Prostate cancer doctors call for changes in screening guidelines over concerns about undetected cases

Amid concerns that too many men are dying unnecessarily, there is an urgent need to rethink the way GPs screen for prostate cancer.

Routine prostate cancer screening is not recommended for most men, but some experts are calling for changes in screening guidelines.

Dr. Peter Swindle, a urologist who specializes in prostate cancer, says, “There are patients who are angry, who are dying, who are underdiagnosed.

Prostate cancer has overtaken breast cancer as the most common cancer type in Australia, with an estimated 24,217 cases recorded this year alone, according to data from the Australian Institute of Health and Human Services (AIHW).

More than 3,500 men are expected to die from the disease this year, according to the AIHW, and in the six years to 2020, prostate cancer deaths increased 15.6%.

Some men told ABC they struggled to get regular medical screenings from their doctors.

One of them is Police Lieutenant Justin Falkiner, who lives in the rural town of Dubbo, New South Wales.

He has a family history of this disease. So did his father and his late grandfather.

So when he was 36, his doctor performed a blood test for prostate-specific antigen, known as PSA.

This test measures a patient’s PSA level. If the PSA level is too high for age, the patient will be tested further. A scan or biopsy is usually done to determine whether it is prostate cancer or a noncancerous condition such as infection or inflammation. prostate.

Falkiner’s test returned to the low range.

When he was in his early 40s, he asked his doctor for a re-examination, but was told that guidelines didn’t require him until he was 50.

“So stupidly, I didn’t ask for a second opinion.”

Prostate cancer can occur in families, and a genetic link has been suggested.

According to the American Cancer Society, a man’s risk of developing prostate cancer is more than doubled if his father or brother has it.

A ‘catastrophic’ diagnosis after a chance test

Mr. Falkiner returned two years later with another problem, and his PSA came back with a reading of 21 after his GP had a full bloodshot. PSA values ​​above 3 should generally be retested within 3 months.

He was referred to a urologist, and a month later a repeat test showed his PSA had risen sharply to 27.

“At that point, my urologist hit the panic button,” he said.

He was diagnosed with stage 2 prostate cancer, which was considered an intermediate risk. During this stage, the cancer grows faster and can become mildly to moderately aggressive.

“Everyone has an opinion that ‘it’s not going to happen to me.’ I didn’t change,” he said.

“So… you may have been prepared for what you were going to say, but it was still shocking to hear those three words.”

Also weighing heavily on his heart was his family. His wife Christine and young children Joshua and Ava.

Given that Falkiner’s PSA level had risen rapidly, Falkiner’s urologist feared his cancer might have already spread to other parts of his body. Luckily it didn’t happen.

But his specialist was certain of one thing.

Why Prostate Screening Is Controversial

Screening for prostate cancer is a controversial area because of the risk of overdiagnosis and potentially ‘dangerous’ treatments, said Harman, professor of primary care cancer research at the University of Melbourne. John Emery says.

“Overdiagnosis actually means detecting prostate cancer that is relatively slow growing and would not have harmed a man if he hadn’t known about it.

“The transrectal biopsy that we have historically used can be harmful.

“So [there are] The harms of cancer treatment are also…especially erectile dysfunction and urinary incontinence. ”

That means doctors have to weigh the risks and benefits of treating cancer, which, if left untreated, could potentially have caused no problems.