In August of 2013, prostate cancer experts from around the word met in Melbourne, Australia at the Prostate Cancer World Congress to discuss the much debated role of PSA testing for the detection of early prostate cancer. The panel, consisting of leaders in urology, radiation oncology, medical oncology, epidemiology, general practice and allied health, released the Melbourne Consensus Statement in an attempt to quell the shared confusion and frustration many healthcare providers face regarding PSA testing. The document, composed of 5 consensus statements, aims to provide a practical, evidence based summary of the use of PSA testing for the early detection of prostate cancer. Broadly speaking, the Melbourne Statement has been warmly welcomed by many as providing some realistic and relevant advice for primary care physicians and others who find this area challenging and confusing.
While specific age ranges are identified as benefitting most from PSA testing, 50-69, the opportunity to test patients in their 40’s and those over 70 is not ignored. The real focus of the consensus statement is on a shifting paradigm in which the goal should not to be to treat all men diagnosed with prostate cancer but to diagnose all men with potentially lethal prostate cancer and to avoid over treatment in men diagnosed with low risk prostate cancer. The authors stress the importance of a multivariable approach to early prostate cancer detection, admitting the shortcoming of the PSA test as a generalized population-based screening tool but not disregarding the role it has played in the last 30 years in decreasing prostate cancer mortality and the incidence of metastatic prostate cancer. In the wake of the USPTF Grade D recommendation on prostate cancer screening, the Melbourne Consensus Statement gives healthcare providers a pragmatic approach to counseling their patients on the early detection of prostate cancer as well as limiting the side of effects of treatment for those men diagnosed with prostate cancer by perhaps not treating them at all.
The five consensus statements are:
- Consensus Statement 1: For men aged 50-69, level 1 evidence demonstrates that PSA testing reduces prostate cancer-specific mortality and the incidence of metastatic prostate cancer.
- Consensus Statement 2: Prostate cancer diagnosis must be uncoupled from prostate cancer intervention.
- Consensus Statement 3: PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection.
- Consensus Statement 4: Baseline PSA testing for men in their 40’s is useful for predicting the future risk of prostate cancer.
- Consensus Statement 5: Older men in good health with over ten year life expectancy should not be denied PSA testing on the basis of their age.
Reid Graves, MD