Prostate cancer detection and care have changed significantly over the past decade. New Australian guidelines, approved by the National Health and Medical Research Council, provide updated advice to help men and their doctors make more informed decisions about testing and diagnosis.

The guidelines recognise that one approach doesn’t suit everyone. A person’s age, family history and individual risk should all be considered when deciding whether to have a PSA (prostate specific antigen) blood test.

So, what’s new?

PSA testing remains an important first step. For people who choose to have regular testing, the guidelines recommend testing every two years from age 50 to 69 for those at average risk. Those with a family history or other higher-risk factors may be advised to start testing earlier, from around age 40 to 45 depending on their level of risk.

Importantly, a raised PSA does not necessarily mean cancer. PSA can increase for several reasons, so further investigation may be needed.

MRI is now an important part of the diagnostic pathway. If a PSA result is concerning, doctors may recommend a multiparametric MRI (mpMRI) to help identify areas that may need further investigation and determine whether a biopsy is appropriate. This can help reduce unnecessary biopsies and make biopsies more targeted.

Treatment is changing too.

For men diagnosed with low-risk prostate cancer, active surveillance is increasingly used instead of immediate surgery or radiation therapy. Active surveillance means regularly monitoring the cancer and starting treatment if there are signs that it is changing or becoming more aggressive. This can help some avoid, or delay, treatment side effects while still allowing treatment when it is needed.

The guidelines also recognise that decisions about testing later in life should take into account a person’s overall health and life expectancy, rather than relying simply on age.

What does this mean for you?

The biggest change is that prostate cancer detection is becoming more personalised. Rather than relying on PSA testing alone, doctors can consider your individual risk alongside PSA results, imaging and other information to decide what happens next.

If you’re concerned about your prostate cancer risk, particularly if you have a family history, talk to your GP about whether PSA testing is right for you. The goal is to detect cancers that need treatment while reducing unnecessary tests and treatment for cancers that may never cause harm.