Charbonneau — A PSA test saved my life

COLUMN — My prostate cancer was detected early by a PSA test. Although I had to pay for the prostate-specific antigen test at first, it seemed well-worth the $35.

If I had my PSA tested annually, I reasoned, a benchmark would be set and any deviation from that point could indicate problems. And it did. In 2008, a sudden rise in PSA levels alarmed my doctor and he ordered a biopsy of my prostate. The results indicated an aggressive form of prostate cancer.

I had the prostate cancer treated and it will come as no surprise that I’m still alive.

Not all prostate cancer is as deadly. Many men die with prostate cancer but not of it. While some prostate cancers crawl at a tortoise rate, other diseases overtake it to the finish. That’s why PSA tests are not recommended for men with a life expectancy of less than ten years: tests would be a waste of time.

There are reasons why PSA tests are not covered by MSP, and I get it. Not every test can be covered by our universal health care system, especially when PSA tests are an unreliable indicator on their own. PSA levels can be temporarily elevated by such things as a Digital Rectal Exam.

Yes, ironically, the very test that checks the size and symmetry of the prostate gland can falsely indicate prostate cancer in a PSA test. If you’ve never had a Digital Rectal Exam, don’t imagine that “digital” means some fancy electronic test; instead think “digit.”

If PSA tests are useful in screening for prostate cancer why has the Canadian Task Force on Preventive Health Care recently come out against tests? Especially when the Canadian Cancer Agency still recommends the test.

Well, says the task force, there is no correlation between the rise in PSA testing and prostate cancer deaths. They present data that compares PSA tests with prostate cancer deaths and there’s no connection.

That’s not surprising. It’s well known that only one out four men with elevated PSA actually have cancer. What would be surprising is if they did find a correlation between an imperfect test and death rates. But because the test is imperfect, that’s no reason to stop using it. It’s just one means.

Rocco Rossi, president and CEO of Prostate Cancer Canada is blunt in his criticism of the task force’s recommendation. In his article for the Globe and Mail titled “Scrapping the PSA test for prostate cancer is an injustice to men,” he acknowledges the shortcomings of PSA tests but emphasizes early detection:

“Early detection of prostate cancer saves lives. That’s especially important for a disease that often has no symptoms until it has advanced to stage when there are fewer treatment options with less positive outcomes.”

I agree with the task force that over-dependence of PSA test can lead to over-treatment and that side effects of over-treatment can be worse than the slow-growing or non-existent cancer. Only foolish patients and doctors would undertake treatment solely based on a limited but useful test.

Meanwhile, PSA tests remain a valid benchmark in the early detection of prostate cancer.

David Charbonneau is a retired TRU electronics instructor who hosts a blog at http://www.eyeviewkamloops.wordpress.com.