Men in their 40s should get a baseline prostate-specific antigen (PSA) blood test to "know their numbers," Prostate Cancer Canada says.
The patient advocacy and research foundation released new recommendations today after reviewing the evidence.
Too much PSA in the blood only sometimes signals prostate cancer. It also can mean a benign enlarged prostate or an infection.
Prostate cancer screening aims to identify men with an aggressive form of the disease compared with those who can be safely watched because the tumour is unlikely to cause harm during the patient's lifetime.
"If something is conventionally normal but a little bit more measurable we would probably follow those men a little bit more closely," said Dr. Rajiv Singal, a spokesman for Prostate Cancer Canada and a urologist at Toronto East General Hospital.
The recommendations make a distinction between testing and treatment, noting that having a baseline PSA value provides a benchmark to compare future PSA values over time.
Previously, the group recommended that men in their 40s talk to their doctor about a baseline PSA test.
In 2011, a U.S. government panel called the Preventive Services Task Force recommended that healthy men should not receive the PSA test as part of routine cancer screening because there is little if any mortality benefit.
The U.S. task force recommended that the PSA test is not justified at any age because there is not more benefit than risk, said Dr. Mike LeFevre, co-chair of the U.S. Preventive Services Task Force.
"Many people would like to say that you can't blame the effects of treatment on the test itself. My response to that is: yes you can," said LeFevre, a professor of family medicine at the University of Missouri.
"We do an enormous disservice to our patients to pretend that this is just a blood test and that we can decide later what to do with the information," said LeFevre. "Men will get biopsies and there will be complications."
Serious complications of treatment include a blood clot, heart attack, stroke, impotence, urinary incontinence and death. Pain, fever, bleeding and infection can also occur from a biopsy, LeFevre said.
Singal countered that some often portray prostate cancer as a benign disease, that isn't always the case. The new recommendations aim to prevent anyone from falling through the cracks, he added.
The Canadian group noted some men are at increased risk because of:
- Ethnicity (black African or black Caribbean descent).
- A family history of prostate cancer in a father, brother or son.
"Men in the high-risk category should have a discussion with their primary care provider about their risk for prostate cancer and when to begin PSA testing," the group said.
For men aged 70 or older, Prostate Cancer Canada said the decision to end PSA screening should be based on individual factors.
The Canadian Cancer Society says the five-year relative survival rate for prostate cancer is 96 per cent, meaning that, on average, men diagnosed with prostate cancer are 96 per cent as likely to live five years after diagnosis as people in the general population.