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Should I get tested for prostate cancer?

test d’APS pour tous les hommes

Prostate Cancer can be cured quite easily, but you still have to take an early screening to be on the safe side.

The prostatic-specific antigen test, or PSA, allows to detect the illness at an early stage, thus preventing many deaths. However, the relevance of this medical examination is being questioned, and it is why men should consider the limits of the test and their own situation before taking it.

The PSA test is actually used to detect the presence of the prostatic antigen in the blood. When its rate is high, this antigen shows that there is an issue with the prostate, but it does not necessarily mean prostate cancer. While this test is the best to screen prostate cancer at the moment, it is not perfect. On its own, it does not show if it’s necessary to cure a patient nor how to do it.

Before deciding to have a PSA test, ask yourself these questions and discuss them with your doctor, your family, and your friends:

  • What are my risks of prostate cancer?
  • Would I be reassured if my PSA test results are normal?
  • What will I do if my PSA level is high?
  • If I am diagnosed with a slow-growing cancer that might not cause me any problems in my lifetime, would I want to undergo a treatment that could have side effects that impact my daily life?

Personal context

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The PSA test is usually offered to any man over 50 years old and with a life expectancy of at least ten years. But after 75, the screening becomes less and less relevant, as many other illnesses can have an impact.

Moreover, a healthy man, who does not show any symptoms nor family background concerning prostate cancer, has very few reasons to worry and wanting to do a screening. On the opposite, a man at risk, namely with a cancer history or of African ancestry, would probably benefit from having regular screenings and examinations as soon as 40.

Despite all this, if a cancer is detected with the test, it is possible that physicians decide of not curing the patient, because the illness has not developed enough yet or it evolves too slowly, for example. In these cases, a thorough follow-up is often the best option.

Consequently, the PSA test can be a useful tool to screen prostate cancer quickly and to prescribe the appropriate treatment. However, it is not an absolute reference and men at risk are the ones who should take this test the most. In case of doubt, ask advice to your physician.

Advantages and limitations

It is important to weigh the pros and cons of the PSA test. What might be an advantage for one man may not necessarily be the case for all men.

Avantages

  • A PSA test can help detect prostate cancer before you show any symptoms.
  • A PSA test can help detect an aggressive cancer at an early stage in its development and allows for treatment before the cancer spreads.
  • A non-aggressive cancer may not need treatment. Regular check-ups and PSA tests can allow you to delay treatment and its associated side effects while keeping an eye on the cancer’s development.
  • Regular PSA tests can be helpful for men at high risk of prostate cancer by allowing for the early detection of cancer.

Limitations

  • An elevated PSA level does not necessarily mean you have prostate cancer. Around three quarters of men with a raised PSA level do not have prostate cancer (false‑positive result).
  • An elevated PSA may require you to undergo other tests that may pose certain risks. For example, a biopsy can cause pain, infection, and bleeding. Around 6% of men suffer a serious infection following a biopsy.
  • The PSA test can have a false-negative result. About 2% of men with an aggressive prostate cancer have a normal PSA level.
  • A slow-growing cancer could have no impact on your life, but the fact that you know you have cancer can be worrisome and lead to unnecessary treatment.
  • Side effects of a treatment for prostate cancer can affect your daily life. These side effects can include urinary, bowel, and erectile problems.

Advice from urologists

Three doctors give their opinions

voix des urologues

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 and 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 just does not make sense. 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 40 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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