A guideline that almost killed me

Hey there, time traveller!
This article was published 11/06/2024 (512 days ago), so information in it may no longer be current.

The Canadian Task Force on Preventive Health Care says my life — and the lives of many other Canadian men — don’t matter. We’re statistically insignificant; inconsequential speed bumps on the road to an efficient health-care system.

The task force sets clinical guidelines for doctors and other health-care professionals to decide whether and when to recommend screening, prevention and/or detection measures for their patients. Over the past two weeks, the organization has received a great amount of criticism over its decision to not lower the recommended age for routine breast cancer screening from 50 to 40 years of age.

For example, Dr. Jean Seely, head of the breast imaging section at the Ottawa Hospital, told the media that, “Unfortunately, we know that will lead to loss of lives. We know that by screening women, we save at least three out of every thousand women screened.”

The criticism of the task force’s position regarding women’s eligibility for mammograms is justified, but don’t assume the breast cancer screening guideline is an outlier. Indeed, another of the organization’s guidelines is arguably putting the lives of Canadian men at even greater risk.

According to the Canadian Cancer Society, prostate cancer is the most common cancer among Canadian men, excluding non-melanoma skin cancers. It is also the third-leading cause of death from cancer in men in Canada.

The society estimates that, on average, 76 Canadian men will be diagnosed with prostate cancer every day this year, and 14 will die from prostate cancer each day. That adds up to more than 5,000 deaths over the course of the year, most of which would be preventable through early screening and detection.

Despite the stark seriousness of those numbers, the task force says that it “recommends not screening for prostate cancer with the PSA test.” The prostate-specific antigen (PSA) test is a blood test that measures the presence of that antigen in the bloodstream. In almost all cases of prostate cancer, there is an elevated PSA level.

In explaining its opposition to the test, the task force says that, for every 1,000 men who are screened with the PSA test, five will ultimately die of prostate cancer, but that for every 1,000 men who aren’t given the PSA test, six will die.

You read that right. According to their own convoluted stats and logic, PSA testing can prevent the death of one out of every 1,000 men who are tested.

That man could be your husband, your father, your child or your friend, but the task force says his death is acceptable because (they argue) PSA testing could lead to prostate cancer treatments that cause complications such as minor infections, urinary incontinence and erectile dysfunction.

I disagree. Fifteen months ago, I insisted on a PSA test as part of my yearly physical. The results of that test revealed a very high PSA level. Based on that result, I was referred to a urologist, who ordered another PSA test. The number from that test was just as high. He then ordered a biopsy and, a few weeks later, I was told I had an aggressive form of prostate cancer, with a Gleason score of 10.

My urologist says I likely would have been dead within two years if the prostate cancer had gone undetected — in other words, if I hadn’t persuaded my family doctor to ignore the task force’s guidelines and order a PSA test. I am that “one in 1,000” guy.

My prostate was removed last September and I am undergoing regular tests to determine if I am cancer-free. The results are encouraging so far, but here’s the kicker: The “gold standard” test that is being used to determine if the cancer is truly gone is the same PSA test that the task force says does more harm than good.

When the task force arrived at its guideline discouraging PSA testing, they were knowingly sentencing hundreds, if not thousands, of Canadian men to death without the knowledge and/or consent of those men. I would have been one of them if I hadn’t insisted on a PSA test when I did.

The guideline almost killed me.

How many men have we lost because their doctor followed the guideline, and they didn’t get a PSA test when they needed it?

Deveryn Ross is a political commentator living in Brandon. deverynrossletters@gmail.com X: @deverynross