I had prostate cancer. Outdated advice is letting down men

All men visiting doctors about prostate cancer should request a Prostate Specific Antigen (PSA) test.

All men visiting doctors about prostate cancer should request a Prostate Specific Antigen (PSA) test. Photo: Getty

I was lucky. If my doctor had listened to his professional organisation I could have been facing death within the next few years, or at the very least a range of debilitating and complex treatments.

Instead, he arranged a simple blood test at my request without suggesting it was probably unnecessary.

Soon after, I had urgent prostate cancer surgery, and can now expect to live for many more years in good health.

I’m telling my story because the attitude of the Royal Australian College of General Practitioners towards these blood tests is outdated and misguided.

I have no doubt it is causing many older men to needlessly suffer, and some men to needlessly die.

‘No obligation’

Cancer affects many women and men.

In men, prostate cancer is the most common cancer – apart from common skin cancers – and the current approach to screening for it is deeply flawed.

A large part of the problem lies with the Royal College of GPs which, bizarrely, recommends against the blood test for symptom-free men (although its opposition is more muted when – as in my case – a blood relative has had prostate cancer).

That’s right. Prostate cancer is very common in men who are in their late 40s or older, it can be present without men knowing it (as in my case), and there is a simple blood test that can indicate its presence.

But the college says ‘‘GPs have no obligation’’ to offer that blood test to symptom-free men, and suggests that in most cases they should advise that it is unnecessary.

The college’s reasoning is that a number of things can cause a blood test result showing elevated PSA (the marker which can indicate cancer needing treatment).

As a result, it says the test is likely to cause too many men to seek out unnecessary, invasive biopsies and treatment.

Follow-up testing

The problem with the college’s reasoning is two-fold.

Firstly, it doesn’t take into account new, non-invasive follow-up testing procedures.

Secondly, it doesn’t take into account the fact that most men aren’t stupid.

First things first. It’s true that PSA levels can be temporarily elevated for benign reasons – for example, if you’ve had sex or even ridden a bike within a few days of the test.

But if a PSA test (or a couple of tests in succession) shows elevated PSA levels then there is another, more precise and non-invasive test that can readily be used to identify whether there is anything to worry about.

An MRI scan is a medical imaging procedure that uses a magnetic field and radio waves to take pictures inside the body, and it can quickly identify whether there are cancerous areas of a type and extent that warrant a biopsy.

An MRI is a widely accepted method of detecting prostate cancer. Photo: Getty

MRIs, of course, are not a particularly new form of imaging. But the college’s attitude to PSA blood tests seems to ignore the role the technology now plays in safely and quickly weeding out high PSA results that are of no concern.

Secondly, the college’s reasoning assumes men can’t understand the most basic nuances of cancer, such as whether they have a form that is extremely slow-growing and likely to never be harmful.

Many prostate cancers fall into that category.

Men with this form of prostate cancer shouldn’t do anything except have further regular blood tests, and maybe an occasional MRI – a strategy known in health circles as ‘‘active surveillance’’.

It’s true that there are a lot of things that are hard to communicate about cancer. But the concept of ‘‘active surveillance’’ isn’t one of them. For anyone to suggest otherwise is ridiculous.

Guidance overhaul

No doubt the College of GPs will say its advice aligns with 2015 recommendations from the Prostate Cancer Foundation of Australia and the Cancer Council – advice that has, in turn, been approved by the National Health and Medical Research Council.

These organisations do excellent work – I experienced first hand the wise advice of the foundation as I was considering treatment options, and am very grateful for it.

However, the 2015 guidance on PSA testing is now outdated, and the studies that are often cited were conducted in the pre-MRI era, as experts have pointed out.

The guidance needs to be overhauled, and in the meantime the College of GPs should immediately drop its resistance to PSA testing of symptom-free men.

Take the step

In the interim, it is men’s wives, husbands, partners, relatives and friends who need to urge them to regularly take this simple, and potentially life-saving step.

There’s no use pretending that prostate cancer treatment doesn’t involve difficulties. It results in a new normal, which isn’t as good as the old normal.

In some cases, there can be challenging additional treatment side effects, although these don’t always last for a long time.

For that reason, men who find they need treatment should ask lots of questions when deciding on their treatment strategy.

And, despite what some medical bodies say, there is an important precursor question that all middle-aged men need to ask their GP: ‘Can I have a PSA test?’

Murray Griffin is a communications adviser and former journalist

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