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Prostate Specific Antigen (PSA)
Prostate cancer is a type of cancer that occurs in the prostate, a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm in men. It's the most commonly diagnosed cancer, other than skin cancer, among Canadian men and it's the third leading cause of cancer-related deaths.
The main challenge with prostate cancer is diagnosing and treating significant cases while avoiding over-diagnosis and over-treatment of less severe, or "indolent," cases. Indolent disease refers to a slow-growing or inactive form of the disease that isn't life-threatening.
The Canadian Urological Association suggests that PSA screening could be offered to men who have a life expectancy greater than 10 years. However, the decision to pursue PSA screening should be based on a discussion about potential benefits and risks with a healthcare provider.
- The Canadian Task for Preventative Health strongly recommends AGAINST screening for prostate cancer with a PSA test in men younger than 55 and older than 70.
- There is a benefit for men between 55 to 69 being screened, though the benefit is very small. Approximately 1 in 1000 men screened will avoid prostate cancer death due to screening.
There is a risk of false positives that can lead to unnecessary anxiety, repeat testing and unnecessary surgical procedures. For example, a quoted statistic is that of 1000 men screened with a PSA level, 178 men will have a positive PSA test where there is no prostate cancer (i.e. they have an enlarged prostate).
- 4 of these 178 men will end up with complications from a biopsy including infection and/or bleeding resulting in hospitalization.
- African American ancestry
- Having a father or brother with prostate cancer before age 65
- Have a genetic risk factor, like the BRCA mutation in your family
- Your symptoms are new and came on suddenly.
- You have fevers or are unwell.
- You cannot urinate.
- You are incontinent (cannot control your bladder)
- You have blood in your urine.
Urinary retention is when the lower urinary tract becomes obstructed by an enlarged prostate, causing urine to back up in the urinary system. This can cause permanent damage to the kidney and is life-threatening. If you are unable to urinate or become incontinent of urine, we recommend an immediate visit to an urgent care centre.
The International Prostate Symptom Score (IPSS) - found here: https://qxmd.com/calculate/calculator_338/international-prostate-symptom-score-ipss is a validated tool used to assess the severity of your prostate symptoms.
- Mild symptoms = IPSS < 7
- Bothersome moderate = IPSS 8-18
- Severe = IPSS 19-35
 Nickel, J. C., Aaron, L., Barkin, J., Elterman, D., Nachabé, M., & Zorn, K. C. (2018). Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 12(10), 303–312. https://doi.org/10.5489/cuaj.5616