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Press Release on PSA Testing

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October 29, 2014 ▪ Calgary, AB

On behalf of Prostate Cancer Canada Network Calgary (aka PROSTAID Calgary), and our 900+ members from Calgary and area, I would like to address the recent publication in the Canadian Medical Association Journal (CMAJ) of the Canadian Task Force on Preventive Health Care recommendations regarding PSA (prostate specific antigen) testing and screening for prostate cancer. As a support group which educates and advocates for men and their families dealing with prostate cancer, we strongly disagree with the task force's recommendations against all PSA testing for men of all ages and risk groups categories. As a patient group that deals with the realities of prostate cancer on a daily basis, we feel that these recommendations have done a great disservice to men's health and the advancement of awareness and decision making for those faced with this dreadful disease.

The task force recommendations appear to be primarily directed towards the family doctor. It is interesting that the task force does not include a single urologist, medical oncologist, radiation oncologist or anyone that appears to be directly affiliated with a clinic that treats men with prostate cancer. Furthermore, it appears that the task force did not seek the counsel of patient representatives, psychosocial practitioners and health care economists. We are uncertain as to the rationale for the task force to exclude other critical inputs to addressing this disease.

The PSA test has been available and used for at least two decades worldwide. Our prostate cancer support group is absolutely certain that many family doctors find the PSA test to be a valuable tool in their medical practices to help them to understand the current status and prostate cancer risk of their individual patients. Similarly, their patients are keenly interested to be similarly informed. The family doctor is, in practice, the 'gatekeeper' to specialists for men who may have a prostate disorder that needs further investigation. By convention, men with concerns supported by PSA tests cannot directly access these specialists. Men can only access specialists via their family doctor.

As a publicly funded task force making recommendations, they have made recommendations against PSA screening, yet offer no alternatives. Their recommendations are also in sharp contrast with those of the Canadian Urological Association (CUA) which is comprised of specialists who treat men with prostate cancer. Specialists who are practiced in assessing specific illnesses tend to have a 'gestalt' or gut feeling, based on a range of medical evidence and experience, when dealing with individuals that cannot be applied with statistical analysis or population based decision making. While it is understood that PSA testing is not an ideal tool for screening it is the best objective tool we currently have, and just one small aspect in the continuum of clinical assessment and decision making that follows a PSA test. As research brings us more accurate testing modalities and better clinical biomarkers, it will be important to have the current PSA screening tool available to benchmark future successes.

Prostate cancer is the leading non‐skin cancer in men and third leading cause of cancer death in men. Why would screening not be considered, even if only 'marginal' benefit is found? The PSA test is a simple, low‐cost, easy to administer blood test, that in and of itself does not directly result in the adverse events highlighted in the article. It merely provides a baseline to help identify men that may be at risk of prostate cancer. It also allows primary care physicians the opportunity to speak to men about their prostate health and help them make informed decisions. The task force addresses the over‐treatment of potentially indolent or slow growing disease, yet discounts the fact that active surveillance and watchful waiting are part of the decision making process for men that may have a high PSA number and subsequent positive biopsies. The report highlights the complications of biopsy such as hematuria (blood in the urine) and infection, but does not stratify this into the severity of these potentially mild complications. Nor does it compare these events to the catastrophic effects of advanced cancer or bone metastases in men who have had a late diagnosis.

PROSTAID Calgary and our members will continue to follow and recommend the guidelines put forth by the CUA and Prostate Cancer Canada. While the task force deals with populations, we deal with individuals. We firmly believe that men have the right to be empowered to make informed decisions based on a variety of trusted sources. We feel that publishing these recommendations in CMAJ, a journal aimed at family physicians, will diminish the opportunity for physicians to discuss prostate health with their patients and significantly set back the opportunity for men to assume greater responsibility for their health and well‐being. It is troubling that the task force's recommendations may not only cause family doctors to stop ordering PSA testing but also to trivialize any meaningful discussion on risk and prostate cancer with their patients. These guidelines are especially a concern to men and their families who are dealing with prostate cancer in their daily lives and are working hard to increase awareness and early detection of prostate cancer in the next generation. We encourage all men and their loved ones to speak out against these recommendations and insist on their rights to make choices based on individual preferences and informed decision‐making.

Steve Belway
President - PROSTAID Calgary/PCCN Calgary
Cell: 403-818-9957

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