Should you get a prostate screening test? New guidelines are against it

TORONTO – Prostate cancer is the most common cancer in Canadian men, but how soon should they test for it?

In new guidelines, a national task force suggests the prostate screening test is doing more harm than good. It’s causing overdiagnosis, infection and other complications. But other experts weighing in say that the PSA test is the best tool doctors have to measure risk of prostate cancer in their patients.

“[Prostate cancer] is now one of the most commonly diagnosed but one of the reasons for that is because we’re doing so much testing,” Dr. James Dickinson told Global News. The University of Calgary primary medicine professor is chair of the Canadian Task Force on Preventive Health Care (CTFPHC), and member of the prostate cancer guideline working group.
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The task force is combing over recommendations for a string of guidelines – Pap tests for cervical cancer, breast cancer screening and chronic conditions, such as diabetes, hypertension and obesity.

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In updated guidelines published Monday in the Canadian Medical Association Journal, the CTFPHC recommended against screening for prostate cancer.

“Basically we’re saying this test is not worth doing so we’re back to square one. We’d like to see better tests, we’d like to see something that would make a difference but this isn’t it…don’t do this test because it’s more likely to cause problems than cause benefit,” Dickinson told Global News.

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Dickinson said that the task force weighed the benefits with the potential harms to come to its conclusion. For men diagnosed with prostate cancer through PSA screening, up to 20 per cent receive a false-positive diagnosis – and up to 56 per cent of that group will be affected by overdiagnosis and invasive treatment.

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Some end up with post-operative complications: infection, urinary incontinence, and erectile dysfunction, as examples.

“If you have a positive test, that may lead to a prostate biopsy which is sticking needles 12 times into the prostate gland…infection can be brought in,” Dickinson warned.

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Yet the prognosis for most prostate cancers is good – the 10-year survival rate is 95 per cent. The cancer is generally slow to progress and not life-threatening, the task force says.

“If I get told I’ve got a cancer that will kill me when I’m 120 … do I care?” Dickinson asked.

The guidelines are aimed at physicians, health care professionals and policymakers. The latest recommendations are a major update to the task force’s 1994 version.

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Now the Canadian task force’s guidelines fall in line with its counterparts in the U.S. and Australia.

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The key recommendations include:

  • For men under age 55 and over age 70, the task force recommends not using the PSA test to screen for prostate cancer
  • For men aged 55–69 years, the task force also recommends not screening, although it recognizes that some men may place high value on the small potential reduction in the risk of death and suggests that physicians should discuss the benefits and harms with these patients
  • These recommendations apply to men considered high-risk — black men and those with a family history of prostate cancer — because the evidence does not indicate that the benefits and harms of screening are different for this group.

But, for its part, Prostate Cancer Canada is urging men to consider the PSA – as long as it’s used appropriately, it can save lives.

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“It’s simple. Early detection saves lives, especially when it comes to prostate cancer. Eliminating the PSA test would mean not screening for prostate cancer, and if that happens, where does that leave us? Men deserve the right to know their risk,” Rocco Rossi, president and CEO of the organization, said in a statement in response to the task force’s updated guidelines.

“We believe the PSA test is one of the most powerful tools we have; early detection can be the difference between life and death,” he said.

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Instead, the organization is calling for “smart screening,” a personalized approach where men are tested to establish a baseline number. That initial measure is then compared to subsequent tests to see if changes are detected. If changes are detected, patients can work with their physicians to consider biopsies, MRIs or rectal exams.

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About 23,600 men will be diagnosed with prostate cancer in 2014, according to Prostate Cancer Canada. It’s the third leading cause of death in Canadian men.

Typically, the risk increases as men age, but it usually grows slowly and can be completely removed or managed if detected and treated early.

To help patients make informed decisions, the task force has decision tools. The full guidelines are available here and Prostate Cancer Canada’s information is also available here.

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