Men wanting to undergo prostate-cancer testing should be told the harms may outweigh the benefits, say Australia's first clinical guidelines.
They don't recommend a national screening program, saying many men are being tested too frequently, or when they are too young, too old or have a short life-expectancy.
But men at average risk of the disease who decide to be tested regularly should be offered a prostate specific antigen (PSA) blood test every two years from 50 to 69.
For those with a family history of prostate cancer, the testing should start from 40/45 depending on the strength of that history.
Routine digital rectal examination is not recommended for asymptomatic men.
PSA Testing and Early Management of Test-detected Prostate Cancer: Guidelines for health professionals was launched on Wednesday after National Health and Medical Research Council approval.
"Contention about the PSA test has made it difficult for health professionals to take a consistent, evidence-based approach to the test," said Associate Professor Anthony Lowe, CEO of the Prostate Cancer Foundation of Australia.
It's estimated that 20-40 per cent of prostate cancers detected as a result of PSA tests would never have bothered the men in whom they were detected had they not been tested.
But their cancer treatment frequently has adverse effects including urinary incontinence, erectile dysfunction and bowel problems.
Men should be fully informed about the pros and cons of testing, with the guidelines saying the harms may outweigh the benefits, particularly for those over 70.
Cancer Council Australia CEO Professor Sanchia Aranda said application of the guidelines should result in less over-treatment associated with the imprecise PSA test.
It also would hopefully reduce mortality rates, said the Urological Society of Australia and New Zealand.
"We know that early diagnosis is key to saving lives for men with aggressive prostate cancer," said society president Professor Mark Frydenberg.
"However, we also know that in some men prostate cancer is a slow-growing disease that may never be life threatening."
PROSTATE CANCER IN AUSTRALIA
* the second most commonly diagnosed cancer for men, after skin cancer
* accounts for one-third of male cancers diagnosed annually
* causes the second most cancer deaths in men after lung cancer
* diagnosis risk increases with age - by 85 it's a one-in-five chance
* has one of the highest five-year survival rates compared with other cancers
