Page 13 - CUAJOctober2022

CUA NEWS The CUA: Advocating for our patients
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Armen Aprikian he Canadian Task Force on Preventative Health Care’s (CTFPHC) position on
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prostate cancer screening has not been updated since 2014. They continue
CUA President Tto recommend against prostate-specific antigen (PSA) screening in men and
do not recommend rectal examinations. Moreover, not even a discussion on the
Cite as: Aprikian A. The CUA: Advocating for our merits of PSA screening with the patient is considered. Since the CTFPHC has sig-
patients. Can Urol Assoc J 2022;16(10):315. nificant influence on primary care and the health of the general population, such
http://dx.doi.org/10.5489/cuaj.8116 recommendations require frequent evidence-based review.
To their credit, the U.S. Preventative Services Task Force (USPSTF) has reviewed
their position and changed their stance on prostate cancer screening in 2018, from
Pour la version française, voir cuaj.ca a blanket D recommendation against screening to one that recommends a pro/con
discussion with the patient, level C. The USPSTF withdrew its previous objections
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The CUA exists to promote the and advised personalized decision-making for screening men aged 55–69 years.
highest standard of urologic care They cited recent clinical trial evidence showing that screening had a greater benefit
for Canadians and to advance in reducing prostate cancer mortality than was previously recognized, as well as a
the art and science of urology. benefit in preventing metastatic disease. Overall, they concluded, with moderate
certainty, that there was a small net benefit for screening. Their document reads:
“The USPTF recommends counselling men, 55–69 years, on the risks and potential
benefits of undergoing periodic PSA-based screening for prostate cancer. Clinicians
should not screen men who, after adequate informed consent, do not express a
preference for screening.”
Of course, the Canadian Urological Association (CUA) updated its guideline in
2017 and then again in 2022, stating: “The CUA suggests offering PSA screening
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to men with a life expectancy >10 years. The decision of whether or not to pursue
PSA screening should be based on shared decision-making after the potential ben-
efits and harms associated with screening have been discussed.”
With respect to provincial positions, the Ontario Ministry of Health recommends
References against systematic mass screening. Its guideline reads: “PSA determination should
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not be used as a population-wide mass screening test for the early detection of
1. Bell N, Gorber SC, Shane A, et al. Recommendations on screen- prostate cancer in asymptomatic males,” but goes on to state that an informational
ing for prostate cancer with the prostate-specific antigen test. brochure has been developed to assist men between the ages of 50–75 with a life
CMAJ 2014;186:1225-34.
2. US Preventive Services Task Force. Screening for prostate can- expectancy of >10 years in making an informed decision on PSA testing.
cer. JAMA 2018;319:1901-13. https://doi.org/10.1001/ The Quebec Collège des médecins goes a little further and recommends that
jama.2018.3710 primary care physicians should initiate a discussion regarding the pros and cons of
3. Rendon RA, Mason RJ, Marzouk K, et al. Canadian Urological prostate cancer screening with periodic serum PSA tests, stating: “Le Collège des
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Association recommendations on prostate cancer screening and médecins du Québec recommande aux médecins de discuter avec leurs patients
early diagnosis. Can Urol Assoc J 2017;11:298-309. http:// âgés de 55–70 ans et qui ont une espérance de vie de 10 ans ou plus des avan-
dx.doi.org/10.5489/cuaj.4888
4. Mason RJ, Marzouk K, Finelli A, et al. UPDATE – 2022 tages et des inconvénients du dépistage par l’APS combiné au toucher rectal, et de
Canadian Urological Association recommendations on pros- s’assurer qu’ils ont bien compris les enjeux avant de prendre la décision de faire
tate cancer screening and early diagnosis: Endorsement of ou de ne pas faire le dépistage.”
the 2021 Cancer Care Ontario guidelines on prostate multi- It is clear the CTFPHC recommendations should be reviewed and based on the
parametric magnetic resonance imaging. Can Urol Assoc J evidence, revised to be more in-line with those described above.
2022;16:E184-96. http://dx.doi.org/10.5489/cuaj.7851
5. Ontario Ministry of Health and Long-Term Care. Summary This is exactly the type of advocacy role the new CUA Advocacy Office will
of recommendations. Available at https://www.health.gov. undertake. The CUA has appointed Dr. Hassan Razvi, Past President, as the interim
on.ca/english/providers/pub/cancer/psa/psa_summary/ Chief Advocacy Officer until an officer is elected at the 2023 annual general meet-
summary.html. Accessed August 30, 2022. ing. On behalf of the membership, I thank Dr. Razi for taking on this position and
6. Collège des médecins du Québec. Prostate cancer screen- organizing our advocacy efforts. The first order of business is for the CUA to join
ing: It’s your decision. Available at http://www.cmq.org/
publications-pdf/p-3-2013-09-01-en-depistage-cancer-de-la- the effort in requesting an immediate evidence-based review of the CTFPHC recom-
prostate.pdf. Accessed August 30, 2022. mendation for prostate cancer screening.

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