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Prostate Specific Antigen (PSA)

Recommendations from the Canadian Task Force
What is the Canadian Task Force's recommendation on prostate cancer screening?
The Canadian Task Force on Preventive Health Care recommends against screening for prostate cancer with the PSA test.
Why does the Canadian Task Force recommend against PSA screening?
The Task Force found that the potential small benefit from PSA screening is outweighed by the potential significant harms of the screening and associated follow-up treatment.
About Prostate Cancer
What is prostate cancer and how common is it among Canadian men?
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.
How many men will have a positive PSA test but no prostate cancer upon follow-up testing?
Out of every 1,000 men aged 55-69 years screened over a 13-year period, 178 will have a positive PSA test but no prostate cancer upon follow-up testing.
What is the main challenge with prostate cancer?
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.
What is PSA screening?
PSA (Prostate-Specific Antigen) screening is a test that measures the level of PSA in a man's blood. It's used to screen for prostate cancer. However, it's controversial due to conflicting recommendations on its use and the risk of over-diagnosis and over-treatment.
Statistics for Benefits & Harms for Prostate Cancer Screening
How many men will have a negative PSA test?
Out of the same 1,000 men, 720 will have a negative PSA test.
How many men will be diagnosed with prostate cancer?
Out of the 1,000 men, 102 will be diagnosed with prostate cancer.
How many men will experience biopsy complications?
Out of the 178 men who have a positive PSA test but no prostate cancer upon follow-up testing, 33 will experience biopsy complications.
What are the potential harms of PSA screening?
Potential harms include false positives leading to unnecessary follow-up testing, biopsy complications such as infection and bleeding, and overdiagnosis leading to unnecessary treatment and associated complications.
How many additional men need to be diagnosed to save one life?
To save one life, an additional 27 men would need to be diagnosed with prostate cancer.
Who should consider PSA screening?
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.
What’s the difference between a screening PSA and a diagnostic PSA?
A screening PSA level is completed when a man has no prostate symptoms.  
A diagnostic PSA level is completed when a man has prostate symptoms.   
What are the symptoms of an enlarged prostate or prostate cancer?
Getting up at nighttime to urinate
Straining to urinate
Starting and stopping when urinating
Having a slow or weak urinary stream 
Having an urgency to urinate
Having to urinate frequency
What is benign prostatic hyperplasia (BPH)?
BPH is the natural enlargement of the prostate that occurs in all men as they age.  Having an enlarged prostate doesn’t mean one has prostate cancer, but it can produce the same symptoms as prostate cancer.  
Should I get PSA screening? 
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.
Are there downsides to getting a PSA test screened for?
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.
What are the risk factors for prostate cancer?
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.
What is acute urinary retention?
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.
What is my prostate score?
​
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
References
[1] https://canadiantaskforce.ca/tools-resources/prostate-cancer-harms-and-benefits/​
[2] 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
[3] https://www.healthlinkbc.ca/illnesses-conditions/cancer/prostate-cancer-screening
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