A recent study suggests that the increasing rate of advanced prostate cancer cases in Canada may prompt a reevaluation of the country’s approach to screening for this prevalent male disease. The research, featured in Current Oncology, analyzed data on prostate cancer cases and fatalities over several decades. It revealed a rise in late-stage cancer occurrences alongside a stabilization in mortality rates, which had previously been decreasing.
Lead author Dr. Anna Wilkinson from the University of Ottawa emphasized that while the study couldn’t determine who underwent screening, the substantial number of cases provided insights into the potential impacts of screening. However, some oncologists argue against the interpretation of the data, citing concerns about the accuracy of the prostate-specific antigen (PSA) test commonly used for screening, which they believe can lead to unnecessary treatments and overdiagnosis.
The Canadian prevention task force has historically refrained from endorsing prostate cancer screening, contrasting with the U.S., where the PSA test gained approval in the early 1990s, leading to significant adoption in Canada as well. Subsequently, both countries shifted away from screening in the early 2010s, allowing researchers to observe changes in case and mortality rates following these policy shifts.
According to the study, incidences of metastatic prostate cancer surged by 50% in men aged 50 to 74 and by approximately 65% in men in their late 70s after the recommendations against screening. Conversely, mortality rates declined during periods of widespread screening support but plateaued post the shift away from screening.
Experts like oncologist Bishal Gyawali view the declining mortality rates as indicative of advancements in prostate cancer treatment rather than the impact of screening recommendations. Conversely, Dr. James Dickinson, a proponent of not using the PSA test in Canada, attributes the rise in late-stage cancer cases to improved imaging technologies and reduced screening practices.
The PSA screening test, which measures a prostate-produced protein, remains a contentious issue due to its perceived inaccuracy and potential for false positives, leading to further invasive diagnostic procedures. Critics argue that unnecessary interventions resulting from PSA screening could lead to adverse outcomes such as incontinence or sexual dysfunction, underscoring the need for more specific and less invasive screening tools.
With ongoing debates around the benefits and risks of prostate cancer screening, new guidelines are anticipated next year following a review of the Canadian Task Force on Preventive Health Care. While organizations like the Canadian Cancer Society and Canadian Urological Association advocate for PSA screening, they stress the importance of discussing both the advantages and drawbacks with a healthcare provider before undergoing the test.