Canadian Medical Association gives thumbs down to PSA test

CANCER DIGEST – Oct. 27, 2014 – About 10 percent to 20 percent of men diagnosed with prostate cancer using PSA screening won’t have cancer. Overall 40 percent to 56 percent of men will be overdiagnosed, meaning they will be considered to have more or more aggressive cancer than they actually do, leading to invasive treatment. 

Surgery can cause postoperative complications, such as infection (in 11 percent to 21 percent of men), urinary incontinence (in up to 18 percent, and erectile dysfunction in nearly a quarter of those treated along with other complications.

Based on that evidence, a new Canadian guideline recommends that the prostate-specific antigen (PSA) test should not be used to screen for prostate. The guideline is published in the Oct. 27, 2014 CMAJ (Canadian Medical Association Journal).

Specifically, the guideline calls for not using the PSA test to screen for prostate cancer in men under age 55 and over age 70. For men 55-69, the guidelines call for physicians to discuss the benefits and harms of PSA screening with these men.

The guidelines are consistent with the recommendations of the US Preventive Services Task Force and the Cancer Council Australia.

In an accompanying editorial Dr. Murray Krahn of the University of Toronto and University Health Network, Toronto, Ontario expressed reservations about the new guidelines. He suggests that recommendations for clinical practice should be based not only on evidence but also on patient preferences, social values and health care costs.

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