Recommendations and Guidelines

PSA Testing Recomendations

The PSA test is the best way to detect prostate cancer at an early stage when there are more treatment options and the chance of survival is the highest. When detected early, the 5-year survival rate is close to 100%. Detected late, it drops to 28%.

Health care providers are often a man’s first stop for advice and information on early detection of prostate cancer and prostate specific antigen (PSA) testing. Prostate Cancer Canada promotes a shared decision making approach and endorses the Canadian Urological Association’s (CUA) recommendations on prostate cancer screening.

You can use the CUA's guide below to help your patients make the decision that is right for them.
 
Canadian Urological Association PSA Testing Guidelines A Practical Approach to the Canadian Urological Association Recommendations on Prostate Cancer Screening and Early Diagnosis



Common Questions about PSA Testing

 
Should my patient have a PSA test?

 

  • A PSA test should be considered for your patient if they have symptoms or you suspect prostate cancer after a digital rectal exam, (DRE).
  • You should have an informed choice discussion with your patient if they do not have symptoms. The discussion should cover their risk factors, overall health, life expectancy, and benefits and risks of the test.
    • If your patient is at higher risk of developing prostate cancer (if they are Black or have a family history), they should consider having a PSA test starting at age 45.
    • If your patient is not at higher risk, they should consider having a PSA test starting at age 50.
  • Here is a resource to guide this conversation with your patients. This resource about PSA testing and other resources can be ordered and shipped to you free.

     

What age should my patient begin testing for prostate cancer?

 

  • Most men should consider getting a PSA test starting at age 50.
  • Men at higher risk (if they are Black or have a family history) should consider testing starting at age 45.

 

How frequently should my patient be tested for prostate cancer?

 

  • This depends on your patient’s PSA levels and can be different for each person.
  • You can use the CUA’s a screening pathway as a guide.

 

What age should my patient stop testing for prostate cancer?

 

  • Testing is not recommended for most patients over age 70 or who have a life expectancy of less than 10 years.
  • If your patient is over 60 and has a PSA <1ng/ml they may also wish to stop testing.

 

What other diagnostic tests are available to ensure my patient is diagnosed early?

 

  • Digital rectal exam (DRE) - Used to look for signs of prostate cancer and may complement information from the PSA test and can sometimes detect prostate cancer in patients with a normal PSA. Prostate Cancer Canada does not recommend the DRE on its own to test for prostate cancer.
  • Biopsy - Used to diagnose prostate cancer.
  • Imaging – Imaging such as MRI may be used to prior to (not common) or after (more common) a biopsy to identify suspicious areas in the prostate that may be cancer or to determine if the cancer has spread beyond the prostate.

 

How can I support a patient who is worried about having a DRE?

 

  • It is the patient’s right to choose if they want to have a DRE.
  • Some patients may feel anxious or embarrassed about a DRE. You can reassure them by explaining:
    • The test doesn’t take long
    • It can be uncomfortable but isn’t usually painful
    • What will happen during the procedure
  • Some patients who have been sexually abused might find the test upsetting. Support them and encourage them to talk to someone about their feelings and experience.
  • Some patients have a preference for the sex of the healthcare provider performing the test to make them feel more comfortable.
What should I do if my patient’s PSA is high?

 

  • Prostate risk calculators are available to estimate your patient’s risk if they present an elevated PSA.
  • A higher than normal PSA level can mean that your patient has a problem with their prostate, which could be prostate cancer or a non-cancerous condition like benign prostatic hyperplasia (BPH) or prostatitis. In most men a PSA of >3 ng/ml is considered higher than normal.
  • If their PSA level is high, consider factors including their prostate health, their DRE results, previous PSA test results (if applicable), their age, health and risk factors before deciding what to do next.
  • Depending on these factors, you may recommend another PSA test to track PSA level changes, or that they see a specialist for further tests like a biopsy or MRI.

 

Does my patient have to pay for a PSA test?

 

  • The PSA test for diagnosis is covered for all men except in British Columbia and Ontario.
  • Most asymptomatic men in British Columbia and Ontario have to pay $30-$50 out of pocket for a PSA test.

 

Should trans women or male assigned non-binary people get a PSA test?
  • It’s important to support your patients who are trans women or non-binary, as prostate cancer screening may not be considered gender affirming and may be both physically and emotionally painful.
  • At this time, there are no prostate cancer screening guidelines specifically for trans women.
  • Trans woman or non-binary people who were assigned male at birth have a prostate and can get prostate cancer. The prostate is typically not removed during gender confirming surgery including orchiectomy and vaginoplasty.
  • It is also possible for trans women on feminizing hormone therapy to develop prostate cancer.
  • The decision to screen for prostate cancer, and how to do so, should be made by the patient after an informed choice discussion with their healthcare provider. Risk factors, such as having a family history of prostate cancer or being Black should be considered.
  • Your non-binary and trans women patients may not know they should be tested for prostate cancer, or may be resistant. Feminizing hormone therapy may also lower levels of PSA. This can result in a delayed diagnosis.
  • Ensure that your patients are informed. A conversation about PSA testing should be approached thoughtfully and as an opportunity for the healthcare provider and patient to discuss the importance of testing and medical follow-up.

 

 


Guidelines






The Canadian Urological Association has created a collection of guidelines and recommendations that can help you provide the best care for your patients. 





Last Updated: October 2019

 
 

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