Prostate Cancer Screening North of the 49th Parallel

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 21^st 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.

For more information on PSA tests, please visit Prostate Cancer Canada’s website at: http://www.prostatecancer.ca/Prostate-Cancer/About-the-Prostate/PSA