Surge in Prostate Cancer Cases Linked to Screening Gaps

New research published in Current Oncology indicates a significant rise in stage four prostate cancer cases in Canada, linked to the reduction of early screening protocols. Dr. Anna Wilkinson, a family physician at the University of Ottawa and lead author of the study, highlights a 50 percent increase in metastatic prostate cancer among men aged 50 to 74, and a 65 percent increase in men in their late 70s, since the U.S. changed its recommendations against screening between 2010 and 2021.

Mortality rates, which had been declining, have plateaued, raising concerns about the implications of current screening guidelines. The Canadian Task Force on Preventive Health Care has historically not advocated for prostate cancer screening, reflecting a shift in perspective since the U.S. endorsed the prostate-specific antigen, or PSA test, in the early 1990s.

Critics, including oncologist Bishal Gyawali from Queen’s University, argue that the interpretation of the data may not accurately reflect the relationship between screening and cancer outcomes, pointing to advancements in treatment as a contributing factor to the declining mortality rates, which continue to fall despite changes in screening recommendations.

Others, like James Dickinson from the University of Calgary, believe the increase in late-stage cancers can be attributed to improved imaging technologies rather than a direct result of reduced screenings.

The PSA test, while widely used, has come under scrutiny for its accuracy, with Suping Ling from the London School of Hygiene and Tropical Medicine emphasizing that it can lead to false positives, resulting in unnecessary invasive procedures such as biopsies and surgeries that carry significant risks of complications.

The discussion surrounding prostate cancer screening is further complicated by individual experiences, such as that of Denis Farbstein, who underwent monitoring and surgery after his PSA levels indicated potential cancer.

Farbstein, now 72, reflects on his journey and the importance of screening in potentially preventing more severe outcomes. As the Canadian health community anticipates new guidelines on cancer screening next year, the debate continues, particularly surrounding the PSA test.

The Canadian Cancer Society and the Canadian Urological Association advocate for PSA screenings, but stress the necessity for patients to discuss the associated risks and benefits with their healthcare providers.

The report underscores a crucial need for increased awareness and access to early screening to combat the unsettling rise in advanced prostate cancer cases in Canada.