STEP 1: Prevention and early detection
This step outlines recommendations for the prevention and early detection of prostate cancer.
The causes of prostate cancer are not fully understood, and there is currently no clear prevention strategy.
While the causes of prostate cancer are not fully understood, there are a number of factors associated with an increased risk of developing the disease, which include:
- increasing age, especially for men aged over 50 years
- a family history of prostate cancer
- having certain germline mutations, for example in the BRCA2 gene, or particular genetic conditions such as Lynch syndrome
- race (e.g. people of African-American descent are at higher risk, while men of Asian and Hispanic/Latino descent are at less risk than Caucasian people) (American Cancer Society 2019).
Dietary factors (e.g. diets high in animal fat, dairy products or calcium and/or low in vegetables and fruit) may increase the risk of developing prostate cancer, but the exact role of diet as a risk factor is not yet clear (American Cancer Society 2019).
Everyone should be encouraged to reduce their modifiable risk factors, including taking the following steps.
Between five and 10 per cent of prostate cancers have a hereditary component, which may be associated with identifiable germline detects in genes such a BRCA1 or BRCA2 (hereditary breast ovarian cancer syndrome), HOXB13 (hereditary prostate cancer), or genes involved in DNA mismatch repair (Lynch syndrome) (Giri et al. 2018). Men should be counselled about possible hereditary/inheritable risk if:
- their family history suggests a pathogenic BRCA1 or BRCA2 gene variation
- three first- or second-degree relatives have been diagnosed with prostate cancer
- two first- or second-degree relatives have been diagnosed with prostate cancer, with one relative being diagnosed before the age of 50 years (RACGP 2019)
- young at the age of diagnosis (< 50–55 years) in a patient or first-degree relative
- there is a family history of prostate, breast or ovarian cancer.
Men should engage in shared decision making about genetic testing.
Genetic testing should only be performed through a familial cancer service, with appropriate genetic counselling available.
For general practitioner referral guidelines for cancer genetics assessment, see General practitioner referral guidelines for cancer genetics assessment.
There is emerging data that germline mutations in genes involved in DNA repair (e.g. BRCA1 or BRCA2 and mismatch repair genes) are more common in patients with advanced disease, and therefore may be significant in the patient’s prognosis. In patients without a family history, it is unclear if early detection and changes in management based on germline testing is advantageous.
Currently there is no organised population-based prostate cancer screening in Australia. Men (including asymptomatic men) may elect to have routine prostate-specific antigen (PSA) testing to screen for prostate cancer; however, their general practitioner should first discuss the benefits and harms of the test with them.
Men at moderate risk of developing prostate cancer (e.g. who have a father or brother who were diagnosed with prostate cancer) should be proactively followed up. If these men decide to undergo PSA testing, it should be offered every two years between the ages of 45 and 69 (PCFA and CCA 2016). For men who are at high risk of developing prostate cancer (e.g. father and two brothers diagnosed with prostate cancer) and are wanting to undergo testing, PSA testing should be offered every two years between the ages of 40 and 69 (PCFA and CCA 2016). PSA testing is not recommended for men who are unlikely to live another 7 years (PCFA and CCA 2016).
Men without risk factors for developing prostate cancer may also consider PSA testing for early detection between the ages of 50 and 69 years. A summary of the benefits and harms of PSA testing for prostate cancer in asymptomatic men can be found in the National Health and Medical Research Council’s PSA testing for prostate cancer in asymptomatic men – information for health practitioners.
Guidance for clinicians counselling their patients about the early detection of prostate cancer is provided in The Melbourne Consensus Statement on the early detection of prostate cancer.
For detailed clinical guidelines on PSA testing and early management of test-detected prostate cancer, refer to the Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer.
