Is Prostate Cancer Screening Useful?

 It’s that time of year again… Mo-vember! Whether you are growing a ‘-stache’ or not, men’s health – and more specifically prostate health - is in the news this month. Do you get your prostate and PSA levels – a marker for prostate health – checked annually? Recently, the Canadian Task Force on Preventive Health Care, an independent panel of volunteer clinicians and methodologists, reviewed whether PSA testing is actually useful for preventing prostate cancer. Their conclusion may surprise you.

After reviewing the latest literature, the task force found that for men between the ages of 55-69, PSA testing only helps 1/1000 men. That’s right, the research shows that men receiving a PSA test died of prostate cancer at a rate of 5 in 1000, whereas those who received no PSA test died at a rate of 6 in 1000. The reviewers on the panel concluded that the unnecessary harm caused from a full investigation and treatment (surgery, radiation) resulted in too many adverse effects and did not significantly improve outcomes.

What were the negative side effects of treatment?

Men who had surgery or radiation to treat the prostate (due to elevated PSA levels) had a high rate of urinary incontinence and erectile dysfunction post treatment. For this reason, the panel concluded that ‘the harm of prostate screening greatly outweigh the benefits’. (Check out this interview with Dr. James Dickinson, a member of the Canadian Task Force on Preventive Health Care, for more info).

The panel goes on to discuss how mortality rates for prostate cancer have dropped by similar rates in countries with no PSA screening, meaning there is much more at play then simply PSA screening as the reason for reduce prostate cancer risks. The panel states that while the PSA marker is great for tracking cancer growth, it is NOT effective as a screen for cancer.

These new recommendations have been received with a lot of controversy across the country.

Rocco Rossi, the CEO of Prostate Cancer Canada does not believe the new recommendations are in the best interest of the patient. He cites the lack of specialists on the panel as a major reason why the recommendations are flawed and believes expert urologists and those on the “front lines” treating patients see benefit with PSA testing.

Rossi outlines that in Canada, we have an active surveillance program, which means that men identified as high risk are not automatically required to get surgery or radiation, reducing the so-called ‘harm’ the panel identified as a major drawback. As prostate cancer is a slow growth tumor, he cites that over 50% of men at high risk are on active surveillance, compared to only 12% in the USA where this type of program is not as prevalent. (Check out this interview with Rocco Rossi, CEO of Prostate Cancer Canada, for more info).

So, what is a guy to do?

There is no easy answer. I believe men should ensure they are seeing their doctor or naturopath at least once a year. Men tend to avoid health issues until they become unbearable, making treatment more difficult. A true preventative approach involves taking into account your current level of health, medical history, and implementing diet, exercise, and lifestyle strategies to reduce your risk of all chronic diseases.

Prostate cancer is the most commonly diagnosed non–skin cancer in men and the third leading cause of cancer-related death among men in Canada. Talk to your doctor today and find out if PSA testing is the right strategy for you. Take a pro-active approach to your health and you’ll look, feel, and perform your best!

 Dr. Marc Bubbs ND, CSCS