Prostate cancer doctors call for changes to screening guidelines over fears about undetected cases

There are urgent calls to overhaul the way general practitioners test for prostate cancer, amid concerns too many men are dying unnecessarily. 

Routine prostate cancer screening is not recommended for most men, but some specialists are calling for changes to testing guidelines.

“There are patients that are angry, that are dying and had a delayed diagnosis,” says Peter Swindle, a urologist who specialises in prostate cancer.

Data from the Australian Institute for Health and Welfare (AIHW) shows prostate cancer has overtaken breast cancer as the most common type of cancer in Australia, with an estimated 24,217 cases recorded this year alone.

This year, more than 3,500 men are expected to die from the disease and in the six years to 2020, there was a 15.6 per cent increase in prostate cancer deaths, according to the AIHW.

Some men have told the ABC they have struggled to get a doctor to regularly screen them for the disease.

One of those is Justin Falkiner, a police acting inspector who lives in the regional New South Wales town of Dubbo.

He has a family history of the disease: His father has it, as did his late grandfather.

So, when he was 36, his GP ran a prostate-specific antigen blood test, known as a PSA.

The test measures a patient’s PSA level: If it’s too high for the person’s age, the patient will undergo further testing — usually scans or a biopsy — to determine if they have prostate cancer, or non-cancerous conditions such as an infection or inflammation of the prostate.

Justin Falkiner with his kids Ava and Josh.(Supplied: Justin Falkiner)

Mr Falkiner’s test came back in the low range.

When he was in his early 40s, he asked his GP to repeat the test but was told guidelines stated it would not be necessary until he was 50.

“So, silly me, I didn’t ask for a second opinion.”

Prostate cancer can run in families, suggesting a genetic link.

According to the American Cancer Society, having a father or brother with prostate cancer more than doubles a man’s risk of developing the disease.

‘Devastating’ diagnosis after chance test

Mr Falkiner returned two years later for an unrelated matter and, after his GP ran full bloods, his PSA came back with a reading of 21. Typically, if a PSA reading is above three, it should be repeated within three months.

He was referred to a urologist and when the test was repeated a month later, his PSA had risen sharply to 27. 

“At that point, my urologist pressed the panic button,” he said.

He was diagnosed with stage 2 prostate cancer, which was deemed an intermediate risk — where cancer is likely to grow faster and be mildly to moderately aggressive.

“Everyone has this opinion, ‘It won’t happen to me.’ I was no different,” he said.

“So … whilst I might have been prepared for what I was going to be told, it was still devastating to hear those three words.”

A group selife photo of Josh, his wife, and two young children, on top of a hill overlooking bushland and a beach.
Justin Falkiner with his wife, Kristin, and kids Josh and Ava.(Supplied: Justin Falkiner)

Also weighing on his mind was his family: his wife, Kristin, and their young children, Joshua and Ava.

Given the rapid increase in his PSA level, Mr Falkiner’s urologist feared his cancer might have already spread to other parts of the body — which would have made his treatment and survival much more difficult. Luckily, that had not occurred.

But his specialist was sure of one thing: “He said to me, basically, had I left this to 50, we’d be not only dealing with a different diagnosis but a very different outcome.”

Why prostate screening is a contentious issue

Screening for prostate cancer is a contentious area because of the risk of overdiagnosis, and potentially “risky” treatments, says Jon Emery, the Herman professor of primary care cancer research at the University of Melbourne.

“Overdiagnosis really means that it picks up prostate cancers that are relatively slow growing and that would have never caused any harm to a man if they’d never known about it,” Professor Emery said.

“The forms of biopsy that historically we used, which went through the passage through the rectum, have the potential to cause harm.

“Then [there are] harms of treating the cancers as well … particularly erectile dysfunction and urinary incontinence.”

That, he said, meant doctors had to weigh up the risks and benefits of treating a cancer that, potentially, may have never posed a problem if left untreated.