Resources for coping with cancer during COVID-19. Learn More

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

comments powered by Disqus
comments powered by Disqus


Local Hero Award A Survivorship Action Partnership Active adt advanced Alex Baumann Annual Moose & Goose Club Black Tie Dinner antigen ASAP athlete awareness Beam biopsies biopsy Bismar blood BOSSS Tournament Boutros Brachytherapy Bristow british Buttyan Calgary Canada Cancer caregiver catheter CFL Chemotherapy cherry cnic columbia Conor Malone Cruisin’ For A Cure Canada Dad dads Dakar Rally day deprivation detection diagnosis digital dna do doctor don donate DRE early Early detection ED Edmonton Education erection eric Eskimos exam experience External family Father and Sons Xcanada Father’s Day Walk/Run FDiagnosis Football for Fred Chartrand funding fundraising genetics Golf Town Charity Classic health High-Intensity history hockey Hope Hormone international it Jack Layton Len Levesque lifelabs lottery loved mccormack Media men's moustache Movember MRI Murray Hill national navigator of Olivia Chow one ones partership Paul PCC PCC Atlantic PCCN pee Pilot Grant Program Plaid post-surgery pre-surgery prosate cancer Prostate prostate cancer Prostate Cancer Awareness Day Prostate Cancer Canada Prostate Cancer Canada Network Prostate Cancer Canada Network Conference prostatecancer Prostatectomy Protect the 5 Hole PSA PSA blood test PSA levels PSA test PSA value psatest Radiation Radical radioligand raffle Ralph Randy Remington Randy Remington Charity Golf Classic recovery rectal remember Research researcher Resources Rhodes Ride Rising risk road Rob robyn Rocco Rossi rock Rocktheroadraffle run Scotiabank StickIt Scotiabank Stick-It screened screening sexuality Sled specific Star step Steve Jones story Stuart Edmonds support surgery Surveillance survivor survivors survivorship programs T2:ERG Tarek test testing the The Breast Friends The Randy Remington Golf Classic Therapy TIEd Together TIEd Together photo exhibit Treatment tumours up urine urine test urologist volunteer volunteering Volunteerism volunteers Wake Up Call Breakfast walk week winner World


December 2019(1)
November 2019(3)
October 2019(2)
September 2019(7)
August 2019(6)
July 2019(5)
Juin 2019(0)
May 2019(5)
April 2019(4)
Mars 2019(5)
February 2019(6)
January 2019(4)
December 2018(1)
November 2018(1)
October 2018(3)
September 2018(4)
July 2018(2)
June 2018(1)
April 2018(2)
February 2018(2)
December 2017(2)
October 2017(1)
April 2017(2)
February 2017(1)
December 2016(2)
July 2016(2)
May 2016(1)
March 2016(1)
December 2015(1)
November 2015(1)
September 2015(1)
July 2015(1)
June 2015(1)
April 2015(2)
March 2015(2)
February 2015(2)
January 2015(2)
December 2014(4)
November 2014(2)
August 2014(1)
July 2014(2)
May 2014(2)
April 2014(1)
December 2013(2)
November 2013(3)
October 2013(1)
September 2013(6)
August 2013(2)
September 2012(4)
August 2012(1)
June 2012(1)
April 2012(1)
March 2012(3)
February 2012(2)
January 2012(1)
October 2011(1)
June 2011(2)
January 2011(1)
November 2010(6)
October 2010(3)
September 2010(3)
August 2010(4)
July 2010(2)
February 2010(3)
January 2010(1)