To test or not to test: Should men get early prostate screening tests?

Research suggests early cancer screening can lead to unnecessary treatment and side-effects. The Canadian Task Force on Preventive Health Care recommends against early screening for prostate cancer and conflicting advice leaves some men wondering what to do.

Research suggests early prostate cancer screening can lead to unnecessary treatment and side effects

Allan Martin gets a PSA test at the 3rd annual Bret Hart Men’s Health Day. (Monty Kruger/CBC)

A nurse hovers over 46-year-old Allan Martin, instructing him to make a fist, before drawing blood from his left arm.

"It's about time I got checked again.… I haven't had it done for four years," he told CBC News moments after having blood collected for a prostate-specific antigen test.

Martin, along with dozens of other men, showed up to get their PSA tested at Calgary's Prostate Cancer Centre and get a photo with the former professional wrestler Bret (The Hitman) Hart just before Valentine's Day in February.

Retired professional wrestling legend Bret (the Hitman) Hart poses for a photo with a fan who had blood drawn to test for prostate cancer screening during 3rd annual Bret Hart Men’s Health Day in February. (Monty Kruger/CBC)

Hart, a former professional wrestler, became an advocate for early testing after getting diagnosed with prostate cancer in 2015.

"If you just get your blood work done, it could save your life," Hart said, his World Wrestling Federation championship title belt resting on the table beside him. Hart's older brother, Smith, died in 2017 months after being diagnosed with Stage 4 prostate cancer.

Hart said his brother's dying wish was to encourage more men to get PSA (prostate-specific antigen) screening early. The annual Bret Hart Men's Health Day is aimed at getting men to "take charge of their health."

The news release announcing the event stressed that when caught early, prostate cancer is "very treatable."

But recent research suggests early prostate cancer screening can lead some men getting unnecessary treatment for a cancer that will never harm them — and some treatments can result in incontinence, impotence and other health implications. 

The Canadian Task Force on Preventive Health Care, in fact, recommends against early screening for prostate cancer, saying the "harms of PSA screening outweigh the benefits."

This conflicting advice, of course, leaves some men wondering what to do.

Needless PSA testing?

Canada has one of the highest rates of prostate cancer in the world, though mortality rates continue to drop by about 3.25 per cent annually. But that decline, argue some medical researchers, is not attributed to early screening alone.

About 360,000 men, according to Alberta Health, get their PSA tested each year, costing the public system slightly more than $5 million.

Dr. James Dickinson, who teaches family medicine at the University of Calgary's Cumming School of Medicine, recommends against PSA screening for prostate cancer.

"For the vast majority of men, particularly younger men, the chance of harm is much greater than any chance of benefit. So they need to know that in order to make an informed decision," said Dickinson.

Dr. James Dickinson is a professor of family medicine and community health sciences at the University of Calgary. He recommends against PSA testing. (CBC)

Dickinson's own research concluded that while PSA screening increases the number of prostate cancer diagnoses, it does not decrease the number of deaths caused by the disease.

"It's like your chance of winning the lottery," Dickinson said.

"You know when you buy a lottery ticket or when you go to the casino that most of the time you're going to lose. The chance of winning is extraordinarily small."

But not everyone agrees.

The argument for getting early screening

Calgary's Man Van, the country's first and only mobile men's health clinic offering free PSA testing, encourages men from 40 to 80 to get tested.

"To say … 'don't do anything,' that's like putting your head in the sand," said Linda MacNaughton, director of development and community resources with the Prostate Cancer Centre.

"For me, it's the only test they have out there right now. There's absolutely nothing else."

Linda MacNaughton is the director of development and community resources with the Prostate Cancer Centre. (Monty Kruger/CBC)
Despite that, the Canadian Urological Association recommends "starting PSA testing at age 50 in most men and at age 45 in men at an increased risk of prostate cancer."

Prostate Cancer Canada offers conflicting advice, encouraging men in their 40s to get their PSA test.

Stuart Edmonds, vice-president of research, health promotion, and survivorship at Prostate Cancer Canada, concedes PSA testing "isn't a diagnostic test."

"It's simply a test to alert to a problem that may be present in the prostate," he said.

PSA testing highlights both harmless and aggressive prostate cancer. Plus, some tests come back false positive.

"We understand that there are limitations to the PSA test — but it's nevertheless a piece of information with which to use to determine when next to follow-up."

Edmonds encourages men who are confused by the conflicting advice to talk with their doctors about the pros and cons of the test.

Talk with your family doctor 

Calling the debate over PSA testing "very controversial," Calgary family doctor Ted Jablonski said he evaluates every patient individually, considering factors such as family history and whether the men come from populations with higher rates of prostate cancer.

"PSA [testing] is not a perfect screening tool," said Jablonski.

Dr. Ted Jablonski is family doctor in Calgary's northwest. (Brooks DeCillia/CBC)

"I view it as a piece of puzzle. So, I do still use it when I think it's helpful."

Prostate Cancer Canada encourages men over 40 to get a PSA test — and especially men with a family history of prostate cancer or of African or Caribbean descent.