If reporter Larry Pynn’s personal and comprehensive five-part series on prostate cancer has raised awareness about the disease and efforts to combat it, his stories may do more than merely inform – they may save lives.
His graphic descriptions of treatments for late-stage prostate cancer my have caused some readers to cringe but they made a compelling case for early detection. Cancers discovered at an early stage are usually easier to treat, halting their advance and thereby avoiding some of the pain and disability that would otherwise ensue.
But this is where the controversy arises. British Columbia is one of few provinces where the medical services plan does not cover the standard screening test for prostate cancer – the prostate specific antigen (PSA) test – lumping it in with “preventive services and screening tests not supported by evidence of medical effectiveness.”
As Pynn explained, the PSA test measures the amount of PSA, a type of protein, in a man’s blood. An elevated PSA may indicate prostate cancer, but it could also be caused by other conditions such as an enlarged or inflamed prostate.
A high PSA reading could lead to aggressive procedures and treatments that may not be necessary, signalling either a benign condition or a slow-growing cancer that poses no threat to an individual in his lifetime. The Canadian Task Force on Preventive Health Care recommended against PSA screening in 2014, arguing there was “inconsistent evidence” of small potential benefit and evidence of harms.
But that small potential benefit may be a reduction in the risk of death from prostate cancer. Advocates for the PSA test say it helps categorize patients as high or low risk of developing prostate cancer. One of the doctors Pynn interviewed said that as a result of the PSA controversy more patients are presenting with higher-risk, aggressive prostate cancer requiring multi-disciplinary treatments.
Dr. Larry Goldenberg, director of development and supportive care at the Vancouver Prostate Centre, told Pynn the task force recommendations “are robbing men of the chance for early detection and treatment.”
The MSP does fund the PSA test if a doctor believes a patient may have cancer – it covered 192,002 tests in fiscal 2016-17 – but healthy men with no symptoms have to pay $35 if they want the test.
Taking a baseline test before a man’s 50th birthday would allow doctors to monitor the PSA level over time. Such watchful waiting would reassure a patient that prostate cancer would be detected early and provide the doctor with the data needed to decide if and when further intervention is necessary.
For women over the age of 40, screening for breast cancer every two years is covered by MSP. It seems appropriate that men should receive similar coverage for the PSA screening test for prostate cancer.
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