Don’t tell Robb Lucy that Canadian men don’t need to bother about a PSA test. The 61-year-old Vancouver man, who is a member of the Prostate Cancer Foundation of British Columbia, calls the prostate-specific antigen test “the male mammogram.” He is one of many men who disagrees with the latest report from the U.S. Preventative Services Task Force, which recommends against the routine PSA screening for men of all ages.
“It’s a frigging blood test,” says Lucy, somewhat emotional that a medical panel south of the border can dismiss the test which he credits for saving his life. He began having the annual blood test at age 50 and his doctor monitored it for changes. When it doubled at the 10-year mark, a followup biopsy revealed an aggressive tumour. Now treated and cancer-free, he is thankful that such a test exists for men.
The U.S. Task Force explained to media that out of 1,000 men who are screened, only one man will not die of prostate cancer who otherwise would have. But Rebecca von Goetz, executive vice-president at Prostate Cancer Canada, says that new Canadian statistics indicate that early detection is working. “The early detection tool is saving lives.”
Not all prostate cancer doctors agree with the U.S. recommendations. Toronto’s Dr. Laurence Klotz, who treats prostate cancer patients at Sunnybrook Hospital, says the U.S. recommendation was made in part because of their tendency to over-treat.
“Our position here is that to a large degree we have dealt with the over-treatment issue in Canada by managing favourable risk patients conservatively. The key to successful PSA screening is to use it properly and to treat selectively.”
The U.S. has been slow to adopt what is known as the active surveillance approach, says Klotz. “In Canada, it has been widely adopted with the result that screening looks more appealing because if you are only treating the patients who have aggressive disease then the number you actually need to treat becomes much more favourable.”
Active surveillance, he explains, means that although you give every man a PSA test, you treat only the most aggressive cancers and “watch and wait” with the others.
“All Canadian men should appreciate the benefits and risks and should be able to access PSA screening if they choose to have it. That’s to me a reasonable approach. No reasonable person who looks at the data would deny there is a mortality reduction.
"What the Task Force did is look at the human cost in terms of quality of life and complications of treatment and said screening is not worth it. This disease is managed differently in Canada, and we think it is managed better. So we think the PSA test is still worthwhile.”
Toronto’s Aaron Bacher says that many cancers do not have early warning screening systems, so the PSA test, though imperfect, still provides a red flag that communicates something may be wrong in the walnut-sized gland just below the bladder. His prostate cancer was diagnosed 13 years ago through a PSA test.
“We survivors hear statistics where they say that only X number of lives were saved through screening but if you happen to be in that 1% saved then you look at it differently. We are not statistics; we are real people.”
Bacher is the Toronto chairman of the Prostate Cancer Canada Network, a man-to-man support group. “Our position on routine PSA screening is that, yes, it is controversial but it is the only game in town. Until they come up with something more definitive, we have to use it.”
The PSA test is a blood test that measures the amount of prostate-specific antigen in the blood. PSA is produced by the prostate and is normally present in a man’s blood in small amounts. An elevated PSA may be due to infection, benign prostate enlargement or cancer. The PSA test for men without symptoms costs about $30; for men diagnosed with prostate cancer, the test cost is covered.
Fathers and sons
“I did not have a family history of prostate cancer. But now my two sons have a family history,” says Aaron Bacher, a survivor. Fathers and sons aged 40 and up should talk to their doctors about routine PSA screening. In a recent report from the Canadian Cancer Society, prostate cancer is the most common cancer among Canadian men: In 2012, 26,500 men will be diagnosed with it and 4,000 will die of it. One in seven men will develop prostate cancer during his lifetime. For more, check out prostatecancer.ca, pccnToronto.ca and health.gov.on.ca.
Pros and cons of PSA
On scientificamerican.com, guest blogger Marc B. Garnick, a prostate cancer expert and editor-in-chief of the Harvard Medical School’s Annual Report on Prostate Disease, addresses the arguments for and against the PSA test. Those against screening include:
* No difference in death rates between those screened and those not screened
* No evidence that low-grade prostate cancer progresses to higher grade cancers
* Men in the age group of 71 to 73 (the average age of prostate cancer diagnosis) are more likely to die of other diseases.
* The risk of harm from biopsy or the side effects of prostate cancer treatment
Having a baseline PSA test at age 50, then comparing annual blood tests to that initial one, showed Vancouver’s Robb Lucy the progression of what turned out to be an aggressive cancer. “Courtesy of the PSA, we were able to monitor it for a decade,” he explains. “Had I not had that first blood test, I wouldn’t have known when the ballgame changed.”
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