Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

From Opportunistic Testing to Initiated Discussion: Developing Australia's 2026 Guidelines for the Early Detection of Prostate Cancer (146394)

David P Smith 1 , Suzanne Hughes 1 , Nicole Heneka 2 , Brett Montgomery 3 , Alan Barlee 4 , Peter Heathcote 5 , Jeff Dunn 6 7
  1. The Daffodil Centre, Cancer Council NSW and the University of Sydney, Sydney, NSW, Australia
  2. Cancer Survivorship Research Group, University of Southern Queensland, Springfield, QLD, Australia
  3. General Practice, Medical School, University of Western Australia , Perth, WA, Australia
  4. Consumer, Geelong, VIC, Australia
  5. Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
  6. Prostate Cancer Foundation of Australia, Brisbane, QLD, Australia
  7. School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, QLD, Australia

Background: For almost four decades, the early diagnosis of prostate cancer has been the subject of sustained public health debate. In the period since the release of the 2016 Clinical Practice Guidelines for Prostate Specific Antigen (PSA) Testing, substantial advances have occurred in risk stratification, multiparametric magnetic resonance imaging (mpMRI), biopsy techniques, active surveillance, and shared decision-making. In response, the development of new, 2026 Australian guidelines to support evidence-based early detection of clinically significant prostate cancer was undertaken.

Methods: Guideline development followed the National Health and Medical Research Council (NHMRC) standards and used systematic evidence reviews, GRADE methodology, expert consensus processes, and extensive stakeholder and consumer engagement. A multidisciplinary Guideline Development Group considered evidence on mortality, clinically significant cancer detection, metastasis, diagnostic accuracy, patient preferences, equity and implementation. Public consultation informed the final recommendations.

Results: The Guidelines addressed 11 clinical questions through 17 systematic reviews. They introduce a risk-adapted approach to early detection, recommending that discussion about prostate cancer risk and testing be initiated from age 50. For men who choose testing, biennial PSA testing is recommended from ages 50–69 years. Earlier testing from age 45 is recommended for men at increased risk, including those with significant family history, BRCA2 pathogenic variants, or Black sub-Saharan African ancestry. The Guidelines recommend mpMRI as the standard investigation after elevated PSA and before biopsy. Active surveillance is recommended as the preferred management approach for most men with low-risk prostate cancer. Shared decision-making is central, supported by decision aids and clinical flowcharts, with dedicated recommendations for priority populations, including Aboriginal and Torres Strait Islander men. The Guidelines were endorsed by NHMRC in May 2026.

Conclusions: The 2026 Australian Guidelines mark a shift from opportunistic PSA testing to initiated, risk-adapted discussion and testing, focusing on clinically significant prostate cancer, patient-centred decisions and reduced harms.