(Revised draft; first draft posted March 21, 2006)

Anyone who knows anything about the Prostate Cancer Canada Network (PCCN), which once went under the name of the Canadian Prostate Cancer Network (CPCN), knows we are strong advocates for early detection. We say things like "early detection is the only cure," or "awareness is the cure." We have promoted the PSA test and advised men in their forties to start a yearly regimen of PSA testing and digital rectal exams. We've produced the Red Green public service announcements with the message: "See your doctor. Get the test."  All of those ideas resonate with prostate cancer survivors, many of whom believe they would not be alive were it not for the PSA test. But, as you know, a number of people - some of them doctors - do not share our enthusiasm for the PSA test. You've probably all picked up a newspaper and seen a doctor quoted as saying that "the PSA is not a reliable test," or words to that effect. Most agree that early detection is the best route to a cure for most cancers. What they don't agree on is whether the PSA test is the way to get there. It's ironic that the PSA test is widely accepted as a useful way to monitor a patient's progress once cancer has been confirmed, but it is still not widely accepted as a screening tool.

How do we, as advocates for prostate cancer patients, talk to those people? How do we talk to men who believe that a positive PSA test means that they will be put through the medical wringer and made to worry when, in the end, chances are they probably don't have cancer or if they do it's not one they need to worry about. Or so they've been told. These men have heard over and over that prostate cancer is usually a slow-developing cancer and that "you're more likely to die with PCa, than die of it." How do we sell our fellows on the value of the PSA test, a test that measures what oncologist Dr. Stephen Strum calls "the single most important biomarker in the history of cancer medicine?"

Perhaps we should start presenting that first PSA test result as baseline information about a man's prostate health as opposed to a "test for cancer." We often hear that if your PSA is below four, you're OK. If it's above four, someone's going to stick needles up your butt and x, y, and z will happen. That's simplistic and misleading. In fact, one of the most important things to do with PSA results, according to knowledgeable experts, is to repeat the test, verify the results, and watch for trends over time. Clinical evidence suggests that PSA doubling time is more important than the score itself. The shorter the PSA doubling time, the greater the risk that cancer is present.

Simply repeating the PSA test on a yearly basis and graphing the results provide data that can help the patient and doctor monitor changes in prostate health. It may also alert them to the possibility that malignancy exists, in which case further testing can be done. A yearly DRE (which is much more common than a yearly PSA) can also provide important information about the volume of the prostate gland. Again, changes can be monitored over time. This information may not necessarily lead to a biopsy and a definitive diagnosis of cancer. For example, information gleaned by monitoring changes in PSA scores may enable some men to detect the risk of cancer early enough that they can forestall clinical disease through changes in diet and lifestyle. Repeated PSA tests could show whether or not their lifestyle changes are making a difference.

But if you don't get the test, you have no information, and, in the world of cancer, lack of information can sometimes be fatal.

Perhaps the best way to initiate discussion with a PSA skeptic is to start with the places where we agree, such as early detection. Almost everyone agrees that early detection is the key to a cure with most cancers. Most people know that prostate cancer often (but not always) develops more slowly than some other cancers. This is precisely why early detection is important in prostate cancer: because we often have time on our side. If we make intelligent use of early detection tools with respect to a typically slow growing cancer, surely we can save thousands of lives. The PSA test along with other early detection methods, used intelligently and monitored over time, can give a man a real head start on prostate cancer. Who wouldn't want to get the jump on cancer?

Other Articles on PSA Testing from the Archives

Recent PSA Controversy: Our Response
The recent publication of two articles on prostate-cancer screening in the March 2009 issue of the New England Journal of Medicine has spurred renewed controversy over the place of the PSA test in promoting men's health. Our policy on early detection remains unchanged. Click here for more. 

More Support for PSA Testing: 2008
Award-winning science writer Tom Keenan argues that provinces should "pony up for prostate tests" that use PSA as an early diagnostic tool. And researchers speculate that the more widespread use of PSA testing in the United States might have resulted in a steeper decline in mortality rates for prostate cancer in that country than in the United Kingdom. Click here for more.

The PSA Test: 2007
The proper role of the PSA test in the early detection of prostate cancer has long been debated, and recent research and events are adding fuel to the discussion. Network representatives lobby politicians and raise public awareness regarding the importance of "getting the test" while, in the scientific community, the debate continues. Click here for more.