PSA funding welcome, but at what age?
June 5, 2008
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Peter Krivel
STAFF REPORTER
The Ontario government has finally agreed to pay for PSA tests, but that isn't the end of the battle to help men survive prostate cancer.
The 2008 provincial budget included a promise to cover the $30 to $40 cost of a prostate-specific antigen test, which aids in the diagnosis of prostate cancer. Coverage will begin Jan. 1, 2009.
"We're obviously thrilled that this is moving ahead," says Greg Sarney, a vice-president of the Prostate Cancer Research Foundation of Canada.
"What we're doing now is to call on the government to follow up with more concrete guidelines on who will be tested, whether there are any restrictions to any men in getting covered, and whether they have access to it for annual screening or if it will be less frequent," he adds. "They've made the promise but they haven't set out any specific guidelines and terms."
John Peck, perhaps Ontario's leading advocate of PSA testing since he was diagnosed with prostate cancer in 2001, says he's heard that the testing will only cover men over the age of 50.
Now an adviser with the foundation, Peck says the free tests should include younger men who are at high risk, such as those with a family history of the disease and men of African origin.
"These men should look at having PSA tests beginning at age 40," he says. "All other men, we think, should begin getting the test at 45."
Sarney says his group will also continue to lobby for free PSA tests in B.C., Alberta and Quebec, the only other provinces where men must pay for it themselves.
"We're also currently looking into how much funding there is for prostate cancer on the federal level," he adds. "We very strongly suspect that prostate cancer doesn't receive the same amount of funding that other cancers receive."
The Ontario promise is also good news for Thunder Bay MPP Bill Mauro, who introduced a private member's bill in early 2005 to force OHIP to cover the cost. It received support from all parties but stalled at the committee level.
"It's great news," he says. "It's a preventive measure that, without doubt, will save lives, and there are many men who won't pay the $30 or more that this test often costs."
One radical prostatectomy costs the health-care system $12,000 to $15,000, according to Laurence Klotz, chief of urology at Sunnybrook Health Sciences Centre.
He explains one of the biggest concerns with the test has been its accuracy. There's a risk of false positives and unnecessary treatment when antigen levels are elevated for reasons other than cancer.
"The basic problem with PSA screening is that many men harbour small amounts of prostate cancer that's part of the aging process," Klotz says. "Many of these people are not at risk of dying of the disease. And there are far more of them out there than there are those slated to die from prostate cancer.
"Until recently, pretty well everyone who was diagnosed was treated radically, unless they were quite elderly," he says. "But urologists have developed an approach that applies to about half of newly diagnosed patients."
Now, men with advanced cancer are treated radically, while others take a wait-and-see approach.
Toronto Star