New guidelines are here. The Prostate Cancer Foundation of Australia and the Australian Government Department of Health, Disability and Ageing have released the 2026 Guidelines for the Early Detection of Prostate Cancer. One in seven Australian men will be diagnosed with prostate cancer. The aim is to find early prostate cancer in the men most at risk, while sparing low-risk men tests they do not need.

The story starts in forensic science. In the 1960s, crime labs needed a better way to detect semen than finding sperm, which break down within minutes to an hour. Dr Travis Brown explains how the Japanese forensic scientist Mitsuhara identified a protein he called gamma-seminoprotein. Teams at Cornell and the University of California found the same protein under other names. Today we call it PSA. By the 1970s, researchers saw it was raised in advanced prostate cancer, and its long, debated path as a screening test began.

The last guidelines came out in 2016. Since then, two things have shifted the balance of risk and benefit: access to multiparametric MRI, and the move from transrectal to transperineal biopsy. In this episode, Ken walks through the key changes:

• Free-to-total PSA ratio is no longer needed. MRI is better at sorting risk. About 80% of men with a confirmed PSA above 3 already have a free-to-total ratio below 25%.
• Ages 45 to 49 (higher risk): refer when PSA is above 1 ng/mL. This group includes men with a brother with prostate cancer, a father diagnosed at 65 or younger, or a BRCA mutation.
• Ages 50 to 69: the threshold stays at 3 ng/mL, or 2 ng/mL for higher-risk men.
• Ages 70 and over: for men likely to live more than seven years, the threshold is 5.5 ng/mL. Men below 5.5 can reasonably stop testing.
• Repeat the test in one to three months. About 30% of men with a PSA above 3 will test well below 3 on repeat, often due to BPH-related variation.
• GPs should now start the conversation. The 2016 guidelines had GPs respond when a man raised it. The new guidelines, endorsed by the RACGP, ask GPs to raise PSA testing with men aged 50 to 69.

Not for prostate cancer screening. In the evidence, rectal exams by non-specialists added as many false positives as false negatives. Ken notes that urologists still gain useful information from it, and a rectal exam remains relevant when you are looking for rectal cancer.

Men with a first-degree relative with prostate cancer, men with BRCA mutations, and men of African ancestry. The guidelines also name Aboriginal and Torres Strait Islander men as a priority population because of poorer access to care. Ken adds that men in regional Victoria have worse prostate cancer outcomes than men in the city.

This is the story of the 2026 Early Detection of Prostate Cancer.

Useful Link:

2026 Guidelines for the Early Detection of Prostate Cancer in Australia

Our Special Guest:

Professor Ken Sikaris is a chemical pathologist and head of clinical integration at Dorevitch Pathology. He is a NATA laboratory assessor, a founding fellow of the RCPA Faculty of Science and a principal examiner in pathology informatics. Ken was one of the first people to measure PSA in Australia, bringing in some of the first test kits around 1989. He helped write the new guidelines.

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