It’s essential to separate prostate cancer diagnosis from treatment, says a visiting US specialist concerned about doing more harm than good.
Doctors are improving their approach to prostate cancer after years of too much testing and unnecessary treatment, says a visiting American specialist.
It’s essential to separate diagnosis from treatment, says Dr Alan Partin.
“Not everyone who is diagnosed needs to be treated,” he told AAP.
“Doctors have to work with patients to understand what is best for them,” said Dr Partin, the keynote speaker at the Urological Society of Australia and New Zealand annual scientific meeting in Brisbane.
Advice could include watching and waiting, prostate removal, radiation therapy or therapy to reduce testosterone.
He said many cases of prostate cancer had a low probability of harming people and therefore treatment could do more harm than good.
“More people die with prostate cancer than die from it.”
However, he disagreed with doctors who were calling for the definition to be changed to exclude the least aggressive forms of the disease.
“A cancer is a cancer. We cannot just simply ignore that they are cancers,” said Dr Partin, Professor of Urology at the Johns Hopkins Medical Institute in Baltimore.
“There are five simple messages,” said conference delegate Associate Professor Declan Murphy, a co-author of the 2013 Melbourne consensus statement on prostate cancer.
The main points are that PSA testing for men aged 40 and older has the potential to save lives, but “prostate cancer diagnosis must be uncoupled from prostate cancer intervention”.
There had been important changes in the way PSA tests were interpreted, said Prof Murphy.
Unlike in the past, results were evaluated according to a man’s age group.
“A PSA reading for a 45-year-old does not mean the same thing as for a 65-year-old.
“There is evidence that PSA testing for men in their 40s may be useful for predicting their future risk of prostate cancer. Only five per cent will be in the dangerous range and the vast majority can be reassured,” Prof Murphy said.
However, it was essential for doctors to realise that not every high PSA reading needed a biopsy.
“PSA testing should not be considered on its own, but as part of a multi-faceted approach including a digital exam, family history and the age of the patient.”
Two people with the same PSA level would be advised differently if one’s father lived until his 90s and the other’s died in his 60s from prostate cancer, he said.
“There are benefits and harms associated with PSA testing. Men should ensure they have a discussion with their GP before they go ahead.”