Prostate-Specific Antigen Test in Canada - Case Study Example

PSA Tests Introduction Pro Specific Antigen (PSA) refers to a glycoprotein found in human beings by the kallikrein-3 (KLK3) gene. It is also referred to as gamma-seminoprotein or kallikrein-3 (KLK3). Prostate-specific antigen is a constituent of the kallikrein-related peptidase group and is buried by the epithelial cells of the prostate gland (CBC News 1). Prostate-specific antigen is created for ejaculation, where it turns to liquid semen in the seminal coagulum thus allowing sperm to flow freely. It is also thought to be influential in breaking up cervical mucus, permitting the entry of sperm into the womb. Prostate-specific antigen exists in small amounts in the serum of people with fit prostates but is frequently elevated in the existence of prostate cancer or other prostate turmoil. Though serum, prostate-specific antigen, measurement is frequently applied in prostate cancer screening. Its cost is controversial (Craig 23). The Prostate Cancer Research Foundation of Canada (PCRFC) does not advocate for its regular use by healthy men. The PCRFC found that PSA-based prostate cancer screening show small or missing reductions in prostate-cancer–specific deaths, and is linked to overtreatment and over diagnosis. This paper will discuss prostate-specific antigen (PSA) test in Canada and determine the level of the test’s use in prostate cancer screening. It will discuss whether the procedure is cost effective and estimate how much money is wasted in the procedure. Finally, it will discuss alternative procedures that are cost effective to the consumers. The prostate-specific antigen test determines the blood level of PSA, enzyme formed by the prostate. Prostate-specific antigen is a serine protease comparable to kallikrein-3. Its function is to liquefy gelatinous semen once ejaculation is carried out, permitting spermatozoa to steer through the uterine cervix. Prostate-specific antigen testing is contentious and may bring unnecessary and damaging effects in some patients. Ever since PSA screening was initiated in Canada, more than a million men in the country have been diagnosed and cured of prostate cancer (Pickles 4). It has been projected that the vast majority, more than 90% of men, get no benefit from this diagnosis. Even though a person makes a positive assumption regarding the advantage of screening, less than 10% of men getting a positive diagnosis receive any benefit at all from it. Positive assumption refers to the entire decline in prostate cancer deaths witnessed since the opening of PSA testing. Other studies, however, point to the achievement of the prostate-specific antigen test in dropping death because of prostate cancer (Craig 24). The Prostate Cancer Research Foundation of Canada (PCRFC) study, observed in the New Canadian Journal of Medicine of February 2009, that screening caused a 20% decrease in prostate cancer deaths. More current researches have shown greater effectiveness on how screening has eased the prostate death rate. A research put in the European Journal of Cancer, September 2009, stated that prostate cancer screening eased prostate cancer death by 37%. The research used a control group of men from Canada, where prostate-specific antigen screening is rare. The study showed a significant reduction in prostate cancer deaths. This was when compared to men who were prostate-specific antigen tested as part of the PCRFC research. The risk of prostate cancer goes up with rising PSA levels. 4ng/ml was selected as a choice level for biopsies, and medical procedures, in the clinical test upon adding prostate cancer detection in 50 years old men and above as an approved suggestion for the initial commercially obtainable PSA test. 4ng/ml was applied as the biopsy choice level in the PSA test. 3ng/ml was applied in the protect tests, and 2.5ng/m was applied in the 2007 PCRFC principles. PSA levels can change for various reasons apart from cancer. Two universal causes of high prostate-specific antigen levels are swelling of the prostate, Benign Prostatic Hypertrophy (BPH) as well as illness in the prostate. The levels can also be raised for a whole day owing to ejaculation and a couple of days after catheterization. Prostate-specific antigen levels are lowered in men who apply dutasteride (Avodart) or finasteride (Propecia or Proscar) to cure benign prostatic hypertrophy. After a year, finasteride was revealed to ease PSA levels by 50%. Finasteride is also advertized as Propecia (1 mg.) for hairlessness, and the lower dosage was revealed also to lower prostate-specific antigen readings by 50% after one year. As a result, calculations and reference ranges of the rate of change in prostate-specific antigen levels per year must be changed in men taking such drugs. Several other means of calculating PSA have been created to avoid the inadequacies of ordinary PSA screening. The application of age-specific reference ranges perks up the specificity as well as sensitivity of the examination. The rate of rise of prostate-specific antigen with time, referred to as the PSA velocity, was utilized in evaluating men with PSA levels from 4 to 10ng/ml. It has not confirmed to be a useful screening test, and it is also hugely expensive. Contrasting the prostate-specific antigen level with the volume of the prostate, as calculated by magnetic resonance imaging or ultrasound, has also been studied. This assessment, referred to as PSA density, is not considered to be an effective screening test and is costly. PSA in the blood may either be bound to or free from other proteins. Measuring the quantity of prostate-specific antigen, which is bound, or free, may give additional screening information. The issues, however, concerning the value of these measurements restrict their widespread use. Critics express the statistical case in this manner. If there were two halls each occupied with 1,000 men, one hall occupied with men who had taken prostate-specific antigen screening tests and the other with men who did not receive the test. There would be just as many men who passed away due prostate cancer in each hall and this leads people to reflect, in the long run it did not achieve any good. Amongst those who engaged in the test of screening there would also be 30 men who were cured for prostate cancer, which never would have brought any symptoms, (SMH 3). Ten of these men would have enduring problems, including incontinence and powerlessness. Prostate cancer can grow into a deadly and painful illness, but it can also build up so slowly that it will never bring problems throughout the mans life. It is hard for a doctor to establish how the cancer will progress basing on the two key screening tests presently available alone. The Prostate Cancer Research Foundation of Canada suggested against PSA screening in fit men finding that the potential risks overshadow the prospective benefits. This recommendation, published in October 2011, was founded on an analysis of facts. The facts conclude that PSA screening results in a small reduction of prostate cancer deaths and is linked to damage related to succeeding evaluation and treatments. The frequent evaluation and treatments are thought to be unnecessary. This suggestion has been condemned by many prostate cancer specialists for an over dependence on findings. This test was anticipated to randomize men between no screening and screening. Nevertheless, the study was instigated during a period when PSA screening was being accepted. There were keen rates of PSA testing amid men who were in the control arm. This rate of contagion was unusually high. It was known to be 50% before the study commenced and 60% during the period of study. In reality, the rate was much higher, as over 90% of the prostate cancers found in the control arm were level T1 or T2. This can only be identified with screening. The Prostate Cancer Research Foundation of Canada authors said in a later publication that they should not be taken as a trial of screening opposed to no screening. They stated that people should consider PCRFC as a trial of annual screening in opposition to opportunistic PSA screening. Prostate-specific antigen testing of men in their early 70s and 80s is dejected. This is because most people at this stage diagnosed with prostate cancer would die of other causes prior to the cancer related issues. Alternatively, up to 30% of men detected in their early 70s and 80s pass away due to prostate cancer. This is if they have high-grade or aggressive prostate cancer (Grimm 44). Critics quarrel against PSA testing for men who are still young, since a lot of men would have to be screened to find one cancer, and a lot of men would have to be treated for cancer that will not grow. Prostate cancer is both widespread. It is by far the most widespread solid-organ cancer diagnosed amid men and beaten only by lung cancer as a cause of cancer death. Prostate cancer is also highly diverse. Many, perhaps all, prostate cancers are sluggish and will never advance to a clinically significant stage if left undiagnosed and untreated in a mans life. Alternatively, a detachment is potentially fatal, and screening can spot some of these within a window of opportunity for cure (Grimm 45). Thus, the idea of prostate-specific antigen screening is supported by means of detecting high-risk, potentially deadly prostate cancer. Lower-risk disease, if revealed, often does not require treatment and is open to active observation. Screening for prostate cancer is controversial due to expenditure and unsure enduring benefits to patients. Testing might bring about over diagnosis and pointless treatment. Follow-up tests can comprise painful biopsies, which can result in extreme blood loss and illness. The pioneer of PSA, Prof. Richard Ablin, stated that the tests popularity has caused a vastly costly public health disaster as only 16% of men will ever get the diagnosis of prostate cancer. He later went on to state that just 3% of these men have a possibility of dying from cancer. He argues that the test is barely useful and can be related to a coin flip. According to the Prostate Cancer Research Foundation of Canada, the argument over prostate cancer should not revolve around the test, but rather how test outcomes influence the choice of treatment. The decision to carry on with prostate biopsy should be found on PSA or irregular Digital Rectal Exam (DRE) outcomes. It should take into consideration numerous factors including free PSA, PSA velocity, patient’s age, family history, PSA density, ethnicity, comorbidities and previous biopsy record. Cancer cannot cure if it is not diagnosed. Not all prostate cancers need urgent treatment. Active observation, in place of instant treatment, is an option that should be thought for some men. Testing provides urologists, and their patients with the information to make crucial decisions. Private health organizations also acknowledge that institutions differ in their recommendations regarding who ought to be given a PSA screening test. They conclude that whether people should have a PSA test is an issue they will have to decide after consulting with their physician, considering the risk factors after weighing their personal preferences. The yearly expenditure of PSA screening in Canada totals at least $3 billion. Much of it is catered for by Veterans and Medicare organization (Walsh 34). A study in Canada resulted in only a small decrease, in mortality rates, and concluded that 50 men would require treatment so as to save one life. $1 billion is, therefore, wasted in treating individuals who will never suffer from prostate cancer. This cost is not effective. A study by the Prostate Cancer Research Foundation of Canada established that over 8 to 11 year period screening did not ease the death rate in adults over 50 years. Previous screening proponents have come out against routine testing. In January 2010, the North American Cancer Organization stated that people should be more caution when using the test. The Prostate Cancer Research Foundation of Canada (PCRFC) concluded that there was inadequate proof to recommend regular screening. According to Ablin, the pioneer of PSA, testing should not be set up to screen the whole population of grownups who are over the age of 50. Ablin states that key promoters of tests should be drug organizations and not just ordinary care givers. He says that these organizations should continue selling the tests along with supporting groups, all of which will benefit, by pushing continual tests. Ablin says that he never dreamed that his discovery forty years ago would bring such a profit-driven public health adversity. The medical society should tackle reality and stop the unsuitable application of Prostate-specific antigen screening (Fagan 1). Tackling the reality would bank billions of dollars and save millions of men from needless, devastating treatments. Conclusion Prostate cancer is a health worry for men. There are issues surrounding early diagnosis and cure options. Presently, there is no concrete proof holding PSA screening for prostate cancer. Because of the doubts surrounding PSA testing it is vital that men who ask for a test get unbiased information to help them in making the correct choice. Works Cited CBC News. PSA: To Test or Not to Test? Toronto: CBC News Press, 2009. Web. Craig, Johanna. The Decision: Your Prostate Biopsy Shows Cancer. Now what?: Medical Insight, Personal Stories, and Humor by a Urologist Who Has Been Where You Are Now. Washington: Jennie Cooper Press, 2010. Print. Fagan, Erin. PSA Screening: Still the Best Test for Early Prostate Cancer Detection. Oakville: Wellspring Cancer Support Foundation, 2008. Web. Grimm, Peter. The Prostate Cancer Treatment Book. New York: McGraw-Hill, 2003. Print. Perry, Patrick. Prostate Cancer: What Men Need to Know: The Post Continues its Three-Part Investigation Exploring the Effects of Antiaging Therapies, PSA tests. New York: Macmillan Publishers, 2006. Print. Pickles, Tom. PSA Toolkit: PSA Screening and Testing For Prostate Cancer. Toronto: Screening Action Group, 2007. Web. SMH. PSA Screening for Prostate Cancer: Information for Care Providers. NP, 2010. Web. Walsh, Patrick. Dr. Patrick Walshs Guide to Surviving Prostate Cancer. New York: Grand Central Life & Style, 2007. Print. Read More