Australia boasts some unique things that originated from nowhere else on earth: a weapon (boomerang), an animal (kangaroo), a musical instrument (didgeridoo), a rock band (AC/DC), and a popular fictional character (Crocodile Dundee), to name just a few.

The continent is now about to add another original enterprise to the list. They want to take a strong stand regarding PSA screening for prostate cancer (PCa). According to recent news, the Prostate Cancer Foundation of Australia (PCFA) initiated a move to review and reform the existing 2016 national guidelines on the PSA test.

It appears the 2016 guidelines have proven inadequate to address the PCa situation in Australia. Here are key facts: “In 2025, prostate cancer is the most common cancer in Australia, regardless of gender, and is the second most common cause of cancer death despite the opportunities for cure.”^[i] Of primary concern is the added fact that about a third of cases are diagnosed late, according to a June 13, 2025 news report.

The 2016 guidelines are as follows:

patients who decide to undergo regular testing for PCa, should be offered PSA testing every 2 years from age 50 years to 69 years. Further investigation is to be offered if the total PSA is > 3.0 ng/mL. … Furthermore, … men aged 50–69 years (without a family history of PCa) should partake in informed decision making about PCa screening. The benefits and harms of prostate screening using the PSA test remain unclear, therefore, the decision to undergo screening is up to the individual to request testing from their GP.^[ii]

In short, “The 2016 Guidelines recommend that men at average risk of prostate cancer who have been informed of the benefits and harms, and who decide to undergo regular testing, should be offered testing every 2 years from 50 to 69 years.”^[iii] Subsequently, both doctors and patients “… described the 2016 Guidelines as ineffective based on negative message framing, lack of uptake of the guidelines by key primary care groups, and low community awareness.”^[iv] When public comment was sought, “…the majority of men reported missed opportunities for testing, resulting in diagnoses with late-stage disease” and “ felt the 2016 Guidelines were ineffective in facilitating early detection and management of prostate cancer.”^[v] 

A similar situation developed in the U.S. after our 2012 guidelines downgraded PSA screening. Within a few years, researchers noticed a downward trend in PCa diagnosis—not surprising, as PSA testing quickly began dropping off—as well as a tragic increase in the number of men being diagnosed with aggressive or advanced PCa when it was too late for successful local treatment. Since then, our 2018 revised guidelines advise doctors to discuss with each patient the merits vs. risks of PSA testing in each patient’s case. The result? PSA screening remains underutilized in the U.S. So, let’s see what the Australians have in mind.

Proposed Australian PSA guidelines

The proposed new guidelines represent a radical call to action. A “first look” at the revisions presents some key points:

• Advice to offer males not at a higher risk or from a priority population ‘who are interested in their prostate health’ an initial PSA test from age 40
• A recommendation to test males aged over 70 based on clinical assessment, including life expectancy
• Recommendations for a) earlier testing for males at higher risk, including those with a family history, those of sub-Saharan ancestry, and b) testing Aboriginal and Torres Strait Islander males, starting at age 40 in recognition of their ‘significantly’ higher mortality risk
• Reinforcement that digital rectal examinations are no longer recommended as screening tests in asymptomatic males in primary care
• For males requiring further investigation on the basis of their PSA, an multiparametric MRI (mpMRI) is recommended as the next diagnostic test to determine if a biopsy is needed.

Sound familiar? As we point out in numerous blogs, annual PSA testing is essential because it saves lives. Of special note, adding mpMRI after suspicious PSA results eliminates past harms caused by previous overuse of biopsy as the only way to overcome the ambiguity of many PSA results. Plus, men at higher risk should begin PSA screening at an earlier age than men with no known risk factors. It remains to be seen if Australia’s National Health and Medical Health Research Council will approve this revolution in guidelines. For the sake of Australian men, we hope they do. And for the sake of our own men, we hope the US Preventive Services Task Force takes note, and embraces annual PSA testing now that MRI takes the sting out of it.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Heneka N, Heathcote P, Malouf P, Chambers SK, Smith DP, Dunn J. Lessons from the implementation of the Australian 2016 prostate specific antigen testing clinical practice guidelines: a descriptive study. ANZ J Surg. 2025 Apr 15.
[ii] Cabarkapa S, Perera M, McGrath S, Lawrentschuk N. Prostate cancer screening with prostate-specific antigen: A guide to the guidelines. Prostate Int. 2016 Dec;4(4):125-129.
[iii] Heneka, ibid.
[iv] Heneka, ibid.
[v] Heneka, ibid.