Table 1

The US, UK and Australian recommendations for prostate-specific antigen (PSA) testing of asymptomatic men for prostate cancer

Professional bodyAdvice for health practitioners (see original documents for exact phrasing)
PopulationUS Preventive Services Task Force (USPSTF)3▸ Discuss PSA screening thoroughly with men who raise the issue or if the man's individual circumstances warrant consideration of PSA testing. Do not feel obligated to offer PSA testing if a patient does not raise the issue or request the test
▸ The decision to start or continue PSA screening should reflect the patient's understanding of the possible benefits and expected harms and should respect his preferences
National Health and Medical Research Council (NHMRC)11▸ Before ordering a PSA test, health practitioners should talk to men about the potential benefits and harms of PSA testing
National Health Service (NHS)12▸ Screening not recommended. An informed choice programme, Prostate Cancer Risk Management aims to provide high-quality information about the risks and benefits to men who ask about screening in order to enable them to decide whether to have the test
NationalAmerican Cancer Society (ACS)10▸ Provide men the opportunity to make an informed decision; for men who are unable to decide, the screening decision can be left to the discretion of the healthcare provider
▸ Men at average risk and expected to live at least 10 more years should receive this information beginning at age 50 years. Men in higher risk groups should receive this information at age 40–45 years
Cancer Council Australia (CCA) and Australian Health Ministers’ Advisory Council (AHMAC), 2010*13▸ Speak to men about the benefits and harms of testing and treatment so that they can make an informed choice
SpecialistAmerican Urological Association (AUA)8▸ Shared decision-making for men aged 55–69 years based on a man’s values and preferences
▸ Routine screening is not recommended in men aged 40–54 years at average risk, or in men over 70 years or with less than a 10–15-year life expectancy; decisions should be individualised for men younger than 55 years at higher risk
Urological Society of Australia and New Zealand (USANZ)14▸ PSA and digital rectal examination (DRE) should be offered to men 55–69 years, after providing information about the risks and benefits of such testing
▸ Interested men in younger age groups (under 55 years) could have a single PSA test and DRE performed at or beyond age 40 to provide an estimate of their prostate cancer risk over the next 10–20 years, with the intensity of subsequent monitoring being individualised accordingly
Primary CareAmerican College of Physicians (ACP)15▸ Inform men 50–69 years about the limited potential benefits and substantial harms of screening for prostate cancer
▸ Base the decision on the man's risk for prostate cancer, a discussion of the benefits and harms of screening, the patient’s general health and life expectancy and patient preferences
▸ Advised not to screen patients who do not express a clear preference for screening
▸ Advised not to screen average-risk men under 50 years, over 69 years, or with a life expectancy of less than 10 to 15 years
Royal Australian College of General Practitioners (RACGP)6▸ Not recommended unless the man specifically asks for it, and he is fully counselled on the pros and cons
▸ General practitioners need not raise this issue, but if men ask about prostate screening they need to be fully informed of the potential benefits, risks and uncertainties of prostate cancer testing
▸ When a patient chooses screening, both PSA and DRE should be performed
▸ Responding to the patient's concerns and fulfilling medicolegal responsibilities are considerations in discussion with patients