\u201cAlthough we couldn\u2019t 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,\u201d said Dr. Anna Wilkinson, lead author and family physician with the University of Ottawa.<\/p>\n
But some cancer doctors disagree with how the data has been interpreted and maintain that the screening tool \u2014 known as a prostate-specific antigen (PSA) test \u2014 isn\u2019t accurate and could lead to overdiagnosis and the harms of unnecessary treatment.<\/p>\n
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A surgeon points to a scan of a patient’s prostate tumour as he prepares to remove it. (Jeff Pachoud\/AFP via Getty Images)<\/p>\n
Shifts in screening<\/p>\n
The Canadian task force in charge of prevention has never advocated for prostate cancer screening.<\/p>\n
But in the early 1990s, the U.S. approved the use of the PSA test, which Wilkinson says led to a big uptake here, too. In the early 2010s, the U.S. shifted and both countries were aligned against screening, which allowed researchers to study how case and death rates changed against the backdrops of shifting recommendations.<\/p>\n
\u201cWhat we actually found is that since recommendations against screening in the U.S.,\u201d Wilkinson said, referring to between 2010 and 2021, \u201cmetastatic or stage four prostate cancer has gone up by 50 per cent in men aged 50 to 74, and by about 65 per cent in men in their late 70s.\u201d<\/p>\n
The study also found that mortality rates plunged when screening was more widely supported, and plateaued following the recommendations against it.<\/p>\n
But to Bishal Gyawali, an oncologist and associate professor at Queen\u2019s University in Kingston, Ont., that\u2019s a continuing sign of progress.<\/p>\n
\u201cNo matter what [screening] recommendation you are doing, the mortality rates keep falling. So that means this has probably more to do with all the advances in treating prostate cancer that we have achieved over the last few decades.\u201d<\/p>\n
James Dickinson, one of the authors who recommended against<\/a> the PSA test in Canada, says the data is sound but disagrees with the interpretation.<\/p>\n He says the higher incidences of late-stage cancer can be attributed to improvements in imaging technology \u2014 but also is a byproduct of less screening.<\/p>\n \u201cIf less screening occurs, then less cancer will be found,\u201d said Dickinson, who teaches family medicine at the University of Calgary. \u201cAnd more will be found when it presents with symptoms, so likely [would] be at later stages, in older men.\u201d<\/p>\n (CBC )<\/p>\n Simple yet controversial test\u00a0<\/p>\n One of the key issues is the PSA screening itself, a blood test which measures a protein that a prostate makes. Too much, and it can be a sign of a problem.<\/p>\n \u201cThe test itself is not so accurate,\u201d said Suping Ling, who researches cancer care at the London School of Hygiene and Tropical Medicine. \u201cFor a screening test, it may identify lots of false positive cases.\u201d<\/p>\n That inaccuracy, she and other experts argue, will lead down a potentially more harmful path.<\/p>\n \u201cThere will be more people who need to get followup to get a more accurate diagnostic test, [such as] MRI, biopsy, which is invasive,\u201d Ling said. The U.K. used some of this reasoning in its draft recommendation<\/a> against prostate cancer screening.<\/p>\n Gyawali agrees, saying the harms of acting on PSA results are real and not often talked about \u2014 including surgeries that may lead to incontinence or sexual dysfunction. Furthermore, he says not all cancers have to be removed, so we need a test that can be more specific.<\/p>\n \u201cWe need to differentiate between prostate cancer that’s going to take your life \u2026 versus prostate cancer that might just be there and grow slowly,\u201d Gyawali said.<\/p>\n Wilkinson, the study author, agrees but says that we have made progress in minimizing the harms, including the choice to do nothing.<\/p>\n \u201cThere’s been a shift to decouple diagnosis and treatment,\u201d Wilkinson said.<\/p>\n \u201cActive 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.\u201d<\/p>\n Burden of knowing\u00a0\u00a0<\/p>\n Denis Farbstein, 72, knows both the benefits and risks of screening. His \u201cadventure,\u201d as he calls it, started with a PSA test at the age of 48 \u2014 but involved testing and monitoring for six years.<\/p>\n \u201cI was followed for six years, having PSAs about every 18 months and my numbers would elevate,\u201d Farbstein recalled. He even had biopsies, one of which gave him an infection. He eventually had surgery and has been cancer-free for nearly two decades.<\/p>\n (Spencer Gallichan-Lowe\/CBC)<\/p>\n \u201cHad 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,\u201d he said from a Toronto clinic where he volunteers, helping newly diagnosed prostate cancer patients.<\/p>\n His case isn\u2019t unique, but indicative of a culture that, Gyawali says, has formed around screening \u2014 where the success of individual cases are used to justify population-level decisions. He says whether screening finds something or not, there is relief and that taking intervention is self-justifying.<\/p>\n \u201cThere 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,\u201d said Gyawali.<\/p>\n \u201cBut even these people will always look back upon their screening as something that was the right thing that they have done.\u201d<\/p>\n New guidance on all cancer screening is expected next year, following an external review that paused the work of the body in charge, the Canadian Task Force on Preventive Health Care. While prostate cancer guidelines were due for an update, public health officials tell CBC News, the pause includes \u201cguidelines under development<\/a>, including screening for prostate cancer.\u201d<\/p>\n Both the Canadian Cancer Society<\/a> and Canadian Urological Association<\/a> advocate for PSA screening, but only after discussing the harms and benefits with your doctor.<\/p>\n","protected":false},"excerpt":{"rendered":"A surge in the rate of incurable prostate cancer cases could be a sign to rethink Canada\u2019s stance…\n","protected":false},"author":2,"featured_media":324350,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[143477,143479,49,48,37162,84,143478,25465,54687,105687,116170,143480,87169],"class_list":["post-324349","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-anna-wilkinson","tag-bishal-gyawali","tag-ca","tag-canada","tag-cancers","tag-health","tag-mortality-rates","tag-prostate","tag-prostate-cancer","tag-prostate-cancer-screening","tag-prostate-specific-antigen","tag-psa-screening","tag-wilkinson"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/324349","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=324349"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/324349\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/324350"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=324349"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=324349"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=324349"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"A](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/f2799e068b0ebb6184b5622d5a99d54a.jpeg\"\/)
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