MELBOURNE, Australia, December 4, 2014 /PRNewswire/ --

Experts take major step towards maximising benefits and minimising harms from PSA testing    

World Cancer Congress: Melbourne, Australia: Leading cancer authorities in Australia today released for public consultation the world's most robust set of clinical practice guidelines, aimed at maximising the benefits and reducing the harms associated with the Prostate Specific Antigen (PSA) test for prostate cancer; the second most common male cancer worldwide.^[1] If ratified, these new draft guidelines are expected to inform international opinion and clinical practice regarding PSA testing, where currently consensus is lacking and widespread confusion about best practice exists.

Professor Mary Gospodarowicz, President of the Union of International Cancer Control (UICC) welcomes the draft guidelines, saying: "The current PSA test is not accurate enough for population screening, yet it remains in widespread use. We need to focus on helping both patients and healthcare professionals understand the risks and benefits of this test to empower them to make more informed choices around screening. We applaud the Australian cancer authorities for taking the lead in developing the strongest set of clinical guidelines seen to date in prostate cancer; developed through a truly multisectoral approach. We expect the final recommendations of this review to clear the current confusions that exist around PSA testing."

Approaches to prostate cancer testing differ across the world. Decision-making is complicated by the need to balance effective cancer detection and care, with concerns about over-diagnosis and prostate cancer treatment adverse side effects, including urinary incontinence, loss of sexual potency in men treated by radiotherapy and bowel problems.

The new draft guidelines, developed under the auspices of Cancer Council Australia's guidelines unit with funding from Prostate Cancer Foundation of Australia (PCFA), address these risk/benefit concerns. Key recommendations include:

For men without a prostate cancer diagnosis or symptoms that might indicate prostate cancer 

• For men informed of the benefits and harms of screening who wish to undergo regular testing, offer PSA testing every two years from age 50 to age 69, and offer further investigation if the PSA is greater than 3.0 ng/mL.
• In asymptomatic men interested in undergoing testing for early diagnosis of prostate cancer, digital rectal examination is not recommended as a routine test in the primary care setting.
• Do not offer PSA testing to a man who is unlikely to live another seven years.
• Offer evidence-based decisional support to men considering whether or not to have a PSA test, including the opportunity to discuss the potential benefits and risks of PSA testing before the decision to test is confirmed.

Active surveillance and watchful waiting 

• Offer active surveillance to men with prostate cancer who meet all the following criteria:
  • PSA ≤ 20 ng/mL, clinical stage T1-2 and Gleason score 6.

• Advise men with potentially curable prostate cancer considering watchful waiting that their risk of developing more advanced prostate cancer and dying from it will be higher with watchful waiting than with immediate definitive treatment but that, in the medium to long term, watchful waiting is unlikely to diminish their wellbeing and quality of life.

Guidelines development panel member and leading cancer epidemiologist Emeritus Professor Bruce Armstrong AM, University of Sydney, noted that the draft guidelines did not recommend a national screening program, in keeping with health policy worldwide. "The draft guidelines are intended to inform the interactions between men and their doctors, when a man might request a PSA test or his doctor might offer one," said Professor Armstrong AM.

Released today for public consultation via a globally-accessible wiki platform, the draft guidelines have been developed by a broad-based Australian Expert Advisory Panel, which included general practitioners, public health experts, urologists, pathologists, patient support groups and allied health professionals. This is the first time anywhere in the world that an expert advisory panel with all key stakeholders and varying perspectives has come together for such a systematic evidence-based review in this area of men's health.

Associate Professor Anthony Lowe, PCFA CEO comments: "Crucial to the development of these new draft guidelines is that a wide variety of stakeholders worked collaboratively to gain consensus. It means we are able to make the most informed recommendations to date on the benefits and harms of PSA testing, and the optimum time to initiate treatment to save lives."

Following today's launch as part of the opening of the 2014 World Cancer Congress, health professionals and interested members of the public from around the world are invited to review and comment on the draft guidelines at: wiki.cancer.org.au/australia/Guidelines:PSATesting. Following the consultation phase, the draft guidelines will be submitted to the National Health and Medical Research Council of Australia for approval.

NOTES TO EDITORS  

About prostate cancer 

Over a million men worldwide were estimated to have been diagnosed with prostate cancer in 2012 (15% of the cancers diagnosed in men), with most cases (almost 70%) occurring in more developed regions. With an estimated 307,000 deaths in 2012, prostate cancer is the fifth leading cause of death from cancer in men.^[2]

About World Cancer Congress (WCC) 2014 

Organised bi-annually by UICC and taking place in Melbourne between 3-6 December 2014; the WCC is the only event which convenes international cancer control experts and leaders in global health under one roof to identify solutions and agree actions to reduce the impact of cancer on communities around the world. This year's event will gather 3,000 people from over 110 countries.

'Big Debates' being tackled at the 2014 event:

• Cost of treatment vs benefits
• Value of e-cigarettes as a smoking cessation tool and their promotion
• Cancer screening - individual decisions or population approaches?

The full Congress programme, including details of the eminent international event speakers, can be found at: http://www.worldcancercongress.org/programme

Media, members of the cancer community and wider public can get involved in WCC 2014 on Twitter at #CancerCongress, and by using @WCC2014 handle, where there's a chance to hear about latest developments, share thoughts and interact with the event delegates and speakers.

About UICC 

UICC unites the cancer community to reduce the global cancer burden, to promote greater equity, and to integrate cancer control into the world health and development agenda. UICC is the largest cancer-fighting organisation of its kind, with over 800 member organisations across 155 countries representing the world's major cancer societies, ministries of health, research institutes, treatment centres and patient groups.

UICC is dedicated to continuing to work with world leaders to increase their support for cancer control measures, and hold them to account for the cancer commitments made in the UN Political Declaration on NCDs. UICC uses key convening opportunities like the World Cancer Congress and World Cancer Day to lobby to:

• Develop targets and indicators to measure the implementation of policies and approaches to prevent and control cancer
• Raise the priority accorded to cancer in the global development agenda
• Promote a global response to cancer

UICC and its multisectoral partners are committed to convincing governments to adopt specific time-bound targets that address the global burden of cancer and other NCDs. UICC is also a founding member of the NCD Alliance, a global civil society network that now represents almost 2,000 organisations in 170 countries.

For more information visit: http://www.uicc.org

REFERENCES 

1. Prostate cancer incidence statistics. Cancer Research UK. Available at http://www.cancerresearchuk.org/cancer-info/cancerstats/types/prostate/incidence/#geog (last accessed November 2014)
2. GLOBOCAN 2014. Cancer Fact Sheet. Available at: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx (last accessed November 2014)

SOURCE UICC