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Fewer than two in every five Canadian men in the high-risk age group have been tested for prostate cancer in the past year, a new survey shows.
Specifically, only 39 per cent of men over the age of 45 have taken a blood test to measure their prostate specific antigen (PSA) level in the past year, while 33 per cent have undergone a digital rectal examination (DRE), according to a poll commissioned by the Prostate Cancer Research Foundation of Canada.
"I'm sad to say that men aren't taking action," said John Blanchard, the group's CEO, in an interview. "Testing levels just aren't where they should be."
A rectal examination should be an integral part of an annual physical, but Mr. Blanchard said too many men have a "locker-room type reaction" to the test.
The foundation also recommends that all men have their PSA level tested annually, even though universal testing is controversial.
"This test isn't perfect," Mr. Blanchard said. "But if men go every year and keep their own numbers, they will see the 'velocity' of change, and that's what's important."
PSA is a protein produced by the cells of the prostate gland, a walnut-sized organ located below the bladder and in front of the rectum. PSA is normally present in the blood at low levels, defined as 0 to 4 nanograms per millilitre. Levels of 5 to 10 ng/ml are considered problematic.
Increased levels of PSA may suggest the presence of prostate cancer. However, PSA levels can also be elevated due to prostate infection, irritation, benign swelling or recent ejaculation. PSA levels rise with age, and they can fluctuate. Furthermore, prostate cancer can be present without an elevated PSA level - which is why the DRE is also done.
Because of the high level of false positives and false negatives, PSA testing is not recommended for population-wide screening.
Michael Pollack, a medical oncologist at the Jewish General Hospital in Montreal, said "there are a lot of subtleties in the PSA screening debate" that can be confusing to men.
While there is no question that PSA tests will detect more cases of cancer, it is not clear that doing so will mean fewer men will die of prostate cancer, he said.
Dr. Pollack said what is important is that men have a frank discussion with their doctor about prostate cancer and take the tests deemed appropriate for them individually.
In the poll, only 64 per cent of men even discussed the issue with a physician.
Even fewer, 49 per cent, did so in the key 45-to-54 age group in which aggressive forms of the cancer are usually detected.
Prostate cancer is the most common cancer in Canadian men. In 2007, an estimated 22,300 men will be diagnosed with prostate cancer and 4,300 will die of the disease, according to the Canadian Cancer Society.
Dr. Pollack said it is important to keep these numbers in perspective: About one in eight men will develop prostate cancer during his lifetime, mostly after age 60; one in 27 men will die of prostate cancer.
"That's not because we cure so many men: It's because so many who are diagnosed have a non-aggressive form of the disease," he said.
What is really needed, Dr. Pollack said, is a better test, one that can identify men with aggressive prostate cancer.
The new survey was conducted by Innovative Research Group. A total of 1,135 Canadians aged 45 and older were polled; the results are considered accurate within +/- 3.1 per cent, 19 times out of 20.
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By the numbers
92
Percentage of Canadian men 45 and older who believe early testing results in more effective treatment.
39
Percentage who were tested for prostate cancer in 2006 via PSA.
33
Percentage who were tested for prostate cancer in 2006 via digital rectal exam.
22
Percentage who can accurately assess their own disease risk.
Source: Prostate Cancer Research Foundation of Canada
