Informed Consent

Amongst health professionals, there is agreement that current evidence does not support population-based PSA screening programs for prostate cancer. In addition, there is a lack of consensus on what advice to offer doctors or men who request a PSA blood test. This is causing widespread confusion for men and their health advisers. We have put together the following information to help you make an informed decision as to whether you should be tested for prostate cancer.

What is prostate cancer testing?

Prostate cancer testing aims to find prostate cancer in men at an early and curable stage before symptoms have developed. The aim is to treat and decrease the death rate from prostate cancer. Testing for the disease at Maxwell Plus is done starting with a PSA (Prostate Specific Antigen) blood test. Further testing may be required such as magnetic resonance (MR) imaging of the prostate.

What is the risk of prostate cancer?

Each year approximately 20000 Australian men are diagnosed with prostate cancer and over 3300 die from the disease. That is 55 men diagnosed with prostate cancer and 9 men dying from it every day. It is the most common cancer in men and the second leading cause of cancer death.

Family history is the most important risk factor for developing prostate cancer. If:

  • One first degree relative has prostate cancer then your risk of developing prostate cancer increases to 20%.
  • Two first degree relatives have prostate cancer your risk increases to 40%.
  • Three first degree relatives have prostate cancer your risk approaches 100%.

An individual’s risk of prostate cancer is determined from their age, race, family history and PSA blood test results.

Who should be tested for prostate cancer?

PSA testing for prostate cancer should only be done if you are well informed about the:

  • current controversies.
  • pros and cons of early prostate cancer detection.
  • consequences of an abnormal PSA result.
  • potential outcomes and treatments that may occur should prostate cancer be diagnosed.

This is called informed consent.

Maxwell Plus does not recommend mass population screening for prostate cancer. Instead, we offer access to testing in a specialised framework for health-conscious men that want to know and manage their risk of prostate cancer.

PSA testing can start as young as 40 to establish a baseline PSA. A baseline PSA will guide the frequency of further testing. This allows for more frequent testing of men at high risk and a lower frequency of testing for low risk. Having a baseline PSA enables the detection of a small number of aggressive cancers that can be found in young men.

What are the risks and benefits of prostate cancer testing?

Testing for prostate cancer has risks and benefits. In making the decision to be tested, you need to understand these risks and benefits.

Potential benefits of prostate cancer testing and early diagnosis include:

  • Reassurance – If your PSA test result is normal or very low, this can provide reassurance.
  • Early Detection – If prostate cancer is detected at an early stage when it is still confined to the prostate gland, there is an opportunity to commence early treatment.
  • Early Treatment – Diagnosing prostate cancer early that is localised can potentially be curable. Prostate cancer that is diagnosed late has often spread beyond the prostate and can be incurable.

Recent research suggests that prostate cancer testing has the potential to decrease the death rate by up to 44%.

Potential risks of prostate cancer testing and early diagnosis include:

  • False positive results. If no cancer is present, a positive test may cause psychological distress and unnecessary prostate biopsies.
  • False negative results. If prostate cancer is present, a normal or low PSA may provide false reassurance and may delay cancer diagnosis.
  • Overdiagnosis. A proportion of prostate cancers detected as a result of PSA testing would never have bothered the men in whom they were detected had they not been tested. Such cancers are commonly referred to as over-diagnosed cancers. Over-diagnosis is estimated to be as high as 20-40% of prostate cancers diagnosed following a PSA test.
  • Overtreatment. Some prostate cancers don’t present a threat to life. Treatment of these cancers may result in side effects that can reduce your quality of life. This is known as over-treatment.
  • Unnecessary biopsies. Not all patients with an abnormal PSA will have prostate cancer and the only way to find out is a prostate biopsy. This results in 2 out of 3 men having an unnecessary prostate biopsy with potential side effects.

What are the potential side effects of treatments?

There are many treatment options for prostate cancer that is diagnosed early and potentially curable. These include:

  • active surveillance,
  • external beam radiotherapy,
  • brachytherapy; and
  • radical prostatectomy.

Unfortunately, all potentially curative options for prostate cancer have possible side effects. Side effects vary from treatment to treatment but can include:

  • impotence,
  • Incontinence; and
  • bowel disturbance.

With modern technology, these side effects have been reduced.

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