CHARBONNEAU – The Canadian context for PSA tests: to test or not to test

THERE’S BEEN a lot of controversy about routine tests for prostate-specific antigen (PSA) in men.

It’s a simple blood test that measures the level of PSA, a protein produced mainly by cells in the prostate gland.

Elevated PSA results can indicate a variety of things, including the presence of cancer.

So, why wouldn’t men get the test? Doctors can determine if the elevated levels indicate cancer or something else.

It’s a serious question.

About 28,000 Canadian men will be diagnosed with prostate cancer each year and 5,000 of them will die. That’s 1 in 30 Canadian men who will die of prostate cancer in their lifetime. Prostate cancer is the third leading cause of cancer death among Canadian men.

Part of the controversy is that, unlike other cancers, prostate cancer is not necessarily a death sentence. Many men die with prostate cancer but not of it. Sometimes “active surveillance” is the best strategy.

Men are starting to be more open about prostate cancer.<

It’s refreshing to hear King Charles openly discuss his treatment for a benign enlarged prostate which was likely indicated by a PSA test. It turns out that it was not prostate cancer. But confusingly, tests revealed another type of cancer which he decided not to reveal.

Also confusingly, doctors are reluctant to prescribe PSA tests even knowing that the results could reveal a life-threatening cancer.

Men in B.C. can get the PSA test if they pay for it. Unlike eight other provinces and territories, British Columbia and Ontario do not cover the cost of a test which is about 35 dollars.

American physicians have consistently recommended against general testing for PSA.

They reason that tests lead to overdiagnosis and the discovery of cancers that would never cause any harm. And the discovery can lead to unnecessary treatment with surgery and radiation. They recommended screening for some groups under the direction of a doctor.

Following their American counterparts, the 2014 Canadian Prostate Cancer Screening Guideline was even stricter. They said routine PSA testing for prostate cancer should not be done for in men of any age group.

Some Canadian doctors are now questioning that recommendation.Neil Fleshner, a urologic oncologist at Princess Margaret Cancer Centre, regards the 2014 recommendation against PSA testing as a “travesty.”

He said the guideline authors failed to acknowledge that “active surveillance,” where low-grade prostate cancer is monitored rather than hastily operated upon, was already commonplace when the negative recommendation was released.

The reason that PSA tests should be routinely done in Canada but not necessarily in the U.S. is in the difference between our healthcare systems.

In the U.S. where healthcare is part of a marketplace, treatment is encouraged. For a man faced with the alarming discovery that he has prostate cancer, he will want it treated now. And the healthcare system is ready to accommodate.

In Canada, healthcare is a limited resource and doctors are the gatekeepers of that resource. Regardless of how alarmed a man is, his Canadian doctor will advise caution –do biopsies, exam the speed of the growth, watch and wait.

The prudent thing to do is to get PSA tests done and have them monitored. A sudden rise can indicate trouble — or not.

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