New guidlines suggest first prostate test should occur earlier
Published Wednesday, September 4, 2013 10:19AM EDT
Last Updated Wednesday, September 4, 2013 11:47AM EDT
New screening guidelines for prostate cancer recommend that men first be tested when in their 40s in order to establish a "baseline" for future risk.
The guidelines -- released by Prostate Cancer Canada on Wednesday -- suggest men should receive an initial Prostate-specific Antigen (PSA) blood test in their 40s so they "know their numbers" earlier.
A PSA test is the standard screening test for prostate cancer, though elevated levels of PSA in the blood can be caused by a number of factors -- and is not necessarily linked to prostate cancer.
It was previously suggested that men could wait until their 50s to take a PSA test.
Prostate Cancer Canada also suggests that the decision to end PSA testing should be based on individual risk, rather than an "arbitrary" cut-off age, such as 70.
The guidelines were released after a nation-wide poll that showed, while 87 per cent of Canadian men over the age of 34 fear prostate cancer, less than 50 per cent anticipate being tested in the next 12 months.
Prostate cancer is the most common form of cancer affecting Canadian men, with approximately one-in-seven being impacted by it over the course of their life.
Dr. Stuart Edmonds, vice-president of research and health promotion at Prostate Cancer Canada, said that men need to be better informed about prostate testing. The new guidelines are the result of an extensive review of the research and evidence, he added.
Prostate Cancer Canada spokesperson and assistant professor of surgery Dr. Rajiv Singal said getting a PSA test in your early 40s can provide a better baseline and later allow doctors to better tailor a clinical follow-up.
"The PSA is an important marker for a disease in which symptoms are not always present," he said in a statement.
Prostate Cancer Canada President Rocco Rossi told CTV's Canada AM that men who are at greater risk for prostate cancer -- including men of African or Caribbean descent or men who have a history of prostate cancer in their family -- should speak with their doctors about getting tested in their 30s.
"All the research shows us that with early detection prostate cancer is treatable in over 90 per cent of the cases. So if you wait too late, you lose the benefit of that early detection," he said.
He stressed that getting a PSA test in your 40s does not automatically mean yearly testing or treatment. Instead, it's about "establishing a baseline."
Rossi compared getting a PSA test to getting your cholesterol checked. "This is one of those numbers that you need to know."
He acknowledged concerns that earlier screening may lead to over-diagnosis and possible unnecessary biopsies, but said that decision lies with the physician.
"We want to avoid that and that's the responsibility of the doctor and the urologist to go through a proper triaging … a proper escalation," Rossi said.
After knowing the results of your PSA test, patients can consult with their doctors and determine the next course of action, including setting up a testing routine that's appropriate for a patient's individual risk level, he added.
Risk of over treating
But with more screening there is always the concern of over treating, says CTV's Medical Expert Dr. Marla Shapiro.
"When we talk about doing a screening test, it's not just the result of the screening test it's what that screening test leads to," Shapiro said Wednesday.
And with prostate cancer screening there is the chance of it leading to a biopsy, which carries risks including infection, sepsis, fever and hemorrhage, she said.
"We want to make sure we're introducing a test where the downside is not going to blur out the potential diagnostic benefit.”
She noted that a good screening test should have the ability to separate high cancer burden that will end up developing into a significant outcome versus cases that might never develop.
She added that guidelines on prostate cancer screening vary across North America which can lead to confusion for patients.
For example, the U.S. Preventative Task Force recommends no one be screened with a PSA test because it doesn't actually show a survival benefit.
Meanwhile the American Urological Association recommends PSA testing between the ages of 55 to 69 and only earlier for special high-risk groups.
Memorial Sloan-Kettering Cancer Center in the U.S. recommends testing between the ages of 45 to 49 for individuals of average risk and additional screening to be determined based on the results of the initial test.
Shapiro said the different recommendations show the need for more education for men so they can speak with their doctor about the best screening options for them.
"I think it's very hard to have these broad screening guidelines," she said. "What this means is that you as an individual man have to have the conversation with your physician and understand the entire implications of what this means to have a PSA, how frequently it should be done and the possible outcomes it could lead to."