Feature Article

Prostate cancer. Part 1. issues in screening and diagnosis

Phillip D Stricker AO



Prostate cancer is common, affecting about 13% of Australian men at some stage in their lifetime. In the face of continuing debate about screening asymptomatic men for the disease, it remains the primary physician’s responsibility to make appropriate patients aware of the potential benefits and risks.

Key Points

  • A man’s lifetime risk of developing prostate cancer is about 13%, and his chance of dying of the disease is about 2%. As the population ages, these statistics are likely to deteriorate further.
  • Patients should be made aware of the PSA test, but should undergo an informed consent process prior to screening.
  • Screening (if elected for by the patient) should commence at the age of 50 years with a digital rectal examination and a serum PSA test. A biopsy should be performed if the rectal examination is abnormal or if the PSA reading is greater than the age specific reference range.
  • If a patient has a family history of prostate cancer, screening should commence at 40 years of age and continue annually until his life expectancy falls below 10 years.
  • Of patients with a PSA level between 4 and 10 ng/mL, 25% have prostate cancer. The use of free/total PSA ratios can improve test accuracy.
  • PSA levels may be elevated significantly by complicated benign prostatic hyperplasia (associated with retention, infection or prostatitis) or by prostate manipulation, such as biopsy or transurethral resection. Recent ejaculation may also increase PSA levels.