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Anyone who knows anything about the Canadian Prostate Cancer Network knows
we are strong advocates for early detection. We say things like "early
detection is the only cure," or "awareness is the cure."
CPCN has promoted the PSA test and advised men in their forties to start
a yearly regimen of PSA testing and digital rectal exams. We've produced
the Red Green public service announcements with the message: "See
your doctor. Get the test."
All of those ideas resonate with prostate cancer survivors, many of
whom believe they would not be alive were it not for the PSA test. But,
as you know, a number of people - some of them doctors - do not share
our enthusiasm for the PSA test. You've probably all picked up a newspaper
and seen a doctor quoted as saying that "the PSA is not a reliable
test," or words to that effect. Most agree that early detection
is the best route to a cure for most cancers. What they don't agree
on is whether the PSA test is the way to get there. It's ironic that
the PSA test is widely accepted as a useful way to monitor a patient's
progress once cancer has been confirmed, but it is still not widely
accepted as a screening tool.
How do we, as advocates for prostate cancer, talk to those people?
How do we talk to men who believe that a positive PSA test means that
they will be put through the medical wringer and made to worry when,
in the end, chances are they probably don't have cancer or if they do
it's not one they need to worry about. Or so they've been told. These
men have heard over and over that prostate cancer is usually a slow
developing cancer and that "you're more likely to die with PCa,
than die of it." How do we sell our fellows on the value of the
PSA test, a test which measures what oncologist, and keynote speaker
at our Calgary Conference, Dr. Stephen Strum, calls "the single
most important biomarker in the history of cancer medicine?"
Perhaps we should start presenting that first PSA test result as baseline
information about a man's prostate health as opposed to a "test
for cancer." We often hear that if your PSA is below four, you're
OK. If it's above four, someone's going to stick needles up your butt
and x y and z will happen. That's simplistic and misleading. In fact,
one of the most important things to do with PSA results, according to
knowledgeable experts, is to repeat the test, verify the results and
watch for trends over time. Clinical evidence suggests that PSA doubling
time is more important than the score itself. The shorter the PSA doubling
time, the greater the risk that cancer is present.
Simply repeating the PSA test on a yearly basis and graphing the results
provide data which can help the patient and doctor monitor changes in
prostate health. It may also alert them to the possibility that malignancy
exists, in which case further testing can be done. A yearly DRE (which
is much more common than a yearly PSA) can also provide important information
about the volume of the prostate gland. Again, changes can be monitored
over time. This information may not necessarily lead to a biopsy and
a definitive diagnosis of cancer. For example, information gleaned by
monitoring changes in PSA scores may enable some men to detect the risk
of cancer early enough that they can forestall clinical disease through
changes in diet and lifestyle. Repeated PSA tests could show whether
or not their lifestyle changes are making a difference.
But if you don't get the test, you have no information, and, in the
world of cancer, lack of information can sometimes be fatal.
Perhaps the best way to initiate discussion with a PSA skeptic is to
start with the places where we agree, such as early detection. Almost
everyone agrees that early detection is the key to a cure with most
cancers. Most people know that prostate cancer often (but not always)
develops more slowly than some other cancers. This is precisely why
early detection is important in prostate cancer: because we often have
time on our side. If we make intelligent use of early detection tools
with respect to a typically slow growing cancer, surely we can save
thousands of lives. The PSA test along with other early detection methods,
used intelligently and monitored over time, can give a man a real head
start on prostate cancer. Who wouldn't want to get the jump on cancer?
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| Recent PSA Controversy: CPCN Responds
The recent publication of two articles on prostate-cancer screening in the March 2009 issue of the New England Journal of Medicine has spurred renewed controversy over the place of the PSA test in promoting men's health. CPCN's policy on early detection remains unchanged.
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| The PSA Test in Ontario: 2009
The Ontario government recently announced that OHIP will now cover the cost of a PSA test if it is authorized by a physician or nurse practitioner. Until now, Ontario men had to pay $30 to have the test administered. Further, the government has authorized community labs to do the test rather than just hospital labs. This makes it much easier for men to receive the test.
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| More Support for PSA Testing: 2008
Award-winning science writer Tom Keenan argues that Alberta should "pony up for prostate tests" that use PSA as an early diagnostic tool. And researchers speculate that the more widespread use of PSA testing in the US might have resulted in a steeper decline in mortality rates for prostate cancer in that country than in the UK.
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The PSA Test: 2007
The proper role of the PSA test in the early detection of prostate cancer has long been debated, and recent research and events are adding fuel to the discussion. In Ontario, CPCN representatives lobby politicians and raise public awareness regarding the importance of "getting the test" while, in the scientific community, the debate continues.
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