New studies show an alarming rise in diagnosis of later stage prostate cancer, particularly stage 4. This increase has mirrored changes to screening recommendations in Canada. Denis Farbstein, a 72-year-old prostate cancer survivor, emphasizes the importance of understanding the benefits and risks of early screening. His passionate, moving firsthand testimony helps reinforce this crucial message. The wagon of normal conversation about prostate cancer screening is changing quickly. This change is particularly significant given that the Canadian Task Force on Preventive Health Care has historically recommended against these screenings.
Dr. Anna Wilkinson, a family physician and researcher at the University of Ottawa, is the study’s first author. As she explains, the stakes of a one-size-fits-all recommendation against routine prostate cancer screening are high. The increase during the early 1990s was largely attributed to the approval of the Prostate-Specific Antigen (PSA) test, which facilitated routine screening. This move away from screening has led to an increase in late-stage cancer diagnoses. The PSA test measures a protein produced by the prostate and has been a controversial tool in managing prostate health.
The Risks of Prostate Cancer Screening
Dr. Bishal Gyawali, an oncologist and associate professor at Queen’s University in Kingston, Ontario, highlights the often-overlooked risks associated with prostate cancer screening. He asserts, “We need to differentiate between prostate cancer that’s going to take your life versus prostate cancer that might just be there and grow slowly.”
The issues related to screening go beyond just catching cancer early. Gyawali elaborates, “There are so many people who have these benign cancers who undergo these procedures, but some of them end up suffering the complications of those procedures for the rest of their life.” These complications might lead to severe sequelae like incontinence or sexual dysfunction due to avoidable surgical procedures.
Family medicine educator James Dickinson of the University of Calgary, an author of the recommendation against PSA testing, has some words of caution about reduced screening, which is of course going to result in finding the cancers we’re expecting to find. He states, “If less screening occurs, then less cancer will be found,” adding that this could lead to more advanced cases being diagnosed once symptoms manifest.
Current Research Findings
New research details a dramatic connection between reduced screening and an increase in advanced prostate cancer cases. She emphasizes that the data does not show whom was screened. It does allow researchers to make important conclusions about the impact of screening practices. “Although we couldn’t tell who was screened, the sheer number of cases allows us to draw some conclusions about what happens when you screen or don’t screen,” she explains.
The real-world implications of these findings are enormous given that Canada is currently in the process of revising its screening guidelines. In the coming year, the Canadian Task Force on Preventive Health Care will issue its new guidance. This guidance will apply to all cancer screenings. This review could not have come at a more opportune time. Unfortunately, the U.K. has suggested new draft recommendations that discourage prostate cancer screening.
We’re grateful to Dr. Gyawali for shedding light on these important advancements in treatment options for prostate cancer. No matter what screening method is used, these improvements are making an impact on mortality rates. It doesn’t actually seem to matter which recommendation you’re implementing, the mortality rates continue to drop. He attributes most of this first and foremost to the major breakthroughs we’ve all made over the decades against prostate cancer. These innovations have indisputably revolutionized the standard of care for the treatment of patients.
Perspectives on Screening Practices
Farbstein’s personal experience with prostate cancer demonstrates the complex conversations that exist around screening. After undergoing surgery at age 54, he reflects on his fortunate outcome: “Had I not been screened, it could have gone into other parts of my body, and then I would have been in trouble. So, for me, personally, I was very fortunate.”
None the less, opposition raised by other outside groups has focused on the need for a more balanced approach to screening. Suping Ling, a medical diagnostic researcher, cautions against the misrepresented judgment of PSA testing. Even the test as a standalone isn’t all that accurate, she explains, pointing out that it produces a lot of false positives. This may force people to pursue more invasive follow-up procedures like biopsies or MRIs.
Ling’s observations further support the call to move toward more targeted screening strategies. “For a screening test, it may identify lots of false positive cases,” she adds, stressing the necessity for careful evaluation before proceeding with potential treatments.
Aside from the basic science research her team has produced, Dr. Wilkinson has witnessed a change in how prostate cancer is clinically tackled. “There’s been a shift to decouple diagnosis and treatment,” she asserts. This approach aims to better differentiate between aggressive cancers requiring immediate intervention and those that can be monitored through active surveillance. “Active surveillance is following those lower-risk prostate cancers so you don’t have harms of treatment, but you’re ready to jump in when you need to,” she explains.
