PSA Testing Controversy
Prostate Cancer Foundation BC supports the views as expressed below.
Toronto, ON - October 27, 2014 - Prostate Cancer Canada responds today to guidelines released from The Canadian Task Force on Preventive Health Care (CTFPHC) recommending that the Prostate Specific Antigen (PSA) test should be eliminated as a screening tool for prostate cancer. Prostate Cancer Canada disagrees with the recommendations and wants to remind Canadians that when performed appropriately, the benefits of PSA screening far outweigh the negatives. According to new research based on modelling estimates, if PSA testing was eliminated, the cases of advanced (metastatic) prostate cancer would double, resulting in an estimated 13-20 per cent increase in prostate cancer deaths annually.
"It's simple. Early detection saves lives, especially when it comes to prostate cancer. Eliminating the PSA test would mean not screening for prostate cancer, and if that happens, where does that leave us? Men deserve the right to know their risk," says Rocco Rossi, President and CEO of Prostate Cancer Canada. "In an age of informed healthcare, we believe the PSA test is one of the most powerful tools we have; early detection can be the difference between life and death."
Prostate Cancer Canada believes PSA testing should be used as part of "smart screening", a personalized approach where men are tested to establish a baseline number. Subsequent tests are performed to monitor any changes to the baseline. If a change is detected, the patient and his health care provider should discuss a course of action based on his personal risk factors. This could include other diagnostic procedures such as a digital rectal exam, biopsy or even an MRI.
Many individuals within the health care community agree with Prostate Cancer Canada and think it would be irresponsible to discontinue testing: "The PSA test is merely the first step in the process to detect prostate cancer in its earliest stages when there are more treatment options. While a single PSA test on its own will not diagnose prostate cancer, it is used as another variable to calculate an individual's personal risk of prostate cancer and allow for tailored clinical follow-up," explains Dr. Laurence Klotz, a urologist with Sunnybrook Health Sciences Centre in Toronto. "We need to remove the association of the PSA test as a diagnostic for prostate cancer and instead regard it as a valuable predictor of risk."
The PSA test may not be perfect but it's the best indicator in clinical practice today and an important red flag to show something may be wrong. The goal of screening is to reduce late detection when death from the disease becomes much more likely.
"This isn't a black and white issue," says Dr. Stuart Edmonds, Vice President, Research, Health Promotion and Survivorship at Prostate Cancer Canada. "You can't abandon testing when there's research out there that says it's useful, particularly in the absence of anything better. We believe that when the results are properly interpreted, the benefits of PSA screening outweigh the risks of not screening."
Currently, statistics show that more than 90 per cent of prostate cancers are found locally for which the five year survival rate is close to 100 per cent.
"The statistics for survival thanks to early detection are unprecedented when compared to other cancers so why wouldn't we want to ensure every man has those odds," says Rocco Rossi. "The PSA test is a simple blood test, and combined with other risk factors, it's an important indicator a doctor can use to save your life."
About the PSA Test
An elevated PSA reading is currently the best early warning sign available that can provide a red flag to explore issues further, which is why Prostate Cancer Canada strongly disagrees with the CTFPHC recommendations around PSA testing for asymptomatic men and instead encourages health care professionals to practice "smart screening".
"PSA testing saved my life. When I was 45 my doctor was reluctant to perform a PSA test because of my age, but I insisted. Thankfully I did because it was the only test that we did that flagged there was an issue," says Jim Sullivan, prostate cancer survivor. "People like me - fathers, brothers and husbands - may not be so lucky if PSA testing is no longer used as a screening tool."
Prostate Cancer Canada believes PSA testing should be used as part of "smart screening", a personalized approach where men are tested to establish a baseline number. Subsequent tests are performed to monitor any changes to the baseline. If a change is detected, the patient and his health care provider should discuss a course of action based on his personal risk factors. This could include other diagnostic procedures such as a digital rectal exam, biopsy or even an MRI.
Many individuals within the health care community agree with Prostate Cancer Canada and think it would be irresponsible to discontinue testing: "The PSA test is merely the first step in the process to detect prostate cancer in its earliest stages when there are more treatment options. While a single PSA test on its own will not diagnose prostate cancer, it is used as another variable to calculate an individual's personal risk of prostate cancer and allow for tailored clinical follow-up," explains Dr. Laurence Klotz, a urologist with Sunnybrook Health Sciences Centre in Toronto. "We need to remove the association of the PSA test as a diagnostic for prostate cancer and instead regard it as a valuable predictor of risk."
The PSA test may not be perfect but it's the best indicator in clinical practice today and an important red flag to show something may be wrong. The goal of screening is to reduce late detection when death from the disease becomes much more likely.
"This isn't a black and white issue," says Dr. Stuart Edmonds, Vice President, Research, Health Promotion and Survivorship at Prostate Cancer Canada. "You can't abandon testing when there's research out there that says it's useful, particularly in the absence of anything better. We believe that when the results are properly interpreted, the benefits of PSA screening outweigh the risks of not screening."
Currently, statistics show that more than 90 per cent of prostate cancers are found locally for which the five year survival rate is close to 100 per cent.
"The statistics for survival thanks to early detection are unprecedented when compared to other cancers so why wouldn't we want to ensure every man has those odds," says Rocco Rossi. "The PSA test is a simple blood test, and combined with other risk factors, it's an important indicator a doctor can use to save your life."
About the PSA Test
An elevated PSA reading is currently the best early warning sign available that can provide a red flag to explore issues further, which is why Prostate Cancer Canada strongly disagrees with the CTFPHC recommendations around PSA testing for asymptomatic men and instead encourages health care professionals to practice "smart screening".
"PSA testing saved my life. When I was 45 my doctor was reluctant to perform a PSA test because of my age, but I insisted. Thankfully I did because it was the only test that we did that flagged there was an issue," says Jim Sullivan, prostate cancer survivor. "People like me - fathers, brothers and husbands - may not be so lucky if PSA testing is no longer used as a screening tool."
About Prostate Cancer
Prostate cancer is the most common cancer among Canadian men (excluding skin cancers) and is the third leading cause of death from cancer in men in Canada The risk of prostate cancer increases as men age. It usually grows slowly and can often be completely removed or managed successfully if detected and treated early. Estimated amount of new cases and number of deaths due to cancer in 2014:
Prostate cancer is the most common cancer among Canadian men (excluding skin cancers) and is the third leading cause of death from cancer in men in Canada The risk of prostate cancer increases as men age. It usually grows slowly and can often be completely removed or managed successfully if detected and treated early. Estimated amount of new cases and number of deaths due to cancer in 2014:
- 23,600 men will be diagnosed with prostate cancer representing 24 per cent of all new cancer cases in men
- 4,000 men will die from prostate cancer
- Roughly every day, 65 Canadian men will be diagnosed with prostate cancer
- On average every day, 11 Canadian men will die from prostate cancer
Prostate Cancer Canada Network -
PROSTAID Calgary
Press Release - for immediate release
October 29, 2014
On behalf of Prostate Cancer Canada Network Calgary (aka PROSTAID Calgary), and our 900+ members from Calgary and area, I would like to address the recent publication in the Canadian Medical Association Journal (CMAJ) of the Canadian Task Force on Preventive Health Care recommendations regarding PSA (prostate specific antigen) testing and screening for prostate cancer. As a support group which educates and advocates for men and their families dealing with prostate cancer, we strongly disagree with the task force's recommendations against all PSA testing for men of all ages and risk groups categories. As a patient group that deals with the realities of prostate cancer on a daily basis, we feel that these recommendations have done a great disservice to men's health and the advancement of awareness and decision making for those faced with this dreadful disease.
The task force recommendations appear to be primarily directed towards the family doctor. It is interesting that the task force does not include a single urologist, medical oncologist, radiation oncologist or anyone that appears to be directly affiliated with a clinic that treats men with prostate cancer. Furthermore, it appears that the task force did not seek the counsel of patient representatives, psychosocial practitioners and health care economists. We are uncertain as to the rationale for the task force to exclude other critical inputs to addressing this disease.
The PSA test has been available and used for at least two decades world‐wide. Our prostate cancer support group is absolutely certain that many family doctors find the PSA test to be a valuable tool in their medical practices to help them to understand the current status and prostate cancer risk of their individual patients. Similarly, their patients are keenly interested to be similarly informed. The family doctor is, in practice, the ‘gatekeeper’ to specialists for men who may have a prostate disorder that needs further investigation. By convention, men with concerns supported by PSA tests cannot directly access these specialists. Men can only access specialists via their family doctor.
As a publicly funded task force making recommendations, they have made recommendations against PSA screening, yet offer no alternatives. Their recommendations are also in sharp contrast with those of the Canadian Urological Association (CUA) which is comprised of specialists who treat men with prostate cancer. Specialists who are practiced in assessing specific illnesses tend to have a 'gestalt' or gut feeling, based on a range of medical evidence and experience, when dealing with individuals that cannot be applied with statistical analysis or population based decision making. While it is understood that PSA testing is not an ideal tool for screening it is the best objective tool we currently have, and just one small aspect in the continuum of clinical assessment and decision making that follows a PSA test. As research brings us more accurate testing modalities and better clinical biomarkers, it will be important to have the current PSA screening tool available to benchmark future successes.
Prostate cancer is the leading non‐skin cancer in men and third leading cause of cancer death in men. Why would screening not be considered, even if only ‘marginal’ benefit is found? The PSA test is a simple, low‐cost, easy to administer blood test, that in and of itself does not directly result in the adverse events highlighted in the article. It merely provides a baseline to help identify men that may be at risk of prostate cancer. It also allows primary care physicians the opportunity to speak to men about their prostate health and help them make informed decisions. The task force addresses the over‐treatment of potentially indolent or slow growing disease, yet discounts the fact that active surveillance and watchful waiting are part of the decision making process for men that may have a high PSA number and subsequent positive biopsies. The report highlights the complications of biopsy such as hematuria (blood in the urine) and infection, but does not stratify this into the severity of these potentially mild complications. Nor does it compare these events to the catastrophic effects of advanced cancer or bone metastases in men who have had a late diagnosis.
PROSTAID Calgary and our members will continue to follow and recommend the guidelines put forth by the CUA and Prostate Cancer Canada. While the task force deals with populations, we deal with individuals. We firmly believe that men have the right to be empowered to make informed decisions based on a variety of trusted sources. We feel that publishing these recommendations in CMAJ, a journal aimed at family physicians, will diminish the opportunity for physicians to discuss prostate health with their patients and significantly set back the opportunity for men to assume greater responsibility for their health and well‐being. It is troubling that the task force's recommendations may not only cause family doctors to stop ordering PSA testing but also to trivialize any meaningful discussion on risk and prostate cancer with their patients. These guidelines are especially a concern to men and their families who are dealing with prostate cancer in their daily lives and are working hard to increase awareness and early detection of prostate cancer in the next generation.
We encourage all men and their loved ones to speak out against these recommendations and insist on their rights to make choices based on individual preferences and informed decision‐making.
Steve Belway
President - PCCN/Prostaid - Calgary
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