PSA test reform opens way for Australian men to live longer

The guidelines many GPs follow – now under ­review – say doctors are under no obligation to refer men of any age for PSA testing. It can prove costly.

The Australian's health editor Natasha Robinson with her father David, who died of prostate cancer.

One of the most poignant memories I have of my dad’s last months of life was waving goodbye to him one autumn day 18 months ago as he stood on his front step wrapped in a blue dressing gown fighting back tears.

Always a softie, Dad cried often. “I’m getting better,” he said as he waved to my car, the hope in his voice breaking my heart; ­because I knew it wasn’t true. But Dad just wanted to live.

When my Dad, David, was ­diagnosed with prostate cancer in mid-2018 at 75, it had already ­metastasised. There was cancer in the bones of his pelvis and small spots in his lungs. Later, he developed a small-cell prostate cancer that was terminal.

We’re almost sure Dad hadn’t been getting regular PSA tests. Like many men, he didn’t tend to go to the doctor unless something was wrong. And national prostate-cancer-testing guidelines do not recommend screening men aged over 70. The guidelines many GPs follow – now under ­review – say doctors are under no obligation to refer men of any age for PSA testing.

Since he died last September, I have never stopped to think that things might have been different for Dad. But when leading urological surgeon Peter Heathcote tells me he is feeling “frustrated, disappointed and shattered” to see rising numbers of men coming to his rooms who have not been PSA screened and now have advanced metastatic cancers with poor prospects of survival, I wonder whether health guidelines and the low profile given to men’s health failed Dad.

I didn’t expect to lose my Dad this soon. He had a lot of life left to live and love to give. I’m grateful he was alive to walk me down the aisle, of course blubbering. He adored being a grandfather. His youngest granddaughter was just a toddler when he died. His tribe of granddaughters loved hanging out with Grandad, him ensconced on a comfy couch where he would stay all afternoon drinking black tea, reading book after book, singing, and joyfully chattering idly. Dad loved to chat, and his view of life was characterised by optimism.

A retired photographer and technology nut, he was adored by the NSW north coast students in Tweed Heads that he taught photography and how to use com­puters. He regularly played bass around the north coast in his jazz band, and enjoyed a beautiful relationship later in life with his partner Kim.

The Prostate Cancer Foundation of Australia now wants ­national guidelines updated so that PSA screening is far more widespread, including being recommended for men over 70. That’s because among the men ­diagnosed with prostate cancer in their 70s each year, 41 per cent of those cancers in men under the age of 75 are high-risk or have ­metastasised, and for men over 75 the figure is a devastating 60 per cent. Many of these men are otherwise healthy and fit with many years ahead of them and deserve to receive preventive healthcare. The era of overdetection and overtreatment of prostate cancer is largely over owing to the routine use of MRI and active surveillance.

It’s time for the guidelines to catch up with the research and urological practice. PSA testing is no longer a road to overdiagnosis. It’s a vital risk-assessment tool.

If Dad’s cancer had been picked up earlier and contained within the prostate, his fervent hope for a few years more of life to play jazz and dote on his grandkids would almost certainly have been possible. And had that been the case, when he stood on his step summoning his courage and hope, I too would have believed he would get better.