CHARBONNEAU – Prostate cancer deaths rise as simple test unused

A SIMPLE BLOOD TEST can reveal the early presence of prostate cancer but its use has been discouraged.

Rates of incurable prostate cancer have jumped 50 per cent in Canadian men aged 50 to 74, and by 65 per cent in men in their 70s. Overall, prostate-cancer survival is lower now than it was two decades ago, according to a study in the journal Current Oncology.

Deaths are increasing despite a multitude of recent advances in the treatment of prostate cancer.

This is the current reality of prostate cancer in Canada.

When the test was widely used in the 1990s, deaths from prostate cancer dropped. It’s a test for prostate specific antigen (PSA).

Dr. Anna Wilkinson, oncologist at The Ottawa Hospital and lead author of the new study says: “I think that we stopped screening and men are presenting, clinically, with advanced disease – advanced, incurable disease,”

If widely used PSA tests reduced deaths from prostate cancer, why are tests now discouraged?

Here’s what happened.

In 2012 the U.S. Preventive Services Task Force (USPSTF) discouraged routine PSA screening.  They said false positives led to unnecessary surgery.

Two years later, a Canadian task force followed the U.S. and strongly discouraged routine PSA screening.

The “me-too” response to by Canadian urologists was because there has never been a national, systematic, screening program in Canada.

However, the health care systems in the two countries are radically different and use the test prompts a different response.

In the U.S., health care is a commodity. In Canada, it’s a universal right.

Doctors in the U.S. are ready to treat illnesses aggressively. And they will do so when patients are alarmed.

In Canada, doctors are the gate-keepers of public health care. They will only prescribe treatment if, in their considered opinion, treatment is necessary.

Caution has to be used when interpreting elevated PSA levels –there can be many causes, prostate cancer being just one.

It may seem that that Canada and the U.S. have the same policy but application of the policy makes a difference.

In practice, Canadian doctors strongly enforce the policy against PSA testing. And in Canada, about 3 million men don’t have a family doctor –they couldn’t get the test if they wanted one without some difficulty.

In the U.S., to test or not to test is a shared decision between the doctor and the patient. If a patient requests the test, under their consumer model, the test will likely be done.

So, how do deaths from prostate cancer compare in the two countries?

Death rates are rising in Canada but in the U.S., rates have plateaued. They are probably constant in the U.S. because PSA screening and diagnostics have done as much as possible in reducing deaths.

Canadian men have a long way to go in advocating screening and awareness of prostate cancer.

Women have done a good job in creating awareness of breast cancer but men are reticent about even thinking of the disease “down there.” Scott Morgan, a radiation oncologist at Ottawa Hospital says:

“Men really have to advocate for themselves and have a primary provider who’s willing to order it, so that is yet another barrier.”

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