The U.S. Preventative Services Task Force (USPSTF) recommendation
against the use of Prostate-Specific Antigen (PSA) blood tests sets a dangerous
precedent for all patients seeking preventative measures in the fight against cancer.
Prostate cancer is the most common form of the disease, representing one
quarter of all new cases diagnosed annually in Canada. A PSA test is the most
common tool to detect prostate cancer when it is still localized and asymptomatic.
All men should have the option to educate themselves about the merits and risks
of PSA screening. The Task Force’s recommendation to deny discussion on this
subject effectively removes this fundamental right from the patient. The
Canadian Cancer Survivor Network (CCSN) is deeply concerned about the potential
spillover effects of this recommendation on screening policies in Canada.
The Task Force’s report was recently touched upon on this
side of the border by André Picard in the May 21st edition of the Globe
& Mail. Mr. Picard is incorrect when “sadly” claiming that the recommendations
of the Task Force will be ignored. They will most certainly not be, especially
if Canada takes a page out of the Task Force’s book and aligns its own policies
to match a U.S. health care system with a very different type of funding
structure. Picard has effectively confused the qualities of a risk-adverse
Canadian public with risk-adverse U.S. insurance companies.
While prostate cancer may not be the most lethal variant of
the disease, it is damaging to simply label it as harmless. It can be gradual in
its development, but there are no other means of detecting its existence prior
to it metastasising. Prostate cancer will kill an estimated 4,000 sons,
fathers, brothers and uncles in Canada this year. But this figure doesn’t take into account the
number of lives saved because of screening practices. Even if patients choose
not to immediately act upon elevated PSA levels, they have an inherent right to
establish the means by which to monitor those levels and respond accordingly.
Over 90% of prostate cancer cases are curable when detected early.
The Task’s Force’s recommendations to eliminate screening
will not sustain this success rate. While they claim that abandoning the
PSA-test won’t have a huge impact on mortality rates, this statement is only
true for patients well into their mid-70s. It does not reflect the reality
facing young Canadians or males in the high risk 50-65
age range. This report does not take into account continuing observational
studies occurring now, instead placing its weight behind several major studies
with self-declared methodological limitations. There were also a number of
major players not represented within the Task Force’s membership, including the
American Urological Association and the American Cancer Society, both of whom
strongly advocate for increased use of PSA tests on the grounds that other
methods can’t detect the cancer until it spreads. It should also be noted that
there are no prostate cancer patients or survivors on the Task Force.
PSA tests are currently covered by seven out of ten
provinces in Canada for screening purposes, however the federal government’s
decision not to renew the 2014 Health Accord could jeopardize coverage for PSA
tests, as provinces will face continuing pressure to reduce their spending on
health care. The CCSN encourages all concerned patients to contact their provincial
Minister for Health to remind them of the importance that PSA tests play in
ensuring the health and safety of all Canadians.
