• What is the prostate?
• What is the Prostate-Specific Antigen (PSA) test?
• What is prostate cancer?
• What causes prostate cancer?
• How common is prostate cancer?
• How is prostate cancer treated?
• What is the Government’s policy regarding payment for PSA testing?
• How does the new policy improve access to PSA testing?
• Why is the Government not implementing a prostate cancer screening program?
• Who should have the test?
• How accurate is the PSA test?
• What factors might have a misleading impact on the test result?
• What is the "normal" PSA level?
• Where can men go to have a prostate test done?

The prostate is a walnut-sized gland just below the bladder. It produces part of the fluid that carries sperm. Normally, as men age, the prostate increases in size. If it grows large enough, it may press on the urethra, the tube that carries urine from the bladder. This may make the urine flow weaker or slower or make men have to urinate more often, especially at night. In the large majority of cases, an increase in the size of the prostate and a change in urine flow do not mean you have cancer - these are just a normal part of aging. Nonetheless, healthy men who experience symptoms should consult a physician without delay.

The PSA test is a blood test that measures the amount of PSA in the blood.  PSA is produced by the prostate and is normally present in a man’s blood in small amounts.  An elevated PSA level may be an indication that cancer is present. 

In some cases, a growth in the prostate is cancerous.  Prostate cancer is different in different men. Sometimes the cancer stays in the prostate gland and has little or no effect on how a man feels or how long he lives. Some men with prostate cancer have no symptoms - in other words, it is possible to have prostate cancer without the prostate being enlarged, without urinary problems, and without pain. About seven out of every 10 men diagnosed with prostate cancer will not die from this disease - rather they will die with the disease and from other causes such as heart disease, stroke or old age.

Prostate cancer can also be serious and fatal and it is therefore important to talk with your doctor to understand if you are at risk.

We don't yet know what causes prostate cancer, but we do know that it's more common in :

• men over 50
• men with a family history of prostate cancer (one or two "first-degree" relatives, such as a father or brother)
• men of African ancestry

We also don't know the effect that other factors (such as diets low in fibre or high in fat, or low levels of physical activity) have on the likelihood of developing prostate cancer.

In Ontario, prostate cancer is the third leading cause of cancer death in men behind lung cancer and colorectal cancer. Prostate cancer is often a slow-growing cancer and very common among older men. In fact, most men with prostate cancer die of other causes.

To treat localized prostate cancer (cancer that has not spread), doctors use one of three methods :

• Surgery (prostatectomy);
• Radiation therapy (including brachytherapy);
• Watchful waiting (expectant management).

Generally, prostate surgery is preferred for younger men if they don't have other significant health problems. Radiation therapy is is an alternative to surgery and in particular for men who are at greater risk for complications from a major operation. Watchful waiting is most appropriate for older men with less aggressive, low-grade, slow-growing cancers as these men are likely to die from other illnesses before needing treatment for their cancer.

No two men with prostate cancer are the same. Some are old, some are young. Some have serious health problems, some are well. Some have fast-growing cancers, others have cancers that grow more slowly. All of these things affect the decision about how to treat a man who has prostate cancer.

When a man has been diagnosed with prostate cancer and is receiving treatment, or is being followed after treatment for the disease, the PSA test is available at no charge to the patient through the hospital or community laboratory service.

When a Health Care Provider suspects prostate cancer because of a man's history and/or the results of his physical examination (including digital rectal examination), PSA testing is available at no charge to the patient through the hospital or community laboratory service.

In men without symptoms (screening), PSA testing is not paid for by the provincial health plan. A man can have the PSA test if he is willing to pay for the test himself. However, it is hoped he will make this decision only after discussion with his Health Care Provider.

As of January 2009, men who are eligible for testing under the guidelines will now be able to have the test done and paid for under OHIP at a laboratory in their community as well as in a hospital lab. By expanding access through testing in a community lab, men will not have to travel distances to a hospital lab and have the benefit of longer business hours in community based labs.

Scientific evidence is inconclusive as to whether or not PSA testing in men without symptoms is saving lives and improving health outcomes whereas the evidence for cervical and breast screening is conclusive.

Most international and national screening guidelines recommend against population-based or general screening purposes for prostate cancer because there is no conclusive evidence that prostate cancer screening reduces illness or death associated with prostate cancer.

The Government's policy will help to ensure that Government funds are being allocated based on evidence and that funding is supporting appropriate PSA testing.

Men should talk to their doctor about whether they are at risk and about the risks and benefits of having the PSA test.

No test is right all the time, and this is true of the PSA test.

For every 100 men over age 50, with no symptoms, who have the PSA test :

• 10 men out of 100 tested will have a higher than normal level of PSA. These men must then go through other tests and examinations. At the end of these tests :
• Three of the ten men with a higher than normal PSA level will be found to have prostate cancer
• Seven of the 10 men with a higher than normal PSA level will be found not to have prostate cancer at the time of screening
• 90 men out of 100 tested will have a normal PSA level. Of these 90 men :
• 88 of the men with a normal PSA level will not have prostate cancer.
• One or two of the men with a normal PSA level will actually have prostate cancer, undetected by the test.

Since the test is not right all the time, there are risks and benefits that come with it. The test will identify some men who don't have cancer, creating unnecessary anxiety. It will also miss some men who do have cancer, giving them a false sense of security about their health.

Any of the following can cause PSA levels to fluctuate modestly: prostate manipulation during digital rectal examination, transrectal ultrasound (TRUS), biopsy, a presence of infection, strenuous exercise, ejaculation and normal day-to-day variation, to mention a few. The way that the blood is drawn and stored for testing may also affect the PSA level. These could all lead to false positive results.

A PSA value of >4 ug/L has often been defined in the literature as abnormal and is frequently used as a cut-off point by some jurisdictions including Ontario and the United States. However, a man's PSA level increases steadily as he ages, and some - not all - urologists advocate the use of age-related "normal" PSA cut-points, rather than using >4 ug/L for all. It is recommended that men should talk with their doctor in regards to PSA levels.

Men can have the test done at any medical laboratory facility that does blood testing requested by health care providers, including both hospital and community lab locations.  Access was expanded in January, 2009 to add PSA testing in community lab locations, so that men will not have to travel distances to a hospital lab and will have the benefit of longer business hours in community-based labs.