Understanding the diagnosis of prostate cancer

Xuan Rui S Ong, Dominic Bagguley, John W Yaxley, Arun A Azad, Declan G Murphy and Nathan Lawrentschuk
Med J Aust 2020; 213 (9): . || doi: 10.5694/mja2.50820
Published online: 2 November 2020


  • Prostate cancer continues to be the most commonly diagnosed cancer, and the second leading cause of cancer death among Australian men.
  • Prostate‐specific antigen testing is personalised (not dichotomous in nature) and its interpretation should take into account the patient's age, symptoms, previous results and medication (eg, 5‐α reductase inhibitors such as dutasteride).
  • Multiparametric magnetic resonance imaging of the prostate has been proven to have a 93% sensitivity for detecting clinically significant prostate cancer. It has the potential to decrease unnecessary prostate biopsies by around 27%.
  • International Society of Urological Pathology (ISUP) grade 1 (Gleason score 6) has been shown to have very little, if any, risk of metastasis
  • ISUP grade 1 (Gleason score 3 +3 = 6) and low percentage ISUP grade 2 (Gleason score 3 + 4 [< 10%] = 7) can be offered active surveillance. The goal of active surveillance is to defer treatment but is still curative when required.
  • With better imaging (magnetic resonance imaging and emerging prostate‐specific membrane antigen positron emission tomography–computed tomography) and transperineal prostate biopsy, more men can be offered screening after discussion of risks and benefits, knowing that overdiagnosis has been minimised and radical treatment is reserved for only the most aggressive disease.
  • Xuan Rui S Ong1,2
  • Dominic Bagguley1,2
  • John W Yaxley3,4
  • Arun A Azad2,5
  • Declan G Murphy2,5
  • Nathan Lawrentschuk1,2

  • 1 EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC
  • 2 University of Melbourne, Melbourne, VIC
  • 3 University of Queensland, Brisbane, QLD
  • 4 Royal Brisbane and Women's Hospital, Brisbane, QLD
  • 5 Peter MacCallum Cancer Centre, Melbourne, VIC


Competing interests:

No relevant disclosures.


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