Australia expands prostate cancer screening to younger and older men under new guidelines

The updated Australian prostate cancer guidelines now have GPs offer PSA testing from age 45 and to men over 70 with sufficient life expectancy, while dropping routine digital rectal exams.

The Prostate Cancer Foundation of Australia has released revised guidelines that broaden eligibility for prostate-specific antigen (PSA) screening. General practitioners are now expected to propose PSA testing from age 45, rather than 50, for both high-risk patients and those simply interested in their prostate health, and to offer biennial tests to men aged 50-69 and to those over 70 who have a life expectancy beyond seven years.

The recommendations also identify men of Black sub-Saharan descent and carriers of the BRCA2 mutation as high-risk, warranting testing from 45 onward. Routine digital rectal examinations have been removed, reflecting evidence of inaccuracy and patient reluctance. When PSA levels are elevated, an MRI is advised before considering a biopsy, a step projected to cut unnecessary procedures by half.

Experts say the revisions balance earlier detection of aggressive disease with a reduction in over-treatment. The National Health and Medical Research Council approved the guidelines, and the federal government allocated $320,000 for a GP awareness campaign, while the Prostate Cancer Foundation will seek Medicare subsidy for the expanded testing and MRI scans.