Use of the prostate-specific antigen (PSA) test in prostate cancer screening in Quebec (report)

Notice Santécom: 108907

According to the Canadian Cancer Society, 4 700 new cases of prostate cancer were diagnosed in Quebec in 2016, which makes it the most common type of cancer in men.

It is estimated that 90 % of cases of prostate cancer can be cured when detected and diagnosed early. Therefore, prostate cancer screening in asymptomatic individuals could reduce mortality, morbidity and the costs associated with treating advanced cancer. On the other hand, screening also has its drawbacks, such as false positives and their consequences (biopsy, overdiagnosis and overtreatment), in addition to the risks associated with the therapeutic procedures.

Despite the abundance of literature on the efficacy of PSA-based prostate cancer screening in terms of reducing mortality, the contradictory results of the main studies compel certain organizations not to recommend it as part of a screening program. In Canada, there is no such program. However, in 2013, the Collège des médecins du Québec (CMQ) recommended “considering prostate cancer screening (PSA and digital rectal examination) in certain individuals”.

To improve consistency between the current state of knowledge and the use of the PSA test in prostate cancer screening practice observed in Quebec, INESSS is publishing a report on the use of the PSA test in prostate cancer screening. The purpose of the report is to evaluate the efficacy of the PSA test in asymptomatic men and the safety of the PSA test and the subsequent treatments in the event of a positive result, and to determine the performance parameters of the PSA test and the conditions and strategies for using it.

In light of this assessment, it is important to ensure that men are well informed of the benefits and risks associated with screening. For those who still want to avail themselves of this test, it is important to make judicious use of PSA-based prostate cancer screening. Therefore, INESSS does not recommend routine PSA-based prostate cancer screening. Because of a certain number of uncertainties, the PSA test should remain accessible to asymptomatic men aged 55 to 69 years with no history of cancer, if they have a life expectancy of more than 10 years.