A rise in the incidence of untreatable cases of prostate cancer may signal a need to reconsider Canada’s approach to screening for one of the most prevalent male diseases, according to recent findings. The latest research, detailed in Current Oncology, examined numerous prostate cancer cases and fatalities over several decades. It revealed an increase in advanced cancer rates alongside a stabilization in mortality rates, which had previously been decreasing.
Lead author Dr. Anna Wilkinson, a family physician at the University of Ottawa, pointed out that although it was challenging to identify who underwent screening, the substantial number of cases provided insights into the potential outcomes of screening. However, some oncologists oppose the interpretation of the data, arguing that the prostate-specific antigen (PSA) test, the primary screening tool, is unreliable and could result in unnecessary treatment and overdiagnosis.
The Canadian preventive task force historically did not endorse prostate cancer screening. Nevertheless, following the approval of the PSA test in the U.S. during the early 1990s, there was a notable increase in screening in Canada as well. Subsequently, both countries shifted against screening in the early 2010s, allowing researchers to observe changes in case and mortality rates in response to evolving recommendations.
According to Wilkinson, the study found a significant rise in metastatic or stage four prostate cancer among men aged 50 to 74 by 50% and about 65% in men in their late 70s following the shift away from screening recommendations. Conversely, mortality rates decreased significantly when screening was more widely supported but plateaued after recommendations turned against it.
While some experts view these findings as indicative of progress in prostate cancer treatment, others attribute the increased late-stage cancer incidences to advancements in imaging technology and reduced screening. They suggest that decreased screening leads to fewer cancer detections, with those identified often being at later stages in older individuals.
The debate also revolves around the effectiveness and accuracy of PSA screening. Critics argue that the test’s inaccuracy may lead to unnecessary invasive follow-up procedures, such as MRIs and biopsies. They emphasize the need for more specific tests to differentiate between aggressive and slow-growing prostate cancers to avoid unnecessary treatments and associated risks like incontinence and sexual dysfunction.
The ongoing discussion highlights the importance of balancing the benefits and risks of prostate cancer screening. New guidance on cancer screening, including prostate cancer, is anticipated next year following a comprehensive review that temporarily halted the Canadian Task Force on Preventive Health Care’s activities. The Canadian Cancer Society and Canadian Urological Association recommend PSA screening but stress the importance of discussing the potential harms and advantages with a healthcare provider before undergoing testing.
