Advice from urologists
Three doctors give their opinions
The PSA test is the best test available to screen for prostate cancer, but it is not perfect. It helps to find prostate cancer early potentially prevent death from it, but does not tell us who to treat, how and when. There has been some real controversy lately in the media about the PSA test for prostate cancer. The real problem is not with the PSA test itself. It’s all about what is done with the result.
Testing every male for prostate cancer no matter what age and no matter what their history is not recommended. On the other hand, not testing patients because the test is not perfect also does not make sense. This test is simply not black and white. There are lots of nuances in its results and how to interpret and act on them. Sometimes there is no need to ask for the test: if there is no possibility of treating prostate cancer in an individual who may be of an advanced age and may have other existing conditions, it may not make sense to administer the PSA test.
When the PSA test was first introduced in the late 1980’s, physicians did not have the knowledge that they have today with respect to how to act based on results. Today this test is used judiciously in most cases to the point that we rarely see advanced prostate cancers in an emergency situation. That, in and of itself, demonstrates the value of the test if used properly. And although most patients with prostate cancer are being treated, more and more patients with prostate cancer are being followed without active treatment.
We recommend that you, at minimum, speak to your doctor about the pros and cons of having the PSA test and a digital rectal exam if you are over the age of 50. You may even consider starting to do so at 45 if you have a family history of prostate cancer.
Armen G. Aprikian, M.D., F.R.C.S.C.: Urologist at MUHC, Director, Department of urology, Interim Director, Department of oncology, Professor, Division of Urology at MUHC & Leader of the PROCURE Quebec Prostate Cancer Biobank committee
Fred Saad, M.D., F.R.C.S.C.: Uro-oncologist at CHUM, Professor, Department of surgery, Medical Director, Interdisciplinary Urologic Oncology Group, University of Montreal Endowed Chair in Prostate Cancer Research & Head, Urologic Oncology, CHUM
Luc Valiquette, M.D., F.R.C.S.C.: Urologist at CHUM, Professor and Director, Department of surgery, University of Montreal, Medical Advisor, Clinical information systems & Chair of PROCURE’S Clinical Advisory Council.
All three doctors are members of PROCURE’S Board of Directors.
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Sources and references
Last medical and editorial review: July 2019
Written by PROCURE. © All rights reserved – 2019