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Prostate cancer experts are praising the Ontario government's budget pledge to pay for screening tests for all men, arguing the potential benefits outweigh concerns about the test's implications and accuracy.
The new subsidies come as part of a three-year, $154-million package to improve cancer screening and to seek to ensure that average- and low-risk men receive free prostate specific antigen (PSA) tests, which can cost $25 to $50 and were previously covered only when a high risk or prior diagnosis existed.
"I think it will encourage some men to get screening, and I think it will also add credibility to PSA," said Neil Fleshner, head of the University Health Network's division of urology. "The lower-income people and people who find $30 a substantial amount of money, they will gain access to PSA [testing]. Over all, this is a positive step."
Dr. Fleshner also said the subsidy will correct a flaw in the system whereby many laboratories charge recovering prostate cancer patients who had undergone treatment such as radiation and were conducting follow-up screenings.
But critics of the move argue the test is far from definitive and could lead to patients taking diagnosis and treatment steps on the false assumption they may have cancer. Though precise, the test only measures for abnormal levels of a particular protein produced in greater quantities when the prostate is swollen.
Dr. Fleshner disagreed, saying the government was right to invest in PSA testing rather than waiting and wishing for a more perfect procedure to be developed.
"There's never going to be a be-all, end-all test for any cancer," he said. "This will continue to evolve, and I personally don't think in 20 years we'll be doing PSAs as much as we are now, but, having said that, PSAs dramatically improve the outcomes for men with prostate cancer."
Cancer Care Ontario president and chief executive officer Terrence Sullivan hopes, in light of this new-found accessibility, the focus will turn to ensuring patients are informed about their options before they take a PSA test. He said more than half of men over the age of 50 are currently being screened and does not anticipate a large rush now that the procedure will be paid for.
"We're offering a decision aid to help say, 'Here are some of the facts, and talk to your doctor about the merits of this procedure.' We're not going to promote it ... instead we're saying you could have a PSA [test]," he said.
Deciding to have a PSA test is seen by some as difficult because patients with an abnormal PSA result who do not have prostate cancer, as well as those with relatively low-risk incarnations of it, can see that result blossom into unpleasant or invasive procedures that may not be warranted.
Some experts say approximately 40 per cent of newly diagnosed cancer patients could turn to surveillance, which monitors the cancer but recognizes that many are able to live with the disease for decades without treatment. Joseph Chin, head of surgical oncology for the Southwestern Ontario region and the University of Western Ontario, said he worries that the subsidy could open the door to screening of patients who don't need the test.
"I'm kind of split on [the decision]. It's good in a way and there certainly are people that it should be funded [for] ... but I think it has to be more qualified, rather than an indiscriminate screening test," he said. "We certainly don't want a 28-year-old or 92-year-old man getting screened. That really doesn't do anybody any good."
Dr. Fleshner acknowledged there are potential drawbacks to getting a PSA test, but favours presenting options.
"The downside is maybe sometimes we do pick up and treat cancers that almost don't need to be found," he said. "But it's better to know what you're watching than having your head in the sand and be one of the unfortunate ones to come up with something that's incurable when you could have picked it up earlier."
