Prostate test underfunded, doctors say
Simple procedure that costs $30 can help diagnose aggressive forms of disease
The B.C. government is coming under fire at the local and national level for failing to adequately fund a simple $30 blood test that can help to detect aggressive prostate cancers and save men’s lives.
Stuart Edmonds, vice-president of Prostate Cancer Canada, said in an interview that B.C. and Ontario are the only holdout provinces in Canada when it comes to funding the PSA, or prostate-specific antigen, test.
He stressed his organization is not suggesting the PSA test be automatically funded on demand, but only after a patient has consulted with his family doctor.
“We’re not talking about a program where guys are lining around the block to be screened. This is through consultation and requested by the physician. If a guy is concerned, he can go and talk to a physician.”
Edmonds said from Toronto it would cost less than $400,000 for every 40-year-old man in B.C. to receive a PSA test that would supply a baseline PSA level for later comparison in testing for the disease, which is estimated to have killed 620 men last year in B.C.
Through improved testing, the B.C. government would spend less money on treating men with advanced cancers, Edmonds argued. One in seven men is expected to get prostate cancer in their lifetime, more than any other cancer.
Edmonds’ comments follow a Postmedia News five-part series last week on prostate cancer, which highlighted the importance of the PSA test in helping men to diagnose aggressive prostate cancers.
Dr. Martin Gleave, executive director of the Vancouver Prostate Centre, is also criticizing the B.C. government’s current restrictive policy on funding the PSA test.
Gleave said the current policy goes against the recommendation of the B.C. Cancer Agency and is “paternalistic,” confusing to general practitioners, and “undermines individualized informed decision making for the men of B.C.”
Dr. Larry Goldenberg, a professor in the department of urologic sciences at the University of B.C., said that the PSA test costs little more than a case of beer. “People should be given a choice,” he said. “If they want to know if they’re at risk or have prostate cancer, they should be allowed to make that choice.”
Alberta is so into the tests that a Man Van program allows men to receive free PSA tests without an appointment when program vehicles roll into their communities.
B.C. Health Minister Adrian Dix did not respond to a request from Postmedia News for an interview.
In B.C., men have to pay for the PSA test unless their doctor has medical grounds to request it, including those who are already known to have the disease and are being monitored on a regular basis.
The province funded PSA tests for 192,002 men in the 2016-17 fiscal year — including LifeLabs and Health Authority outpatient labs, but not counting in-patient lab tests performed in hospitals — which is down from 206,630 men in 2013-14.
The B.C. Ministry of Health considers the digital rectal exam — not the PSA test — as the “standard method in B.C.” for early detection of prostate cancer. “Clinical evidence indicates that PSA screening yields a high rate of false-positive results. A biopsy is the only way to confirm prostate cancer,” the ministry states.
But family doctors do not always detect prostate cancer with the rectal exam.
Edmonds said some men on a tight budget might not pay $30, while others may feel that the test is of dubious value if it is not supported by the province.
Rick Glumac, NDP MLA for Port Moody-Coquitlam, is a firm believer in the PSA test. He recently had his prostate removed and now receives regular followup tests.
During the last B.C. election, the official Liberal party platform endorsed a policy of working with the relevant agencies to develop “funding models and guidelines to support a funded PSA screening program.”
The PSA test has been the subject of controversy in recent years to the detriment of men who unknowingly have aggressive highrisk prostate cancers.
In 2014, the Canadian Task Force on Preventive Health Care issued a report recommending against PSA screening for men, although the strength of its recommendations varied by age group: strongest for men under 55 years of age and those 70 years and older; and less so for the 55-69 age group, saying “there is inconsistent evidence of a small potential benefit of screening, and evidence of harms.”
There is a remote risk of death due to a biopsy test, and the potential for infections. Removal of the prostate carries the risk of incontinence and erectile dysfunction.
The task force, which will report back in five years, said its recommendations reflect “concerns with false positive results, unnecessary biopsies, over-diagnosis of prostate cancer, and harms associated with unnecessary treatment.”
In the U.S., the medical community has also addressed the issue, but recently made some important changes. In 2017, draft recommendations of the U.S. Preventive Services Task Force softened its 2012 opposition to PSA screening, by suggesting only men 70 and older should not receive such tests.
Within the 55 to 69 age group, it noted the risk of over-treatment has been reduced in recent years by the use of active surveillance in men with low-risk prostate cancer, a way of monitoring prostate cancer that hasn’t spread outside the prostate. Men whose cancers progress during surveillance are offered surgery or radiation treatment.
Edmonds said the PSA test itself should not be controversial, since it only provides information on which men and their physicians can ultimately choose a treatment option.
Edmonds said he also supports a system in B.C. whereby all men diagnosed with prostate cancer have the opportunity to receive a consultation with both a surgeon (for potential removal) and radiation oncologist (for potential brachytherapy) before deciding on a treatment path.
Postmedia News revealed in the series that during the 2016-17 fiscal year, 180 brachytherapy procedures were conducted on B.C. residents in this province compared with 969 radical prostatectomies.