Prostate Cancer Screening Guidelines in Canada: A Snapshot of Strategies
The Canadian Partnership Against Cancer annually collects and summarizes data on national, provincial, and territorial prostate cancer screening guidelines and strategies. Despite the absence of organized screening programs, some provinces have policies in place, with opportunistic screening by primary care providers. The Canadian Task Force on Preventive Health Care does not recommend prostate cancer screening with the PSA test for men of any age. Funding availability for PSA testing varies across Canada, with certain provinces funding the test. Details of screening strategies in provinces like Alberta and British Columbia are highlighted.
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Prostate Cancer Screening in Canada Environmental Scan April 2017
Background The Canadian Partnership Against Cancer collects information annually on national, provincial and territorial prostate cancer screening guidelines, strategies, and activities. This scan summarizes the data collected and is intended to provide information on policy and practice. April 2017 2
Outline Prostate Cancer Screening Guidelines and Strategies Canadian Task Force on Preventive Health Care Guidelines Prostate-Specific Antigen (PSA) Testing: Strategies Across Canada Funding Availability for Prostate-Specific Antigen Testing April 2017 3
Prostate Cancer Screening Guidelines and Strategies There are currently no organized prostate cancer screening programs in Canada; however, some provinces have prostate cancer screening policies. Opportunistic screening for prostate cancer may be offered by primary care providers. April 2017 4
Prostate Cancer Screening Guidelines and Strategies - Highlights Prostate-Specific Antigen (PSA) Testing: Strategies Across Canada (refer to slides #7-9) There are no organized prostate cancer screening programs in Canada. Five provinces and territories have a strategy for population-based prostate cancer screening, which is defined as guidelines, policies and/or recommendations for screening men for prostate cancer. Prostate-Specific Antigen (PSA) Testing: Funding Availability Across Canada (refer to slides #10-11) PSA testing is funded in twelve provinces and territories. April 2017 5
Canadian Task Force on Preventive Health Care Guidelines (2014) The Canadian Task Force on Preventive Health Care (2014) does not recommend prostate cancer screening with the prostate-specific antigen test for men of any age. For more information please visit: http://canadiantaskforce.ca/ April 2017 6
Prostate-Specific Antigen (PSA) Testing: Strategies Across Canada Province/ Territory Does your province/territory have a strategy* for population-based prostate cancer screening? (Yes/No) Details of strategy (who is eligible, what is recommended) Alberta No No organized provincial program however a strategy for prostate cancer risk management is being planned. PSA testing for prostate cancer screening is done opportunistically. British Columbia No The BC Cancer Agency and the Vancouver Prostate Centre recommend that asymptomatic men 50-55 years of age or older, with an estimated life expectancy of more than 10 years, who are well informed about the risks of over-diagnosis and over-treatment, consider PSA testing for the early diagnosis of prostate cancer. Unselected, population-wide PSA screening is not supported because of the potential for over-diagnosis, over-treatment and detriment to quality adjusted survival. A recommendation to create a Prostate Cancer Risk Management Taskforce has been proposed to the Ministry of Health. Manitoba No No provincial policies or program. PSA testing is done upon doctor referral. New Brunswick No No provincial policies or program. PSA testing is done at hospitals upon physician/nurse practitioner referral. Newfoundland & Labrador No No provincial policies or program. PSA testing is done at hospitals upon doctor referral. Northwest Territories Yes There is no population based prostate cancer screening program in place. In March 2002, the Department of Health and Social Services provided guidelines: Use of Free PSA Ratio and Total PSA in screening for prostate cancer (developed by the Lab Advisory Committee); providing recommendations for PSA testing. PSA testing by itself is not used as a general screening test for prostate cancer. April 2017 * Strategy refers to guidelines, policies and/or recommendations for screening men for prostate cancer.
Prostate-Specific Antigen (PSA) Testing: Strategies Across Canada Cont d Does your province/territory have a strategy* for population-based prostate cancer screening? (Yes/No) Details of strategy (who is targeted, what is recommended) Nova Scotia Yes There is a 2012 position statement. There is no organized, population-based screening for prostate cancer in Nova Scotia. Screening is an individual decision between the patient and their health care provider. Cancer Care Nova Scotia's 2012 position statement is available at: http://www.cancercare.ns.ca/en/home/preventionscreening/prostate.aspx Nunavut No No organized screening program in place but opportunistic screening/testing is available if requested by designated health professional. Ontario Yes No program, but government has policies for funding of PSA test. PSA testing is not insured for routine screening. For more information, visit: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4488.pdf Cancer Care Ontario position statement on prostate cancer screening and key messages for primary care providers available at: https://www.cancercare.on.ca/pcs/primcare/pcresources/. * Strategy refers to guidelines, policies and/or recommendations for screening men for prostate cancer. 8 April 2017
Prostate-Specific Antigen (PSA) Testing: Strategies Across Canada Cont d Does your province/territory have a strategy* for population- based prostate cancer screening? (Yes/No) Details of strategy (who is targeted, what is recommended) Prince Edward Island No No program but testing is available if requested by physician or nurse practitioner at no cost to the patient. A prostate cancer study was completed in 2016-17 with the support from CPAC. This was to examine the high rate of low risk prostate cancers in PEI. The study examined and reported disease surveillance statistics, use of PSA testing in the province and management strategies of those diagnosed in PEI. The reports will be made available shortly to clinicians and public. Provincial clinical practice guidelines and decision aids for clinicians and patients are under development. Quebec Yes No program, but there is a policy to fund PSA testing when requested by a physician. The College of Physicians in Quebec, in collaborationwith the Institut national d excellence en sant et en services sociaux (INESSS), has prepared a flyer with information for the public. Its content is based on the recommendations of a group of experts in addition to some public consultation. http://www.cmq.org/fr/RSSFeeds/~/media/Files/Depliants/Depliant-depistage-cancer-prostate- 2013.pdf A revision of these recommendations by the INESSS is currently under way. Saskatchewan Yes PSA test is available free of charge to all men in Saskatchewan and government covers cost. Current practice is ad hoc, widely spread and unorganized. No official screening guidelines are in place, but an expert panel has been established to develop guidelines for Saskatchewan. The expert panel has been meeting regularly to review possible options. As a result of this work, a proposal has been developed and ready to be shared with the Ministry of Health to explore possible options to implement a risk management program. Yukon No ---- * Strategy refers to guidelines, policies and/or recommendations for screening men for prostate cancer. ---- No information was provided at the time the data was collected 9
Prostate-Specific Antigen (PSA) Testing: Funding Availability Across Canada Is the PSA test funded by your province/territory? (Yes/No) If funding for PSA testing is available, please explain the funding details: 1. When can the test be ordered (e.g. opportunistic screening in asymptomatic, symptomatic males, risk factors) 2. Through which mechanism (e.g. physician referral, lab etc.) 3. Source of funding (e.g. insurance coverage) Alberta Yes The Alberta Health Insurance Plan does cover it for screening i.e. testing of asymptomatic individuals. British Columbia Yes PSA tests are funded for diagnostic purposes when ordered by a clinician but not for population-based screening. Manitoba Yes PSA testing is an insured service when ordered by a clinician. New Brunswick Yes PSA testing is an insured service when ordered by a physician or Nurse Practitioner. Newfoundland & Labrador Yes The cost for a PSA test is an insured service when ordered by a physician Northwest Territories Yes The cost for a PSA test is an insured service when ordered by a clinician. Appropriate use for PSA testing is for the following scenarios: follow-up for prostate cancer, prostatism or an abnormal digital rectal exam. Patients at higher risk for prostate cancer or those who express concern for developing prostate cancer should discuss risk: benefits with the clinician. April 2017 10
Prostate-Specific Antigen (PSA) Testing: Funding Availability Across Canada Is the PSA test funded by your province/territory? (Yes/No) If funding for PSA testing is available, please explain the funding details: 1. When can the test be ordered (e.g. opportunistic screening in asymptomatic, symptomatic males, risk factors) 2. Through which mechanism (e.g. physician referral, lab etc.) 3. Source of funding (e.g. insurance coverage) Nova Scotia Yes The cost for a PSA test is an insured service when ordered by a Physician or Nurse Practitioner. Nunavut Yes PSA test is an insured service in Nunavut. Ontario Yes Government has policies for funding of PSA test; PSA testing is not insured for routine screening. Prince Edward Island Yes If ordered by clinician. Quebec Yes It is funded if the test is requested by a urologist or a treating physician. Saskatchewan Yes The PSA test, no matter how it is used is fully funded. Yukon Yes ---- ---- No information was provided at the time the data was collected 11 April 2017
Reference Please use the following reference when citing information from this presentation: Canadian Partnership Against Cancer. Prostate Cancer Screening in Canada: Environmental Scan [Internet]. Toronto (ON): Canadian Partnership Against Cancer; 2017 [cited (Enter Date Accessed formatted as YYYY MM)]. Available from: (Enter Link) April 2017 12
Acknowledgements Production of this environmental scan has been made possible through financial support from Health Canada through the Canadian Partnership Against Cancer. April 2017 13
