Former federal treasurer and prostate cancer survivor Wayne Swan. Photo: Jeffrey ChanLabor veteran Wayne Swan has cast confusion over prostate cancer testing guidelines that were designed to settle 20 years of controversy over when and if men should be tested for the fatal condition.
The first official guidelines on testing for prostate cancer recommend that men are not routinely screened for prostate cancer and do not need digital rectal examinations, but that those aged between 50 and 69 should be offered the test every two years.
They represent a truce between clinicians, researchers and advocates, who have been at loggerheads over whether the benefits of the test outweigh its harms, particularly among men who are not at high risk of developing the condition or those aged over 70.
Men should be fully informed about the benefits and harms associated with the PSA test, which overdiagnoses prostate cancer in 20 to 40 per cent of men who produce high measurements of prostate-specific antigen, the guidelines say.
Some of those men undergo treatment that carries the risk of impotence or incontinence.
Mr Swan, a passionate advocate for the PSA test, joined Labor figures on Wednesday in welcoming the guidelines, which were approved by the National Health and Medical Research Council.
“As a prostate cancer survivor, I know the importance of early detection and treatment, and the benefits of the new guidelines,” Mr Swan said
“Early detection is only possible if you get tested, so I urge all men, especially those with a family history of prostate cancer, to consult with your general practitioner and arrange to be tested – it might save your life.”
But the authors of the guidelines said they specifically did not recommend that all men be tested, and particularly not those aged under 50 or over 70 with no family history of the disease.
Cancer Council Australia chief executive Sanchia Aranda said there should be ongoing discussions between men and their GPs about whether the test was necessary.
“Wayne Swan is a survivor,” Professor Aranda said.
“And clearly many who have been diagnosed with prostate cancer have had PSA tests, so we do see it as an important thing for men to do, but there are harms associated with testing and many men have had treatments for cancers that may not have become problematic in their lifetime.”
Some GPs were ordering the PSA without their patients’ knowledge when they arranged for other blood tests, Professor Aranda said.
“It’s almost like an assault, having something done without your consent. We really want to see that stopped.”
As an ardent supporter for the PSA test, Mr Swan was at odds with the former Cancer Council chief executive Alan Coates who declared he would not personally take the test.
At the time, Mr Swan said Professor Coates was condemning young men to death and that he should be removed from his job. Professor Coates subsequently resigned from the board of the Prostate Cancer Foundation of Australia, where his fellow board members shared Mr Swan’s concerns.
But several international studies have since investigated the benefit of the PSA test, including a European study that noted a reduction in deaths among 50- to 69-year-olds who took the test.
A US study found there was no benefit to the test.
Prostate Cancer Foundation of Australia chief executive Anthony Lowe said differences between the urologists, who were in favour of regular testing, and the GPs, who were more circumspect, had crumbled after the publication of those studies.
“It’s been a contentious subject for almost 20 years, and so to reach the point where we have got agreement with the urologists, the GPs, the radiologists and the oncologists has been absolutely fantastic,” Professor Lowe said.
Mr Swan’s comments reflected his personal view, Professor Lowe said.
An earlier version of this story was changed to reflect the position from which Professor Alan Coates resigned.