cricketing legends
have been confirmed. Merv's great
mates and fellow Aussie legends Ian
Healy, David Boon, Damien Fleming and
Rodney Hogg are all starters, and will be
joined by an eclectic mix of Australia’s
other sporting code and entertainment
celebrities yet to be announced.
The latest celebrity cricketer to be
announced boasts one of the longest
bowling run ups in the history of cricket
at 42km. Australian Olympic Champion
Steve Monaghetti has confirmed his
attendance on the day and support of
the importance of raising awareness
of men’s health. The event will be
officially opened by and participated
in by cricket lover and men’s health
advocate, the Governor of Victoria,
Professor David de Kretser AC who is
also Patron of Andrology Australia.
Andrology Australia also welcomes
and is proud to announce ‘Diadora’ as
the official merchandise and apparel
event sponsor. Diadora is a leading
Italian sports brand and it’s licence
in Australia is owned by Overland
Group (Australasia) Pty Ltd.
STAGE ONE:
The unique opportunity to register
a team for the event or secure
the limited categories of event
sponsorship available will soon close.
Register your interest today on the
Merv’s Have a Crack website at
www.mervshaveacrackday.com.au
A single PSA test is not a reliable sign of prostate cancer on its
own. Once a decision is made to be tested for prostate cancer,
a man starts on a ‘testing journey’ made up of three stages that
can continue for the rest of his life. If the additional stages
are not discussed with a man prior to his decision to have
the first PSA test and he receives an abnormal PSA result, the
additional stages can be highly unexpected and may cause
psychological distress.
The decision to have a PSA test should be made with the
understanding of all possible outcomes; including the physical
and psychological side-effects that can come with further testing,
prostate cancer diagnosis and its various treatment options, which
may include erectile dysfunction and continence problems.
For men diagnosed with prostate cancer, there are three treatment
possibilities: i) curative intent (radical prostatectomy or radiation
therapy); ii) commencement of androgen deprivation therapy
(ADT) following monitoring (watchful waiting) and iii) active
surveillance (which includes further biopsies). Monitoring may
be measuring PSA (+/- DRE) with a view to commencing ADT at
some later date or by active surveillance (involving PSA, DRE and
further biopsies). An increasing number of men diagnosed with
prostate cancer are proceeding to active surveillance for what is
considered to be cancer with a low-risk of progression; with the
option of radical prostatectomy or radiation therapy reserved
for those men whose cancers subsequently show evidence of
progressing as revealed by intense monitoring.
A cancer diagnosis is complicated by the fact that in about 1 in 4
men prostate cancer may act in an aggressive fashion (e.g. spread
to lymph nodes and to bone which may have already occurred at
03!$2%
2EPEATTESTINGFREQUENCYFOR
INDIVIDUALASRECOMMENDED
BYTREATINGDOCTORUROLOGIST
To ensure men are able to make informed decisions about
whether to be tested for prostate cancer, it is important
that evidence-based information about the current state of
knowledge about PSA testing is provided to men, the community
and health professionals in a form that they can easily
understand; including the physical and psychological impact the
decision and diagnosis may have.
Upcoming events
Time is passing
quickly and
momentum
is gathering
for the first
Andrology
Australia Merv’s
Have a Crack
Day event on
December 11,
2009. There has been a tremendous
amount of interest in teams registering
and companies securing their place
in sponsoring the event, which will
become an annual and coveted fixture
on Melbourne’s sporting calendar.
More sponsorship opportunities and
teams are available, but are filling up
fast, so register your interest today at
www.mervshaveacrackday.com.au.
Prostate cancer ‘Testing Journey’
PSA LEVEL
.ORMALRESULT
!BNORMAL03!ANDOR
$2%INMEN
STAGE TWO:
FURTHER TESTING
OFTENINCLUDESBIOPSY
.ORMALRESULT
#ONFIRMEDDIAGNOSISOF
PROSTATECANCERINMEN
STAGE THREE:
MANAGEMENT
$ISCUSSIONWITHPATIENTOF
MANAGEMENTOPTIONS
WATCHFUL
WAITING
-ONITORINGOFTEN
LEADSTO
SUBSEQUENT!$4
!.$2/'%.
$%02)6!4)/.
4(%2!09!$4
TREATMENT WITH CURATIVE
INTENT & MONITORING
s2ADICALPROSTATECTOMY
Or
s2ADIATIONTHERAPY!$4
!NDROGENDEPRIVATIONTHERAPY
ACTIVE
SURVEILLANCE
-ONITORINGINCLUDES
03!AND$2%AND
FURTHERBIOPSIES
presentation but may not be demonstrable with imaging tests),
while in another 1 in 4 men the cancer remains indolent (e.g.
remaining localised to the prostate). At this stage there is no
useful marker to identify which cancers will behave in an indolent
or an aggressive fashion.
> PSA levels rise as a normal part of ageing as the prostate tends
to grow larger so the ‘normal’ levels (or reference range) of PSA
must be adjusted for a man’s age. Even when the PSA level is
within the normal range for that age group, a PSA velocity (the
time it takes for PSA levels to increase, such as a doubling over
12 months) trigger further investigation by your doctor
> Increases in single PSA levels taken at age 40 years (cut-off
0.6 ng/ml) and 50 years (cut-off 1.5 ng/ml) may suggest an
increased risk of prostate cancer over the next 10-20 years
> The combination of a DRE with a PSA improves detection rates.
However a DRE only allows a doctor to feel that part of the
prostate immediately in front of the rectum (back passage) but
not the other areas of the prostate that could also be affected
by cancer
> An abnormal PSA/DRE needs further assessment by a urologist
(specialist) to confirm if this is due to a growing cancer or a
non-cancerous problem such as prostatitis (inflammation due to
infection) or benign prostatic hyperplasia (BPH)
> The limitations of PSA testing should be discussed with your
doctor; including the inability of the PSA test to confirm
prostate cancer or to detect how advanced the cancer is and
how quickly it is progressing
> A normal PSA test (combined with a negative DRE) reduces the
chance that prostate cancer is present but does not exclude it
completely
> There is no level of PSA that identifies whether a man does or
does not have prostate cancer
What if I have a family history of prostate cancer?
Men with a strong family history of prostate cancer (whether a
grandfather, father, brother, uncle or cousin with the disease) are
at a greater risk of cancer and should think about being tested
from 40 years of age. On average, hereditary prostate cancer may
develop six years earlier than non-hereditary prostate cancer.
A history of breast cancer in female family members can also be
linked with a higher risk of prostate cancer in men. It is important
to discuss any family history of disease with your doctor.
What if I’m a health professional talking to my
patients about prostate cancer testing?
One in eight men diagnosed with prostate cancer will die of the
disease with this number varying depending on age and Gleason
score of disease at diagnosis, with younger men diagnosed with
more advanced cancer more likely to die from the disease (as
there are fewer competing causes of death or co-morbidities, such
as cardiovascular disease which is increasingly common as men
become older.)
Being tested for prostate cancer should be a shared decisionmaking discussion between a man and his doctor, and should only
happen if a man is properly informed of the potential gains and
risks of testing and then agrees to proceed with testing. It is not
appropriate to order a PSA test without a patient’s knowledge
or as part of a suite of blood tests unless the patient has been
adequately informed.
What if I’m a man thinking about prostate cancer testing?
It is essential that any health professional ordering and discussing
PSA testing is up-to-date with the scientific evidence and ensures
that balanced evidence-based information and resources are
provided to the patient before a decision is made.
Men should be aware that there is debate about the potential
gains and risks from PSA testing and prostate cancer treatment
options. If you are considering having your first PSA test/DRE,
you should discuss the following with your doctor and use the
resources listed to help guide the discussion:
A man seeking PSA testing should be given access to written or
web-based, relevant material which is evidence-based (when this
is available), is easy to read and understand, and is endorsed by
reputable professional bodies. Any information provided should be
given in a way that respects the man’s education level, personal
circumstances, language skills and culture, and is sensitive to the
man’s values and personal preferences. It should not be assumed
that patients requesting PSA testing are adequately informed.
Health practitioners should recognise that an abnormal PSA
test followed by a biopsy, that shows even low-risk cancer, may
have the potential to cause anxiety and distress for some men.
However, providing information and support is likely to help men
to maintain a good quality of life without psychosocial stress,
even if there is a cancer diagnosis. Such support is particularly
important through all stages of testing and treatment.
Referral to a urologist is essential for assessment of an abnormal
PSA result including a low free/total PSA ratio, or a rapidly rising
PSA. Early referral to a urologist is recommended for consideration
of transrectal ultrasound (TRUS)-guided biopsy. The urologist must
provide full information about the possible TRUS findings, risks
and subsequent management options to the man and his doctor.
What health information and resources are available
on PSA testing?
Current resources which provide information based on the current
evidence available include:
> Andrology Australia website (www.andrologyaustralia.org)
> Fingertip Urology (www.bjui.org/FingertipUrology.aspx)
Topic: ‘Whether to test for Prostate Cancer’
(including PSA Decision Card)
Topic ‘Pertinent Points in Prostate Cancer’ Appendix 2:
Age-related ranges for Caucasian and Asian men
> Lions Australian Prostate Cancer website
(www.prostatehealth.org.au)
> PSA Decision Card: ‘The Early Detection of Prostate Cancer in
General Practice: Supporting Patient Choice’. Available from:
www.andrologyaustralia.org/docs/PSAdecisioncard20041007.pdf
Where do we go from here?
Newer and more specific prostate cancer markers are needed
before an effective population-wide prostate cancer screening
program can be trialled, recommended or implemented. The key
challenge for any prostate cancer population-screening program
is to identify men with aggressive cancer, and to intervene early
and effectively.
There is no current recommendation for population-wide
screening for prostate cancer in Australia by government or
professional societies, including the Urological Society of Australia
and New Zealand and the Cancer Councils of Australia. This lack
of recommendation is due to the lack of evidence.
Until such evidence is available, targeted testing of informed
individuals is considered appropriate practice. PSA testing
combined with DRE is currently considered to be the most suitable
method of identifying men at risk of having prostate cancer.
A full list of references for this article is available by emailing
[email protected]
Community education
Supporting the Lions Australian Prostate Cancer Website
The Lions Australian Prostate Cancer
website was established in 2000 by the
education committee of the Australian
Prostate Cancer Collaboration (APCC).
The website was developed in response to
a needs assessment survey of men with
prostate cancer, which was done with
the help of the Association of Prostate
Cancer Support Groups (now the
Support and Advocacy Committee of the
Prostate Cancer Foundation of Australia).
Development funding was kindly
provided by Lions Australia, and the
website was supported in kind by the
Repatriation General Hospital as the
developer of much of the original
content. The site received a Public Health
Association of Australasia Award in 2001.
The site assists men affected by prostate
cancer and their families by providing
information on prostate cancer
and treatment options, educational
resources and stories and experiences.
It also has an online helpline. The
site attracts 400,000 hits and 45,000
visitor sessions per month. Since its
development, the content of the site
has been contributed to and updated
by the education committee of the
APCC, which includes representatives of
the Cancer Councils across Australia.
provides men and their families
with accurate and evidence-based
information on prostate cancer.
We look forward to an ongoing
collaboration with Lions Australia and
continuing to provide accessible sources
of information on prostate cancer.
In continuing to support the quality
and evidence-based prostate cancer
education activities and information
developed by the Australian Prostate
Cancer Collaboration, which will cease
operations in 2009, Andrology Australia
is pleased to take on the management
of the Lions Australian Prostate Cancer
website (www.prostatehealth.org.au).
Focus on: PSA testing: What everyman (and health professional) needs to know
Author: Professor RA 'Frank' Gardiner
Although there is limited evidence that PSA testing reduces the
risk of death from prostate cancer, there has been a noticeable
change recently with more men now asking for information
about being tested.
What is a PSA test and when is it used?
Andrology Australia will continue to
work with the education committee
of the Australian Prostate Cancer
Collaboration and Lions Australia
to ensure that the content of
the site is kept up to date and
Prostate Specific Antigen (PSA) is a protein made mainly in the
prostate and is normally found in low levels in a man’s blood
stream. A PSA test measures the level of PSA in the blood and
may help to diagnose prostate disease. A high PSA in the blood
almost always means that something is wrong with the prostate,
but not necessarily prostate cancer.
A high PSA may be found in men who have prostatitis
(infection or inflammation of the prostate), benign prostatic
hyperplasia (BPH known as prostate enlargement), or least
commonly, prostate cancer.
Why is the decision to have a PSA test a complex one?
Merv’s Have a Crack Day Update
The first group of cricketing legends
have been confirmed. Merv's great
mates and fellow Aussie legends Ian
Healy, David Boon, Damien Fleming and
Rodney Hogg are all starters, and will be
joined by an eclectic mix of Australia’s
other sporting code and entertainment
celebrities yet to be announced.
The latest celebrity cricketer to be
announced boasts one of the longest
bowling run ups in the history of cricket
at 42km. Australian Olympic Champion
Steve Monaghetti has confirmed his
attendance on the day and support of
the importance of raising awareness
of men’s health. The event will be
officially opened by and participated
in by cricket lover and men’s health
advocate, the Governor of Victoria,
Professor David de Kretser AC who is
also Patron of Andrology Australia.
Andrology Australia also welcomes
and is proud to announce ‘Diadora’ as
the official merchandise and apparel
event sponsor. Diadora is a leading
Italian sports brand and it’s licence
in Australia is owned by Overland
Group (Australasia) Pty Ltd.
STAGE ONE:
The unique opportunity to register
a team for the event or secure
the limited categories of event
sponsorship available will soon close.
Register your interest today on the
Merv’s Have a Crack website at
www.mervshaveacrackday.com.au
A single PSA test is not a reliable sign of prostate cancer on its
own. Once a decision is made to be tested for prostate cancer,
a man starts on a ‘testing journey’ made up of three stages that
can continue for the rest of his life. If the additional stages
are not discussed with a man prior to his decision to have
the first PSA test and he receives an abnormal PSA result, the
additional stages can be highly unexpected and may cause
psychological distress.
The decision to have a PSA test should be made with the
understanding of all possible outcomes; including the physical
and psychological side-effects that can come with further testing,
prostate cancer diagnosis and its various treatment options, which
may include erectile dysfunction and continence problems.
For men diagnosed with prostate cancer, there are three treatment
possibilities: i) curative intent (radical prostatectomy or radiation
therapy); ii) commencement of androgen deprivation therapy
(ADT) following monitoring (watchful waiting) and iii) active
surveillance (which includes further biopsies). Monitoring may
be measuring PSA (+/- DRE) with a view to commencing ADT at
some later date or by active surveillance (involving PSA, DRE and
further biopsies). An increasing number of men diagnosed with
prostate cancer are proceeding to active surveillance for what is
considered to be cancer with a low-risk of progression; with the
option of radical prostatectomy or radiation therapy reserved
for those men whose cancers subsequently show evidence of
progressing as revealed by intense monitoring.
A cancer diagnosis is complicated by the fact that in about 1 in 4
men prostate cancer may act in an aggressive fashion (e.g. spread
to lymph nodes and to bone which may have already occurred at
03!$2%
2EPEATTESTINGFREQUENCYFOR
INDIVIDUALASRECOMMENDED
BYTREATINGDOCTORUROLOGIST
To ensure men are able to make informed decisions about
whether to be tested for prostate cancer, it is important
that evidence-based information about the current state of
knowledge about PSA testing is provided to men, the community
and health professionals in a form that they can easily
understand; including the physical and psychological impact the
decision and diagnosis may have.
Upcoming events
Time is passing
quickly and
momentum
is gathering
for the first
Andrology
Australia Merv’s
Have a Crack
Day event on
December 11,
2009. There has been a tremendous
amount of interest in teams registering
and companies securing their place
in sponsoring the event, which will
become an annual and coveted fixture
on Melbourne’s sporting calendar.
More sponsorship opportunities and
teams are available, but are filling up
fast, so register your interest today at
www.mervshaveacrackday.com.au.
Prostate cancer ‘Testing Journey’
PSA LEVEL
.ORMALRESULT
!BNORMAL03!ANDOR
$2%INMEN
STAGE TWO:
FURTHER TESTING
OFTENINCLUDESBIOPSY
.ORMALRESULT
#ONFIRMEDDIAGNOSISOF
PROSTATECANCERINMEN
STAGE THREE:
MANAGEMENT
$ISCUSSIONWITHPATIENTOF
MANAGEMENTOPTIONS
WATCHFUL
WAITING
-ONITORINGOFTEN
LEADSTO
SUBSEQUENT!$4
!.$2/'%.
$%02)6!4)/.
4(%2!09!$4
TREATMENT WITH CURATIVE
INTENT & MONITORING
s2ADICALPROSTATECTOMY
Or
s2ADIATIONTHERAPY!$4
!NDROGENDEPRIVATIONTHERAPY
ACTIVE
SURVEILLANCE
-ONITORINGINCLUDES
03!AND$2%AND
FURTHERBIOPSIES
presentation but may not be demonstrable with imaging tests),
while in another 1 in 4 men the cancer remains indolent (e.g.
remaining localised to the prostate). At this stage there is no
useful marker to identify which cancers will behave in an indolent
or an aggressive fashion.
> PSA levels rise as a normal part of ageing as the prostate tends
to grow larger so the ‘normal’ levels (or reference range) of PSA
must be adjusted for a man’s age. Even when the PSA level is
within the normal range for that age group, a PSA velocity (the
time it takes for PSA levels to increase, such as a doubling over
12 months) trigger further investigation by your doctor
> Increases in single PSA levels taken at age 40 years (cut-off
0.6 ng/ml) and 50 years (cut-off 1.5 ng/ml) may suggest an
increased risk of prostate cancer over the next 10-20 years
> The combination of a DRE with a PSA improves detection rates.
However a DRE only allows a doctor to feel that part of the
prostate immediately in front of the rectum (back passage) but
not the other areas of the prostate that could also be affected
by cancer
> An abnormal PSA/DRE needs further assessment by a urologist
(specialist) to confirm if this is due to a growing cancer or a
non-cancerous problem such as prostatitis (inflammation due to
infection) or benign prostatic hyperplasia (BPH)
> The limitations of PSA testing should be discussed with your
doctor; including the inability of the PSA test to confirm
prostate cancer or to detect how advanced the cancer is and
how quickly it is progressing
> A normal PSA test (combined with a negative DRE) reduces the
chance that prostate cancer is present but does not exclude it
completely
> There is no level of PSA that identifies whether a man does or
does not have prostate cancer
What if I have a family history of prostate cancer?
Men with a strong family history of prostate cancer (whether a
grandfather, father, brother, uncle or cousin with the disease) are
at a greater risk of cancer and should think about being tested
from 40 years of age. On average, hereditary prostate cancer may
develop six years earlier than non-hereditary prostate cancer.
A history of breast cancer in female family members can also be
linked with a higher risk of prostate cancer in men. It is important
to discuss any family history of disease with your doctor.
What if I’m a health professional talking to my
patients about prostate cancer testing?
One in eight men diagnosed with prostate cancer will die of the
disease with this number varying depending on age and Gleason
score of disease at diagnosis, with younger men diagnosed with
more advanced cancer more likely to die from the disease (as
there are fewer competing causes of death or co-morbidities, such
as cardiovascular disease which is increasingly common as men
become older.)
Being tested for prostate cancer should be a shared decisionmaking discussion between a man and his doctor, and should only
happen if a man is properly informed of the potential gains and
risks of testing and then agrees to proceed with testing. It is not
appropriate to order a PSA test without a patient’s knowledge
or as part of a suite of blood tests unless the patient has been
adequately informed.
What if I’m a man thinking about prostate cancer testing?
It is essential that any health professional ordering and discussing
PSA testing is up-to-date with the scientific evidence and ensures
that balanced evidence-based information and resources are
provided to the patient before a decision is made.
Men should be aware that there is debate about the potential
gains and risks from PSA testing and prostate cancer treatment
options. If you are considering having your first PSA test/DRE,
you should discuss the following with your doctor and use the
resources listed to help guide the discussion:
A man seeking PSA testing should be given access to written or
web-based, relevant material which is evidence-based (when this
is available), is easy to read and understand, and is endorsed by
reputable professional bodies. Any information provided should be
given in a way that respects the man’s education level, personal
circumstances, language skills and culture, and is sensitive to the
man’s values and personal preferences. It should not be assumed
that patients requesting PSA testing are adequately informed.
Health practitioners should recognise that an abnormal PSA
test followed by a biopsy, that shows even low-risk cancer, may
have the potential to cause anxiety and distress for some men.
However, providing information and support is likely to help men
to maintain a good quality of life without psychosocial stress,
even if there is a cancer diagnosis. Such support is particularly
important through all stages of testing and treatment.
Referral to a urologist is essential for assessment of an abnormal
PSA result including a low free/total PSA ratio, or a rapidly rising
PSA. Early referral to a urologist is recommended for consideration
of transrectal ultrasound (TRUS)-guided biopsy. The urologist must
provide full information about the possible TRUS findings, risks
and subsequent management options to the man and his doctor.
What health information and resources are available
on PSA testing?
Current resources which provide information based on the current
evidence available include:
> Andrology Australia website (www.andrologyaustralia.org)
> Fingertip Urology (www.bjui.org/FingertipUrology.aspx)
Topic: ‘Whether to test for Prostate Cancer’
(including PSA Decision Card)
Topic ‘Pertinent Points in Prostate Cancer’ Appendix 2:
Age-related ranges for Caucasian and Asian men
> Lions Australian Prostate Cancer website
(www.prostatehealth.org.au)
> PSA Decision Card: ‘The Early Detection of Prostate Cancer in
General Practice: Supporting Patient Choice’. Available from:
www.andrologyaustralia.org/docs/PSAdecisioncard20041007.pdf
Where do we go from here?
Newer and more specific prostate cancer markers are needed
before an effective population-wide prostate cancer screening
program can be trialled, recommended or implemented. The key
challenge for any prostate cancer population-screening program
is to identify men with aggressive cancer, and to intervene early
and effectively.
There is no current recommendation for population-wide
screening for prostate cancer in Australia by government or
professional societies, including the Urological Society of Australia
and New Zealand and the Cancer Councils of Australia. This lack
of recommendation is due to the lack of evidence.
Until such evidence is available, targeted testing of informed
individuals is considered appropriate practice. PSA testing
combined with DRE is currently considered to be the most suitable
method of identifying men at risk of having prostate cancer.
A full list of references for this article is available by emailing
[email protected]
In brief
Latest news
The Healthy Male
Practice Nurse Men’s Health Education
Practice nurses are becoming more
widely recognised as an integral part
of delivering health information within
general practice. Andrology Australia has
been working with the Australian Practice
Nurses Association (APNA) to identify
if a need exists for the development
of a men’s health education program
developed specifically for practice nurses.
A Men’s Health Education Survey was
distributed to members of the APNA
to determine the information and
education needs of practice nurses when
engaging men in general practice.
Feedback from the survey showed that
the majority of practice nurses had never
undertaken professional education on
male reproductive health topics such as
erectile dysfunction and prostate disease.
who have an interest in men’s health, are
members of the APNA and have links with
their local Division of General Practice.
The survey results established a need
for the development of a men’s health
education program specifically targeted
toward practice nurses, with 78 per cent
of the respondents indicating that they
would like further education on men’s
health issues within general practice.
The reference group will guide and
develop a practical education program
for practice nurses to deliver current
evidence-based men’s health education
specific to practice nurses across
Australia, including rural areas. The
initial aim of the reference group is to
develop a pilot education program in a
format suitable to practice nurse needs
and preferred methods of education.
To address the need for Practice Nurse
Education on men’s health issues, an
Andrology Australia Practice Nurse
Education Reference Group has been
established. The reference group includes
practice nurses from across Australia
Evaluation of the pilot will help
determine areas of improvement for
a broader roll-out nation-wide.
Research round-up
Public Knowledge of Benefits of Prostate Cancer Screening in Europe
A recent study1 surveyed 10,228 people
across nine European countries to
establish the extent of the public’s
knowledge of the benefits of screening
for breast and prostate cancer, to find
out whether decisions about testing
are likely to be informed. With respect
to prostate cancer screening, the
study explored whether the public’s
knowledge of the benefits is realistic,
which sources are used for health
information, and if the number of times
men used the information sources
impacts their level of understanding.
The male participants were given a
multiple choice question to estimate the
number of lives saved by screening after
ten years, if 1000 men aged 50 and older
had PSA testing every two years. Only
11 per cent of the men surveyed made
reasonable estimates (that the number
of prostate cancer deaths prevented
for every 1000 men screened was less
than or equal to one). The remaining
89 per cent either over-estimated the
benefit or didn’t know. The estimates
made by men aged between 50 and
69 were no more correct than those
made by men in young age groups.
Family or friends were the most used
source of health information, followed
by experts (doctors and pharmacists),
general media, and lastly healthspecific resources (including health
organisation pamphlets, reference
books, health insurance, Internet).
The number of times a man used the
sources of information didn’t increase
his understanding of the real benefits
of screening, but was often related to
an overestimation of the benefit.
To ensure men can make informed
and rational decisions about whether
to have PSA testing, they must be
aware of the benefits of populationscreening (or lack of). An Australian
study2 has shown that resources that
help patient decision-making used
in general practice can increase the
doctor’s knowledge and confidence in
discussing testing with men; such as the
PSA Decision Card: ‘The Early Detection
of Prostate Cancer in General Practice:
Supporting Patient Choice’. Available
from: www.andrologyaustralia.org/
docs/PSAdecisioncard20041007.pdf)
1 Gigerenzer G et al. Public Knowledge of Benefits
of Breast and Prostate Cancer Screening in Europe.
JNCI 2009; 101: 1216-1220
2 Steginga S et al. Shared decision-making and
informed choice for the early detection of prostate
cancer in primary care. BJU 2005; 96: 1209-1210
New resources on the
Andrology Australia website:
Andrology Australia is pleased
to be able to include two new
booklets on the website www.
andrologyaustralia.org for download.
The first booklet, ‘Maintaining your
well-being: Information on depression
and anxiety for men with prostate
cancer and their partners’ was
developed by beyondblue: the national
depression initiative in partnership
with the PCFA. The booklet provides
information on common reactions
to a diagnosis of prostate cancer, the
cancer journey, helpful strategies to
deal with prostate cancer, signs of
distress, including depression and
anxiety, and how to seek help for
depression and anxiety. Hard copies
are also available from the beyondblue
website (www.beyondblue.org.au) or the
beyondblue info line (1300 22 46 36).
The second booklet now available to
download is the ‘Boys and Puberty:
almost everything boys will ever need
to know about body changes and other
stuff!’. Produced by the Government of
Western Australia, Department of Health.
Farewell to Board Member,
Professor Doreen Rosenthal AO
Andrology Australia bids a sad farewell
to Professor Doreen Rosenthal AO from
the Advisory Board. We thank Doreen
for her invaluable contribution to the
ongoing success of the Andrology
Australia program and wish her all
the best in her future endeavours.
PCA3 testing for prostate cancer
A recent study examined whether the level
of prostate cancer antigen 3 (PCA3) in
the urine following a DRE (Digital Rectal
Examination) can be used to help guide
the decision to perform a repeat biopsy to
confirm prostate cancer after a raised PSA.
The study suggested possible benefit of
using this urine test in addition to the
current PSA test and DRE. The study
also explored whether PCA3 could act
as an indicator of the clinical stage and
aggressiveness of prostate cancer.
Many researchers are looking for new
markers of prostate cancer. At this stage,
PCA3 is still an experimental test and
does not have a place in the routine
assessment of prostate disease. There are
only a few published studies on PCA3 and
diagnostic, cutoff values are not clear
and have limited reproducibility. There
is no evidence to suggest that the PCA3
test is better than the current testing
of PSA and/or DRE in the detection
or exclusion of prostate cancer.
While the Internet provides men with
access to information about new
prostate markers for prostate cancer,
PCA3 is not currently approved for use in
Australia by the TGA (Therapeutic Goods
Administration). While some doctors may
offer the technology, as it is not covered
by the Medicare Benefits Schedule, there
may be significant costs to a patient
without any rebates being available.
Given the lack of robust evidence, the
PCA3 test would potentially raise more
doubts than current PSA testing methods
and subsequently may increase the rate
of biopsies, rather than decrease it.
If you are concerned about prostate
cancer, talk to your doctor about the
pros and cons of testing using currently
available and well-validated methods.
Change of Address
For any future correspondence, please
note that our address has changed to:
Public Consultation on draft Clinical Practice Guidelines for the
management of Locally Advanced and Metastatic Prostate Cancer
The Australian Cancer Network is inviting public submissions on its draft Clinical Practice Guidelines for the
Management of Locally Advanced and Metastatic Prostate Cancer. The guidelines address the management of locally
advanced and metastatic prostate cancer including clinical, psychosocial and palliative aspects of the disease.
The draft document and directions on how to make a submission can be viewed and downloaded from
the ACN website at www.cancer.org.au/clinical_guidelines. Submissions close 5 October 2009.
Andrology Australia
Monash Institute of Medical Research
PO Box 5418, Clayton,
Victoria, Australia 3168
Professor Doreen Rosenthal AO and
Andrology Australia CEO, Dr Carol Holden
Newsletter of Andrology Australia
Australian Centre of Excellence in
Male Reproductive Health
Editor: Sarah Camille
Postal Address:
Andrology Australia
Monash Institute of Medical Research
PO Box 5418, Clayton,
Victoria, Australia, 3168
Andrology Australia is supported by a
grant from The Australian Government
Department of Health and Ageing.
2
Community education
Supporting the Lions
Australian Prostate Cancer
Website
2
Upcoming events
Merv’s Have a Crack Day
Telephone:
1300 303 878
3
Focus on
PSA testing: What everyman
(and health professional)
needs to know
Facsimile:
+ 61 3 9594 7156
Email:
[email protected]
Population-screening for Prostate Cancer
using the PSA Test
Contents
Street Address:
27-31 Wright Street,
Clayton Victoria 3168
Internet:
www.andrologyaustralia.org
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
Issue 32 – Spring 2009
5
Professional education
Practice Nurse Men’s Health
Education
5
Research round-up
Public Knowledge of
Benefits of Prostate Cancer
Screening in Europe
6
In brief
6
Latest news
Andrology Australia is administered by
Monash Institute of Medical Research
Prostate cancer testing is a complex and
controversial topic of discussion amongst the
community, health professionals, professional
societies and policy makers. The debate is
due to a current lack of evidence on the
effectiveness of PSA (prostate specific antigen)
testing as a population-screening method for
reducing deaths of men with prostate cancer.
Even without a current recommendation
for population-wide screening for prostate
cancer, PSA testing is widespread in
Australia: estimates suggest that more
than 50 per cent of Australian men over
the age of 50 have had a PSA test1.
The anticipated and recently released interim
results of two large-scale randomised controlled
trials in the USA2 and Europe3 were hoped
to provide more definite answers on the
pros and cons of population-screening for
prostate cancer. Unfortunately, their results
differed and their interpretation was made
difficult by the differing study methods. So
what do the results mean for men considering
having PSA testing and their doctors?
In an effort to interpret the results, two
commentary papers with an Australian
perspective have been released4 5.
Subscribe Today!
Andrology Australia extends an
invitation to all to take advantage
of the FREE SUBSCRIPTION offer.
Call, fax or email us to register
on our mailing list and
receive this regular quarterly
publication and other items
from Andrology Australia.
DISCLAIMER
This newsletter is provided as
an information service.
Information contained in this newsletter is
based on current medical evidence but should
not take the place of proper medical advice
from a qualified health professional. The
services of a qualified medical practitioner
should be sought before applying the
information to particular circumstances.
From the Director
Professional education
Due to the uncertainty of the results, neither
paper recommends population-screening.
Instead, men should be informed on the current
evidence-base regarding PSA testing, including
the benefits and limitations of testing, and the
common and significant risks of detection and
treatment (such as erectile dysfunction and
urinary problems). If the well-informed man
chooses to have a PSA test, he should be given
one. To ensure that men are well informed,
both papers call for more evidence and point
to the need for more understanding of the
benefits (in essence, the extent to which deaths
can be prevented) versus harms (in essence,
the burdens of invasive testing and treatment
side-effects) that flow from routine PSA testing.
Both papers conclude that the current
data suggests that a population-screening
program using PSA testing would result in
over-diagnosis of low grade tumours with
over-treatment resulting in significant and
unwarranted side-effects. Furthermore it is
suggested that testing should only be applied
to men with an anticipated life-expectancy
of more than seven years making populationscreening inappropriate for many elderly men.
1 Holden CA et al. Men in Australia Telephone Survey (MATeS):
a national survey of the reproductive health and concerns of
middle-aged and older Australian men. Lancet 2005; 366: 218-224.
2 Andriole GL et al (2009). Mortality Results from a Randomized
Prostate-Cancer Screening Trial. N Engl J Med. 360: 1310-1319
3 Schroder FH et al. Screening and Prostate-Cancer Mortality
in a Randomized European Study (2009). N Engl J Med. 360
1320-1328 Andriole GL et al (2009). Mortality Results from a
Randomized Prostate-Cancer Screening Trial. N Engl J Med. 360:
1310-1319
4 Barratt A et al. Screening for prostate cancer: explaining new
trial results and their implications to patients. MJA 2009; 191:
226-229
5 Smith et al. Evidence-based uncertainty: recent trial results on
prostate-specific antigen testing and prostate cancer mortality.
MJA 2009; 191: 199-200
In response to the results of the overseas trials,
Andrology Australia provided its position on the
debate about PSA testing for prostate cancer
in the last newsletter; with an ‘Andrology
Australia Statement on PSA Testing for Prostate
Cancer’. Since then, Andrology Australia has
received much feedback from men asking
“What do the findings mean for me?”
Male is PSA testing from the viewpoint of an
individual man considering testing, and aims
to communicate the current evidence-base to
men, the community and health professionals.
It translates the evidence-base into information
relevant for discussion between a man and
his doctor when considering whether to have
a PSA test, and lists additional resources
that can help to guide the discussion.
With a lack of conclusive evidence about
population-screening, and the recommendation
for men to make informed decisions on
whether to have a PSA test/DRE (Digital
Rectal Examination), it is important that
professional societies and health professionals
provide a consistent and coherent message
on PSA testing to avoid confusion in men
considering being tested for prostate cancer.
The 'Focus On' for this edition of The Healthy
We hope this edition of our newsletter
helps clarify and guide discussions
between men and their doctor in regard
to this important health issue.
Professor Rob McLachlan
In brief
Latest news
The Healthy Male
Practice Nurse Men’s Health Education
Practice nurses are becoming more
widely recognised as an integral part
of delivering health information within
general practice. Andrology Australia has
been working with the Australian Practice
Nurses Association (APNA) to identify
if a need exists for the development
of a men’s health education program
developed specifically for practice nurses.
A Men’s Health Education Survey was
distributed to members of the APNA
to determine the information and
education needs of practice nurses when
engaging men in general practice.
Feedback from the survey showed that
the majority of practice nurses had never
undertaken professional education on
male reproductive health topics such as
erectile dysfunction and prostate disease.
who have an interest in men’s health, are
members of the APNA and have links with
their local Division of General Practice.
The survey results established a need
for the development of a men’s health
education program specifically targeted
toward practice nurses, with 78 per cent
of the respondents indicating that they
would like further education on men’s
health issues within general practice.
The reference group will guide and
develop a practical education program
for practice nurses to deliver current
evidence-based men’s health education
specific to practice nurses across
Australia, including rural areas. The
initial aim of the reference group is to
develop a pilot education program in a
format suitable to practice nurse needs
and preferred methods of education.
To address the need for Practice Nurse
Education on men’s health issues, an
Andrology Australia Practice Nurse
Education Reference Group has been
established. The reference group includes
practice nurses from across Australia
Evaluation of the pilot will help
determine areas of improvement for
a broader roll-out nation-wide.
Research round-up
Public Knowledge of Benefits of Prostate Cancer Screening in Europe
A recent study1 surveyed 10,228 people
across nine European countries to
establish the extent of the public’s
knowledge of the benefits of screening
for breast and prostate cancer, to find
out whether decisions about testing
are likely to be informed. With respect
to prostate cancer screening, the
study explored whether the public’s
knowledge of the benefits is realistic,
which sources are used for health
information, and if the number of times
men used the information sources
impacts their level of understanding.
The male participants were given a
multiple choice question to estimate the
number of lives saved by screening after
ten years, if 1000 men aged 50 and older
had PSA testing every two years. Only
11 per cent of the men surveyed made
reasonable estimates (that the number
of prostate cancer deaths prevented
for every 1000 men screened was less
than or equal to one). The remaining
89 per cent either over-estimated the
benefit or didn’t know. The estimates
made by men aged between 50 and
69 were no more correct than those
made by men in young age groups.
Family or friends were the most used
source of health information, followed
by experts (doctors and pharmacists),
general media, and lastly healthspecific resources (including health
organisation pamphlets, reference
books, health insurance, Internet).
The number of times a man used the
sources of information didn’t increase
his understanding of the real benefits
of screening, but was often related to
an overestimation of the benefit.
To ensure men can make informed
and rational decisions about whether
to have PSA testing, they must be
aware of the benefits of populationscreening (or lack of). An Australian
study2 has shown that resources that
help patient decision-making used
in general practice can increase the
doctor’s knowledge and confidence in
discussing testing with men; such as the
PSA Decision Card: ‘The Early Detection
of Prostate Cancer in General Practice:
Supporting Patient Choice’. Available
from: www.andrologyaustralia.org/
docs/PSAdecisioncard20041007.pdf)
1 Gigerenzer G et al. Public Knowledge of Benefits
of Breast and Prostate Cancer Screening in Europe.
JNCI 2009; 101: 1216-1220
2 Steginga S et al. Shared decision-making and
informed choice for the early detection of prostate
cancer in primary care. BJU 2005; 96: 1209-1210
New resources on the
Andrology Australia website:
Andrology Australia is pleased
to be able to include two new
booklets on the website www.
andrologyaustralia.org for download.
The first booklet, ‘Maintaining your
well-being: Information on depression
and anxiety for men with prostate
cancer and their partners’ was
developed by beyondblue: the national
depression initiative in partnership
with the PCFA. The booklet provides
information on common reactions
to a diagnosis of prostate cancer, the
cancer journey, helpful strategies to
deal with prostate cancer, signs of
distress, including depression and
anxiety, and how to seek help for
depression and anxiety. Hard copies
are also available from the beyondblue
website (www.beyondblue.org.au) or the
beyondblue info line (1300 22 46 36).
The second booklet now available to
download is the ‘Boys and Puberty:
almost everything boys will ever need
to know about body changes and other
stuff!’. Produced by the Government of
Western Australia, Department of Health.
Farewell to Board Member,
Professor Doreen Rosenthal AO
Andrology Australia bids a sad farewell
to Professor Doreen Rosenthal AO from
the Advisory Board. We thank Doreen
for her invaluable contribution to the
ongoing success of the Andrology
Australia program and wish her all
the best in her future endeavours.
PCA3 testing for prostate cancer
A recent study examined whether the level
of prostate cancer antigen 3 (PCA3) in
the urine following a DRE (Digital Rectal
Examination) can be used to help guide
the decision to perform a repeat biopsy to
confirm prostate cancer after a raised PSA.
The study suggested possible benefit of
using this urine test in addition to the
current PSA test and DRE. The study
also explored whether PCA3 could act
as an indicator of the clinical stage and
aggressiveness of prostate cancer.
Many researchers are looking for new
markers of prostate cancer. At this stage,
PCA3 is still an experimental test and
does not have a place in the routine
assessment of prostate disease. There are
only a few published studies on PCA3 and
diagnostic, cutoff values are not clear
and have limited reproducibility. There
is no evidence to suggest that the PCA3
test is better than the current testing
of PSA and/or DRE in the detection
or exclusion of prostate cancer.
While the Internet provides men with
access to information about new
prostate markers for prostate cancer,
PCA3 is not currently approved for use in
Australia by the TGA (Therapeutic Goods
Administration). While some doctors may
offer the technology, as it is not covered
by the Medicare Benefits Schedule, there
may be significant costs to a patient
without any rebates being available.
Given the lack of robust evidence, the
PCA3 test would potentially raise more
doubts than current PSA testing methods
and subsequently may increase the rate
of biopsies, rather than decrease it.
If you are concerned about prostate
cancer, talk to your doctor about the
pros and cons of testing using currently
available and well-validated methods.
Change of Address
For any future correspondence, please
note that our address has changed to:
Public Consultation on draft Clinical Practice Guidelines for the
management of Locally Advanced and Metastatic Prostate Cancer
The Australian Cancer Network is inviting public submissions on its draft Clinical Practice Guidelines for the
Management of Locally Advanced and Metastatic Prostate Cancer. The guidelines address the management of locally
advanced and metastatic prostate cancer including clinical, psychosocial and palliative aspects of the disease.
The draft document and directions on how to make a submission can be viewed and downloaded from
the ACN website at www.cancer.org.au/clinical_guidelines. Submissions close 5 October 2009.
Andrology Australia
Monash Institute of Medical Research
PO Box 5418, Clayton,
Victoria, Australia 3168
Professor Doreen Rosenthal AO and
Andrology Australia CEO, Dr Carol Holden
Newsletter of Andrology Australia
Australian Centre of Excellence in
Male Reproductive Health
Editor: Sarah Camille
Postal Address:
Andrology Australia
Monash Institute of Medical Research
PO Box 5418, Clayton,
Victoria, Australia, 3168
Andrology Australia is supported by a
grant from The Australian Government
Department of Health and Ageing.
2
Community education
Supporting the Lions
Australian Prostate Cancer
Website
2
Upcoming events
Merv’s Have a Crack Day
Telephone:
1300 303 878
3
Focus on
PSA testing: What everyman
(and health professional)
needs to know
Facsimile:
+ 61 3 9594 7156
Email:
[email protected]
Population-screening for Prostate Cancer
using the PSA Test
Contents
Street Address:
27-31 Wright Street,
Clayton Victoria 3168
Internet:
www.andrologyaustralia.org
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
Issue 32 – Spring 2009
5
Professional education
Practice Nurse Men’s Health
Education
5
Research round-up
Public Knowledge of
Benefits of Prostate Cancer
Screening in Europe
6
In brief
6
Latest news
Andrology Australia is administered by
Monash Institute of Medical Research
Prostate cancer testing is a complex and
controversial topic of discussion amongst the
community, health professionals, professional
societies and policy makers. The debate is
due to a current lack of evidence on the
effectiveness of PSA (prostate specific antigen)
testing as a population-screening method for
reducing deaths of men with prostate cancer.
Even without a current recommendation
for population-wide screening for prostate
cancer, PSA testing is widespread in
Australia: estimates suggest that more
than 50 per cent of Australian men over
the age of 50 have had a PSA test1.
The anticipated and recently released interim
results of two large-scale randomised controlled
trials in the USA2 and Europe3 were hoped
to provide more definite answers on the
pros and cons of population-screening for
prostate cancer. Unfortunately, their results
differed and their interpretation was made
difficult by the differing study methods. So
what do the results mean for men considering
having PSA testing and their doctors?
In an effort to interpret the results, two
commentary papers with an Australian
perspective have been released4 5.
Subscribe Today!
Andrology Australia extends an
invitation to all to take advantage
of the FREE SUBSCRIPTION offer.
Call, fax or email us to register
on our mailing list and
receive this regular quarterly
publication and other items
from Andrology Australia.
DISCLAIMER
This newsletter is provided as
an information service.
Information contained in this newsletter is
based on current medical evidence but should
not take the place of proper medical advice
from a qualified health professional. The
services of a qualified medical practitioner
should be sought before applying the
information to particular circumstances.
From the Director
Professional education
Due to the uncertainty of the results, neither
paper recommends population-screening.
Instead, men should be informed on the current
evidence-base regarding PSA testing, including
the benefits and limitations of testing, and the
common and significant risks of detection and
treatment (such as erectile dysfunction and
urinary problems). If the well-informed man
chooses to have a PSA test, he should be given
one. To ensure that men are well informed,
both papers call for more evidence and point
to the need for more understanding of the
benefits (in essence, the extent to which deaths
can be prevented) versus harms (in essence,
the burdens of invasive testing and treatment
side-effects) that flow from routine PSA testing.
Both papers conclude that the current
data suggests that a population-screening
program using PSA testing would result in
over-diagnosis of low grade tumours with
over-treatment resulting in significant and
unwarranted side-effects. Furthermore it is
suggested that testing should only be applied
to men with an anticipated life-expectancy
of more than seven years making populationscreening inappropriate for many elderly men.
1 Holden CA et al. Men in Australia Telephone Survey (MATeS):
a national survey of the reproductive health and concerns of
middle-aged and older Australian men. Lancet 2005; 366: 218-224.
2 Andriole GL et al (2009). Mortality Results from a Randomized
Prostate-Cancer Screening Trial. N Engl J Med. 360: 1310-1319
3 Schroder FH et al. Screening and Prostate-Cancer Mortality
in a Randomized European Study (2009). N Engl J Med. 360
1320-1328 Andriole GL et al (2009). Mortality Results from a
Randomized Prostate-Cancer Screening Trial. N Engl J Med. 360:
1310-1319
4 Barratt A et al. Screening for prostate cancer: explaining new
trial results and their implications to patients. MJA 2009; 191:
226-229
5 Smith et al. Evidence-based uncertainty: recent trial results on
prostate-specific antigen testing and prostate cancer mortality.
MJA 2009; 191: 199-200
In response to the results of the overseas trials,
Andrology Australia provided its position on the
debate about PSA testing for prostate cancer
in the last newsletter; with an ‘Andrology
Australia Statement on PSA Testing for Prostate
Cancer’. Since then, Andrology Australia has
received much feedback from men asking
“What do the findings mean for me?”
Male is PSA testing from the viewpoint of an
individual man considering testing, and aims
to communicate the current evidence-base to
men, the community and health professionals.
It translates the evidence-base into information
relevant for discussion between a man and
his doctor when considering whether to have
a PSA test, and lists additional resources
that can help to guide the discussion.
With a lack of conclusive evidence about
population-screening, and the recommendation
for men to make informed decisions on
whether to have a PSA test/DRE (Digital
Rectal Examination), it is important that
professional societies and health professionals
provide a consistent and coherent message
on PSA testing to avoid confusion in men
considering being tested for prostate cancer.
The 'Focus On' for this edition of The Healthy
We hope this edition of our newsletter
helps clarify and guide discussions
between men and their doctor in regard
to this important health issue.
Professor Rob McLachlan