PSA screening is back in the conversation, and Australian GPs are quietly recalibrating

PSA testing for prostate cancer screening has been one of the more contested areas of preventive medicine in Australia for the last decade. The 2014 USPSTF position — that the harms of screening outweighed the benefits — pushed many Australian GPs away from offering PSA tests proactively. The 2024 RACGP guideline updated that position.

What changed

The new RACGP guidance recommends GPs proactively discuss PSA testing with men aged 50-69 who have one or more risk factors — family history of prostate cancer, African ancestry, BRCA mutation carrier. Shared decision-making remains the principle, but the trigger for the conversation is now condition-based, not patient-initiated.

Why the shift

Two things changed. First, multiparametric MRI as a follow-up to elevated PSA has dramatically reduced unnecessary biopsies — and the morbidity associated with them. Second, the long-term mortality data from the ERSPC trial now consistently shows a 21% relative reduction in prostate-cancer-specific mortality with screening in the eligible age range.

How to have the conversation

The patient needs to understand the trade-off: PSA picks up indolent cancers that would never have caused harm, AND it picks up aggressive cancers in time to treat. The MRI pathway reduces over-diagnosis. The decision rests with the patient.

The practical blocker is finding the time. A 'shared decision-making' conversation takes 8-10 minutes done properly. Without dedicated workflow, it gets skipped.