PSA test: Yes, no, maybe?
Prostate cancer can be cured quite well, but you still need to be screened early to put the odds on your side. The prostate-specific antigen test, or PSA test, makes it possible to detect the disease at an early stage, often in the absence of symptoms, thereby preventing many deaths related to advanced and aggressive cancers.
The PSA test is used to detect the presence of the prostate antigen in the blood. When its level is high, this antigen indicates that there is a problem with the prostate, but it is not necessarily prostate cancer. While this test is currently the best for screening for prostate cancer, it is not perfect. It does not say on its own whether it is necessary to treat a patient or how to do it.
The controversy surrounding this test does not come from the PSA test itself, but rather from the way the results are used. Prostate cancer is very common but does not always require treatment in cases where the cancer is small and non-aggressive, or if the patient is not in a physical form allowing him to undergo treatment.
When the PSA test appeared in the late 1980s, the researchers did not have the knowledge they now have regarding the actions to be taken based on the results obtained. Although current scientific evidence suggests that PSA testing is not routinely offered today, the test is used much more judiciously, making it much less common to discover prostate cancer at a critical level of advancement (Three specialists give their opinion).
The decision-making context
According to INESSS 1, the College of Physicians of Quebec 2, the Canadian Task Force on Preventive Health Care 3 and the US Preventive Services Task Force 4, the decision to screen men aged 55 to 69 years should be individual and should include a discussion of the potential pros and cons of a PSA test.
Although these recommendations are in the right direction, several associations and organizations recommend a discussion on the relevance of taking a PSA test and a digital rectal examination rather earlier in the screening process.
45, 50, 70?
According to the Canadian Urological Association (AUC) 5, the PSA test should generally be offered to any man, aged 50 and over with a life expectancy of at least ten years. A man at risk, that is to say with a history of cancer or of African origin, would undoubtedly benefit from considering taking these tests from the age of 45. Similar recommendations from the Canadian Cancer Society, Prostate Cancer Canada, Memorial Sloan Kettering Cancer Center, American Cancer Society, Prostate Cancer Foundation (PCF / USA), Prostate Cancer UK, are other examples.
Screening should be discontinued in men at the age of 70 with no symptoms; however, for men 70 and older, in excellent health, one could consider further testing taking into account their family history, their values and their preferences 5.
Personal context - Making an informed decision
Before making the decision to have a PSA test, ask yourself these questions and discuss them with your doctor, your family and those around you:
- What are my risks of having prostate cancer?
- Will I be reassured by normal PSA test results?
- What would I do if my PSA level turned out to be high?
- If I have slow-growing prostate cancer that may be harmless for the rest of my life, would I still want to take treatment that could affect my daily life?
Despite all of this, if cancer is detected using the test, doctors may choose not to treat the patient, because the disease is not advanced enough or is progressing too slowly, for example. In these cases, rigorous monitoring is often preferable.
Therefore, the PSA test can be a valuable tool for quickly detecting prostate cancer and prescribing the right treatment. However, this is not an absolute benchmark and it is especially the men most at risk who should undergo screening. If in doubt, ask your doctor for advice and discuss the pros and cons of getting tested.
Attention should not be on the PSA test
When screening for prostate cancer, the overall goal should be the early detection of clinically important prostate cancer in healthy men while minimizing the detection and treatment of low-risk cancers 5. Attention should not be on PSA screening and testing, but rather on:
- Who to screen?
- Who to watch?
- Who to treat?
- When to treat
- How to treat?
Watch for the risks and do not delay in consulting if necessary is not really the adage of men. Unlike women, we already know that it is more difficult to get a man to see a doctor when a health problem or symptoms appear. Prostate cancer remains the third leading cause of death from cancer in Quebec; 880 men die each year. Since it is silent and insidious, causing no symptoms, the only way to detect it at a curable stage is through screening. And this is not trivial in itself!
Take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease with our expert lectures, our section on available resources, the support that is offered to you.
Do you have any questions or concerns? Above all, do not hesitate. Contact us at 1 855 899-2873 to discuss with a nurse specializing in uro-oncology. It's simple and free, like all our services.
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Sources and references
1- INESSS : Use of the prostate specific antigen (PSA) assay for screening for prostate cancer in Quebec. 2018-01-08 | CANCEROLOGY. Santécom Notice: 108907
2- College of Physicians of Quebec : Prostate Cancer Screening - 2013
3- Canadian Study Group on Preventive Health Care : Prostate Cancer — Summary for Clinicians - 2014
4 - US Preventive Services Task Force : Prostate Cancer: Screening-Release Date: May 2018
5- Canadian Urological Association: Recommendations for early detection and diagnosis of prostate cancer. Originally cited as follows: Can Urol Assoc J 2017; 11 (10): 298-309. http://dx.doi.org/10.5489/cuaj.4888
Written by PROCURE. © All rights reserved - 2019