Rocco Rossi is president and CEO of Prostate Cancer Canada.
The Canadian Task Force on Preventive Health Care released guidelines Monday recommending against using the prostate specific antigen (PSA) test to screen for prostate cancer. Quite simply, these guidelines do not only a great disservice but also a great injustice to men and their loved ones.
Why is that? Early detection of prostate cancer saves lives. That's especially important for a disease that often has no symptoms until it has advanced to stage when there are fewer treatment options with less positive outcomes. The Task Force will say that the PSA test isn't a perfect test – and we don't disagree. But it is currently the best clinical indicator – a red flag – that something might be amiss and warrants further follow-up. That type of monitoring allows for the best possible outcomes.
The PSA test can and should be used to help determine an individual's risk of prostate cancer. That baseline PSA test value, considered along with other risk factors such as family history and age, will better inform the patient-physician conversation about appropriate follow-up. That's not just screening – that's smart screening. We are not advocating for mass population screening, or annual PSA tests – smart screening encompasses tailored clinical follow-up appropriate for the individual. But if PSA testing is eliminated, men who are at high risk of prostate cancer won't benefit from early detection; this includes men of Black African or Black Caribbean descent or men with a family history of prostate cancer
And men have a right to know their risk. Men have a right to decide how they will use that information. The reality suggested by the task force harkens back to the not-so-distant past of paternalistic medicine rather than informed decision-making.
The task force will also say that PSA testing will lead to overtreatment. Let me be clear here: The PSA is one tool, really just the entry point to more specific diagnostics should there be any warning signs that more follow-up is required. One PSA test should never mean leaping into treatment. Perhaps in the past physicians were too quick to recommend treatment without determining if the prostate cancer was low-risk or potentially aggressive. But the solution to that is more education about the appropriate interpretation of the test result, not a full-scale ban on using the test.
A recent study from the United States estimated what would happen if PSA testing was eliminated, as was recommended by the task force. It found that cases of metastatic disease would double, leading to an almost 20 per cent increase in deaths from prostate cancer. That outcome is simply unacceptable. Applied to the estimated Canadian mortality rate from prostate cancer of 4,000 deaths a year – that's 800 additional dads, brothers, husbands, sons and friends. The world has spent the last 20 years reducing the mortality rate for prostate cancer by more than 40 per cent, but these guidelines will erase that progress and turn the clock back.
We feel so strongly about the issue that we have launched supportpsatests.ca to help clear up the confusion around this task force and for everyone to get and share the facts about PSA tests.
Ultimately, we are campaigning to safeguard the benefit of the early detection of prostate cancer, which can lead to a survival rate for prostate cancer of more than 90 per cent. Those are odds we want every man to have. Why would we discard a tool that makes that type of positive outcome possible?
We at Prostate Cancer Canada have met with thousands of men across the country who know that they are alive only because of early detection. Had this recommendation been in place previously, many would not be alive today. Men have a right to choose. A right to know. And everyone has a right to the best possible survival rates.
For the men out there and the people who love them, we recommend you #YesToPSA.