Amid ongoing debate about the effectiveness and necessity of prostate-specific antigen (PSA) screening for prostate cancer, Canadian family physicians are being encouraged to consider offering the test more proactively to certain high-risk populations. At the Family Medicine Forum 2024, Anmol Lamba, MD, an assistant professor of family medicine at The University of British Columbia in Vancouver, emphasized that family doctors should stratify prostate cancer risk among their patients, particularly by considering racial background.
Prostate Cancer Risk and Race: Emerging Evidence
Dr. Lamba referenced two recent Canadian cohort studies examining prostate cancer outcomes across racial groups. One study found that Black Canadian men had prostate cancer outcomes comparable to those of men from other racial backgrounds. However, these men tended to be diagnosed at a younger age, suggesting that earlier screening could be beneficial.
Another study, focused on Indigenous men in Alberta, found that despite the presence of a universal healthcare system, Indigenous patients were less likely to undergo PSA testing. They were, however, more likely to receive a diagnosis of aggressive prostate cancer and to experience metastasis. These findings underscore both a healthcare access disparity and a potential need for targeted screening efforts.
Health Equity and Access to Screening
According to Dr. Lamba, these data suggest that Black and Indigenous men in Canada may have a greater need for PSA testing and highlight the broader issue of equitable healthcare access. “Black, Indigenous, and other racialized patients with prostates may need earlier screening and possibly universal screening,” he noted. “They tend to experience worse disease progression due to a complex web of factors, not solely because of their racial background.”
He further explained that poorer outcomes in these populations likely stem from systemic barriers to care, including reduced healthcare access and persistent inequities within the medical system. These disparities call for healthcare strategies that focus not only on medical risk but also on social determinants of health.
Current Screening Recommendations and Guideline Updates
The Canadian Task Force on Preventive Health Care currently advises against routine PSA testing for all men, citing limited evidence of mortality benefit and concerns about overdiagnosis. Specifically, the task force recommends:
- No screening for men younger than 55 years or those 70 years and older (strong recommendation, low-quality evidence)
- A weak recommendation against screening for men aged 55–69 years (moderate-quality evidence)
However, Guylène Thériault, MD, a family physician and vice chair for the prostate cancer screening guideline committee, stated that the task force is currently revising its prostate cancer screening recommendations. “This is a weak recommendation,” she explained. “That means shared decision-making should be a central part of the discussion between doctor and patient.”
Balancing Benefits and Harms of Screening
Dr. Thériault emphasized that physicians must clearly explain both the advantages and drawbacks of PSA testing. While screening may help detect cancers earlier and potentially save lives, it also carries risks such as false positives, which can lead to unnecessary biopsies and anxiety. Moreover, overdiagnosis can result in treatments for cancers that may never have caused symptoms, leading to complications such as urinary incontinence or erectile dysfunction.
“Patients need to understand these trade-offs,” Dr. Thériault said. “In some cases, there may be an increased survival benefit, but this depends on individual risk factors and life expectancy.”
Guidelines from the Canadian Urological Association
In contrast, the Canadian Urological Association recommends that PSA screening be offered to men with a life expectancy of more than 10 years. This recommendation is also rooted in shared decision-making, with physicians expected to discuss the potential benefits and harms in detail before proceeding with the test.
Conclusion: Toward Personalized and Equitable Screening
As evidence continues to evolve, the conversation around PSA screening in Canada increasingly points toward a more personalized and equitable approach. For populations such as Black and Indigenous men—who face both higher risks and systemic barriers—targeted PSA testing could play a key role in improving early detection and outcomes.
Family physicians, guided by both scientific evidence and patient values, will remain at the forefront of these shared decisions. Ensuring that all Canadians, regardless of race or background, have equal access to informed screening options is critical in achieving fair and effective prostate cancer care.
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