PSA Velocity and PSA Testing: Recent Happenings

For more information, see: Steven Reinberg, "PSA trends predict aggressive prostate cancer," CBC News, October 31, 2006. Maggie Fox, "Rapid rise in PSA levels may signal killer cancer," Globe and Mail, November 1, 2006.

In early November, the media gave considerable coverage to an American study on PSA velocity, a study whose results, published in the Journal of the National Cancer Institute, support the usefulness of PSA testing.

The study found that a PSA velocity of 0.35ng/mL per year or less, when measured 10 to 15 years before any prostate cancer diagnosis, was associated with cancer survival 25 years later. PSA velocity, for those needing a refresher, is a measure of how quickly the level of prostate-specific antigen in a man's blood increases over a period of time. (Click here for more information on the PSA test and PSA velocity.) In simple terms, then, the study looked at data collected from the 39-year Baltimore Longitudinal Study of Aging and determined the PSA velocity of 980 men. It found that men with a PSA velocity of over 0.35 ng/mL were more likely to develop prostate cancer and had a poorer survival rate than men with a lower PSA velocity.

Why is this important? Dr. Ballentine Carter, the lead researcher, now advises men to get a "baseline" PSA test at about age 40 - "against which to compare future changes." PSA velocity calculation, because PSA velocity measures the rate at which PSA levels change over time, requires a man to get multiple PSA tests, and the study suggests that these tests should start earlier than previously recommended. However, the main significance of the study, according to Carter, is that "it is the first time that the rate of change in PSA has been shown to be a marker for identifying men who have a disease that is life-threatening at a time when the disease is still curable."

Advocacy: Ontario and BC
This study, then, strengthens the voices calling for a more widespread use of PSA testing among men who show no symptoms of the disease, who are asymptomatic. Policies and practices associated with PSA testing vary across Canada. Currently, three Canadian provinces - Ontario, British Columbia, and Alberta - require that asymptomatic men pay for PSA blood tests while other provinces cover the test through provincial insurance in some circumstances.

Advocacy efforts are currently underway to support the amendment of current provincial health insurance legislation so as to provide coverage for the use of the PSA test as a screening tool. In Ontario, for example, Bill 201, introduced by MPP Bill Mauro in May 2005, seeks to amend the Ontario Health Insurance Act to make "screening for prostate cancer using the prostate-specific antigen test ... an insured service." Prostate Cancer Canada supports this legislation and urges "governments to fund annual PSA testing for men over 40" across Canada. (Click here for the Early Prostate Cancer Diagnosis Ontario sample petition advocating OHIP coverage of PSA testing.)

In British Columbia, the Vancouver Island Prostate Cancer Research Foundation is supporting a sexual discrimination action that Laurie Armstrong, a local lawyer, has brought against the BC Ministry of Health. The case, which will be heard on December 11, 2006, claims that a man, because he has to pay for an annual PSA blood test to screen for prostate cancer, is being discriminated against since a woman can have an annual mammogram to screen for breast cancer provided to her for free. (Click here for a form letter that supports Laurie Armstrong's Human Rights Tribunal application.)

Update on Laurie Armstrong's case: The report from the Chair of the Human Rights Tribunal is still pending. However, David Durksen, chairman of the Vancouver Island Prostate Cancer Research Foundation, attended most of the hearings, which took place between December 13 and December 19 in Victoria. To read a copy of his observations, click here. For media coverage of the hearings consult "Group battles BC over PSA tests" and "BC discriminates by sex in screening tests, lawyer claims."

Also see:
Early Detection, CPCN