PSA Testing: Empowering Patients, Trusting Clinical Teams

September 9th, 2013

Written by Dr. Stuart Edmonds, Vice President, Research, Health Promotion and Survivorship

Every debate has two sides – at Prostate Cancer Canada (PCC), we knew when we released our recommendations that they would stimulate an interesting and well-informed discussion. With that philosophy firmly in place, we would like to address a few points that have been raised recently.

Mitigating the "harms" of testing

We agree completely that the benefits of large-scale screening must outweigh the harms. As a simple blood test, there is no direct harm in actually having a PSA test. However, physical harms may occur in some of the follow-up testing particularly in biopsies.  As Dr. Sullivan’s recent blog highlighted, they can be “common but rarely serious”. Metastatic cancer resulting from a lack of early detection, on the other hand, is more rare but commonly very serious.

By advocating for a baseline test, we are, in fact, helping patients become more accustomed to the PSA test for what it is – a tool that can be used to find cases that warrant a closer look. An informed approach to the variety of tests that are becoming available will be increasingly important in this era of personalized medicine. We hear a lot about moving away from a paternalistic attitude in medicine, with support being voiced for shared decision-making. However, if we are saying that men cannot be trusted to make the right decisions with the results of their own PSA tests, and that the decision should be removed from them entirely, isn’t this a return to “doctor knows best” style of medicine?

Trusting the Expertise of Specialists

PCC’s approach to PSA testing supports removing the concept of getting the test from treatment– the two are not dependent. This sentiment was also presented in the recently released Melbourne Consensus Statement, comprising an international panel who similarly stated: Prostate cancer diagnosis must be uncoupled from prostate cancer intervention. However, to manage any potential risk of over-treatment, we must have faith in our healthcare professionals to make the reasonable and professional decisions with patients as to when treatment is necessary. In Canada, we are fortunate to have some of the leaders in prostate cancer clinical management. These teams, more than anyone, are aware of the harms of over-treatment. They are going to do their best to prevent such negative outcomes through a well-informed discussion with their patients.

Different Countries, Different Healthcare Systems

In discussing PSA testing, evidence and guidelines, we hear a lot about what is happening in the U.S. and Europe. We can only advise caution when looking at guidelines and evidence from other countries, with very different healthcare systems and thus different healthcare outcomes. We should be looking at Canadian guidelines, which are more closely aligned with PCC’s new recommendations.

Future Goals

Certainly, the goal is to continue to research and develop better tests, like the PCA3 test that could prevent perhaps needless repeat biopsies. We are also investing a considerable amount of research funding to determine better approaches to identifying men who need treatment and those that don’t. In the absence of such a perfect test or identification methodology, however, the PSA is the best tool that we have right now to catch aggressive prostate cancer. Turning away from testing for prostate cancer means that the excellent survival rate afforded by early detection is lost and men are diagnosed at a much later stage, when death from the disease becomes more certain.

Bio: Dr. Stuart Edmonds joined Prostate Cancer Canada in February 2011. During his time at the organization he has spearheaded the launch of the Research Strategic Plan, providing the direction for research and survivorship activities for 2012-2015. From this plan, PCC has launched numerous new research programs based on the key pillars: Collaboration, Innovation and Talented People. Dr. Edmonds has also instituted a fair and transparent peer review process to steward and safeguard funds raised in support of prostate cancer research and to ensure that only the most promising, high quality research is funded. Prior to joining PCC Dr. Edmonds held leadership roles at the Canadian Cancer Society, the Canadian Partnership Against Cancer, the Canadian Cancer Research Alliance and the National Cancer Institute of Canada. Stuart holds a doctorate in pharmacology from Oxford University.
Posted: 2013-09-09 3:58:44 PM
Filed under: Early detection, PSA, PSA blood test

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