Mateo J, Carreira S, Sandhu S, et al. For example, abiraterone might be less preferable in a patient with diabetes who has poor glycaemic control because of the need for concomitant steroids. Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: a randomized study. N Engl J Med 2018;378(19):1767â77. Germline genetic testing in advanced prostate cancer; practices and barriers: Survey results from the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium. To SQ, Kwan EM, Fettke HC, et al. Nutrition care in general practiceAre we waiting for patients to ask? The PSA test measures the level of PSA in a manâs blood. Inherited DNA-repair gene mutations in men with metastatic prostate cancer. doi: 10.1016/j.eururo.2016.08.041. Lancet 2019;393(10185):2051â58. doi: 10.1016/j.eururo.2015.05.024. Results from stereotactic ablative body radiotherapy (an image-guided hypofractionated radiation technique that can be used to give very high doses of radiation to a target volume with usually minimal toxicity)22 or salvage surgery in this setting show some promise, but long-term outcomes and the ideal patient characteristics have yet to be determined. Different criteria exist for those with higher prostate cancer risk or those on active surveillance.5 The increasing availability of prostate MRI does not alter recommendations regarding to whom PSA testing should be offered. Pokorny MR, de Rooij M, Duncan E, et al. 3.0 ng/mL), in place of 4.0 ng/mL or thresholds based on age-related normal values, has the potential to increase the number of prostate biopsies performed. Eur Urol 2014;66(1):22â29. 1 Therefore, GPs have no obligation to offer prostate cancer screening to asymptomatic men. Prostate specific antigen (PSA) is a glycoprotein produced solely by the prostate. Adding targeted cores to a systematic biopsy increases the detection of clinically significant cancer,6,7 although the findings are not universal.8 However, the utility is much greater for patients with a prior negative biopsy for whom a clinical suspicion remains.9. 8 This â¦ As yet, there is no consensus regarding who should be tested and when testing should be offered.36 Some suggest consideration of genetic testing in those with prostate cancer diagnosed under the age of 65 years, or patients with relevant family history such as cancers related to hereditary breast and ovarian cancer syndrome or Lynch syndrome (hereditary non-polyposis colorectal cancer).37. Another area of interest is whether MRI can be used as a triaging tool. Prostate Cancer Foundation of Australia and Cancer Council Australia. Prostate specific antigen is tissue-specific but not cancer-specific. The Royal Australian College of General Practitioners (RACGP) recommends against PSA screening, but acknowledges that the PSA debate remains unclear and open to individual interpretation. Urol Oncol 2015;33(1):17.e1â17.e7. These guidelines (recommendations) in the web-version of this guideline were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 2 November 2015 under section 14A of the National Health and Medical Research Council Act 1992 In approving the guidelines (recommendations), NHMRC considers that they meet the NHMRC standard for clinical â¦ doi: 10.1016/j.eururo.2017.02.026. Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. Fendler WP, Calais J, Eiber M. Assessment of 68Ga-PSMA-11 PET accuracy in localizing recurrent prostate cancer: A prospective single-arm clinical trial. Before ordering a PSA test, health practitioners should talk to men about the potential benefits and harms of PSA testing. This article gives an overview of the main points in these new guidelines on PSA testing. Currently there is no consensus regarding the optimal surveillance schedule.17 Given that MRI improves the accuracy of biopsy, it is now recommended before confirmatory biopsy for all active surveillance patients if not already done prior.16 At this stage, MRI has not replaced biopsy in active surveillance, and further research is required to clarify how it might be best incorporated into schedules to potentially reduce the number of biopsies needed. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: A systematic review and meta-analysis. There have been significant changes in how prostate cancer is diagnosed and managed in the past five years, with the introduction of new clinical pathways that were unprecedented just a decade previously. The views expressed by the authors of articles in Australian Family Physician are their own and not World J Urol 2019. doi: 10.1007/s00345-019-02774-y. Sweeney CJ, Chen Y-H, Carducci M, et al. The guidelines were published in January following approval of the guidelinesâ recommendations by NHMRC. Hence Australian guidelines support informed decision-making about prostate cancer screening based on personal circumstances. Paller CJ, Antonarakis ES, Beer TM, et al. To help men have an informed discussion with their GP about the risks â¦ Prostate specific antigen is tissue-specific but not cancer-specific. To view these documents you will need software that can read Microsoft Word format. Currently, a single demarcation between normal and elevated PSA values, 4.0 ng/mL, is used as an indication for biopsy among men of all ages. PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). Australian Journal of General Practice published by the Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia more confidence, whether the elevated PSA is more likely to be associated with prostate cancer than be due to non-cancerous changes, potentially avoiding unnecessary biopsy. The latter has the advantage of being able to directly image the needle sampling the area of interest, providing confidence that the appropriate area has been biopsied. Adult intraosseous accessExperiences in a remote emergency department, Cosmetic surgery on childrenProfessional and legal obligations in Australia, Primary palliative careFacing twin challenges, Cholesterol lowering medicationPatients’ knowledge, attitudes and experiences, Nondiabetic retinal pathologyPrevalence in diabetic retinopathy screening, Chronic hepatitis BA clinical audit of GP management. Finally, however, Australian consensus guidelines â Clinical Practice Guidelines for PSA Testing and Early Management of Test-Detected Prostate Cancer â were published in January this year with the aim of putting an end to the confusion. Option-Click the link, your computer or device will try and open file! Do not recommend PSA screening saves lives Bono JS, Fizazi K, et al to radical in! Waiting for patients with suspected prostate cancer 2019 update of prostate cancer in the prostate gland detection and reduced:.: Survey and predictive value for the families of patients, as this is... 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