Geoff Johnson: Prostate test is a red flag worth paying attention to

Re: “Annual prostate-cancer screening has little benefit,” comment,” Sept. 6.

I would be happier with Dr. James A. Dickinson’s or, for that matter, anybody else’s advice about the frequency or otherwise of non-symptomatic PSA testing only if the advice came after the individual’s PSA tests had raised doubts that led to a biopsy that in turn led to a diagnosis, or not, of cancer in the prostate gland.

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If at that point, and in the event of a positive biopsy result, it was Dickinson’s decision to pursue what oncologists call “watchful waiting” and take no further action, fair enough, as long as the knowledge that he was carrying a time bomb in his body did not concern him.

According to the Canadian Cancer Society, prostate cancer is the most common cancer among Canadian men (excluding non-melanoma skin cancers). It is the third leading cause of death from cancer for men in Canada. In 2017, again according to the cancer society, an estimated 21,300 men were diagnosed with prostate cancer.

It is estimated that about one in seven Canadian men will develop prostate cancer.

In Canada, the incidence rate of prostate cancer peaked in 1993 and again in 2001.

These peaks are compatible with two waves of intensified screening activity using the prostate-specific antigen test. Since 2001, the incidence rate has generally been declining.

The mortality rate for prostate cancer has declined since the late 1990s. The decline likely reflects improved treatment once a diagnosis has been confirmed.

The most common sites to which prostate cancer spreads, without any further indication or treatment, include the bones, liver and lungs. The disease is, indirectly, the eventual second leading cause of cancer-related deaths in men.

I did not have the kind of courage needed to ignore these statistics and dismiss the availability of the simple PSA test in the belief that the test could or might lead to a false positive. No test is infallible, but neither is ignorance bliss.

I’ll admit I did not have the courage, once diagnosed by the biopsy, to pretend that I could wait cancer out and hope for the best. I sought treatment after the PSA test, itself not a diagnosis, had flagged the advisability of a biopsy, again a relatively simple procedure. That confirmed the existence of the cancer. The choice of treatment was mine after that.

The point is that it was the PSA red flag that originally and eventually led to my being cancer-free today.

I’ve always paid attention to red flags of any kind.

So, gentlemen, avoid annual PSA tests at your peril. A PSA test takes five minutes out of the rest of your life, and while a PSA test is definitely not a diagnosis of cancer, if you like to gamble, go to Las Vegas where all you can lose is a few dollars.

Geoff Johnson is a regular Times Colonist columnist.

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