Browsing the newspaper recently, Kim Cammidge came across a message from Ontario’s Minister of Health David Caplan announcing that the province is now covering the cost of a test used to detect prostate caner, when ordered by a doctor.
Caplan’s letter to the editor, published in The Star, led Cammidge to believe that her husband Godfrey was eligible for a free prostate-specific antigen test since his doctor had ordered one as part of a regular health check-up.
“Contrary to some misconceptions, a man does not need to be showing symptoms of prostate cancer in order to get a free PSA test,” Caplan wrote.
“I said to my husband: ‘Hey, look at this,’” Cammidge said. “I thought it was about time.”
But when Godfrey, 56, arrived at a local clinic for the PSA test, he was asked to pay the standard $30 fee for the procedure. Cammidge was fuming.
“What I read was so misleading,” she said. “I was really frustrated. The McGuinty government said the test was free, but it’s not free for everyone. They didn’t make that clear.”
The Cammidges were not the only local residents confused by the province’s new PSA coverage, effective since January.
Several people have written letters to The Star asking for clarification on the eligibility criteria after they too were billed $30 for a PSA test. Even some physicians were mystified.
“Originally, the province made it sound like everyone is going to get (a free PSA test), but then they started putting all these qualifiers in. It was confusing,” said Dr. Nick Krayacich, president of the Essex County Medical Society.
A PSA test is a blood test that measures the amount of prostate specific antigen, a protein produced in the prostate gland. An elevated PSA level may mean that cancer is present, but further tests are necessary to get a definitive answer.
In October 2007, the Liberals announced that if re-elected they would cover the cost of the annual PSA test for all Ontario men over the age of 50. Coverage of the PSA test was also mentioned in the 2008 provincial budget as part of a multimillion-dollar plan to build on the province’s cancer screening program.
“It was kind of a blanket statement,” said Krayacich, a family physician. “When we heard that announcement pre-election, we were very pleased by that. And then when we started ordering (the PSA test), that was apparently not the case. Then we got a release from OHIP clarifying all of the criteria.”
Contrary to what some people believed, when a doctor orders a PSA test for screening purposes, the patient still must pay for it. The test is covered by OHIP only for “diagnosing or monitoring purposes,” regardless of the man’s age, under these circumstances:
• If the patient has been diagnosed with prostate cancer and is receiving treatment or being monitored after treatment. (The PSA test was already free for these patients.)
• If the doctor suspects prostate cancer after a physical examination or is concerned about a patient who has first-degree relatives (father, brother, etc.) diagnosed with prostate cancer.
Men who meet the criteria, which are outlined on the Ministry of Health’s website, can now also get the PSA test done in a community laboratory or clinic. Previously, OHIP only covered PSA tests done in hospital labs.
Krayacich said the increased access to PSA testing is “a step in the right direction” — but not a big stride.
“The majority of (PSA tests) we order are for screening purposes. We feel everyone should be covered,” he said. “If the physicians order the test, (OHIP) should pay for it regardless. I liken it, for example, to a female who is going in for a mammogram. She won’t get charged for it. It would be ridiculous to say to a woman: ‘We’ll only pay for your mammogram if we feel a lump or we suspect cancer.’ That defeats the whole purpose of what a screening test is.”
In its argument against implementing a prostate cancer screening program, the Ministry of Health has said that scientific evidence has not yet proved that PSA testing in men without cancer symptoms is improving their health outcomes and reducing their risk of dying from prostate cancer. According to the ministry’s website, most international and national screening guidelines recommend against general screening programs for prostate cancer.
Dr. Verna Mai of Cancer Care Ontario said PSA tests can result in false positives, subjecting men to further unnecessary exams and procedures and “doing more harm than good.” Various factors can cause PSA levels to increase and fluctuate, including infections and the way the blood is drawn and stored for testing. A man’s PSA level also naturally increases as he ages.
“When it comes to PSA and using it as a general screening test, that should be really thought through,” Mai said. “It is not a clear-cut ‘yes’ that all men in a certain age group should get the test.”
Krayacich acknowledged that the PSA test has generated controversy, but “no screening test is 100 per cent accurate,” he said. “The PSA test is the best thing we have at the moment.”
Krayacich said he and other physicians will continue to lobby for a free PSA test “for everyone, as it should be.”
“We want men coming in for health checkups and preventative care.”
Prostate cancer is the most common cancer in Canadian men. In 2008, about 8,900 Ontario men were diagnosed with prostate cancer and 1,650 died from it. Men older than 50 are at the highest risk of developing the disease.