1. Prostate Cancer Screening Guidelines Across Canada Environmental Scan July 2015

2. Background Biannually, the Canadian Partnership Against Cancer collects information from the provinces/territories and international organizations on the status of population- based prostate cancer screening strategies. This information compares current guidelines and evidence-based recommendations in order to identify leading practices. July 2015 2

3. Presentation Outline  Canadian Task Force on Preventive Health Care Guidelines  Prostate Cancer Screening Programs/Strategies in Canada  Funding Available for Prostate-Specific Antigen Testing  Changes to Prostate Screening Strategies, Programs, or Funding for PSA Testing July 2015 3

4. Canadian Task Force on Preventive Health Care Guidelines The Canadian Task Force on Preventive Health Care (2014) recommends the following for prostate cancer screening with the prostate-specific antigen test: For men aged <55 years, routine screening not recommended. (Strong recommendation; low quality evidence) For men aged 55–69 years, routine screening not recommended. (Weak recommendation; moderate quality evidence) For men aged ≥70 years, routine screening not recommended. (Strong recommendation; low quality evidence) For more information please visit: http://canadiantaskforce.ca/http://canadiantaskforce.ca/ July 2015 4

5. Prostate-Specific Antigen (PSA) Testing: Programs or Strategies Across Canada Province/ Territory Which is in place (program or strategy)? Details of program or strategy (who is targeted, what is recommended) AlbertaStrategyNo organized provincial program however a strategy for prostate cancer risk management is being planned. PSA testing for prostate cancer screening is done opportunistically. Clinical Practice Guidelines for PSA testing is available : http://www.topalbertadoctors.org/informed_practice/cpgs/prostate_cancer.html British ColumbiaNoneThe 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. Recommendations available at: http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prostate/PSAScreening/Recomm endations.htmhttp://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prostate/PSAScreening/Recomm endations.htm. A recommendation to create a Prostate Cancer Risk Management Taskforce has been proposed to the Ministry of Health. ManitobaNoneNo provincial policies or program. PSA testing is done at hospitals upon doctor referral. New BrunswickNoneNo provincial policies or program. PSA testing is done at hospitals upon doctor referral. Newfoundland & Labrador NoneNo provincial policies or program. PSA testing is done at hospitals upon doctor’s order. Does your province/territory have a program or strategy* for population-based prostate cancer screening? 5 * Please note: Program = organized population based prostate cancer screening program; Strategy = guidelines, policies and/or recommendations for screening men for prostate cancer July 2015

6. Prostate-Specific Antigen (PSA) Testing: Programs or Strategies Across Canada Cont’d Which is in place (program or strategy)? Details of program or strategy (who is targeted, what is recommended) Northwest TerritoriesStrategyThere is no population–based prostate cancer screening program in place. March 2002, Dept 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. Guideline available at: http://www.hss.gov.nt.ca/sites/default/files/page_25_use_of_free_psa_ratio_and_total_psa_in_ the_screening_for_prostate_cancer.pdf Nova ScotiaStrategyThere 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 http://www.cancercare.ns.ca/en/home/preventionscreening/prostate.aspx Nunavut**NoneNo organized screening program in place but opportunistic screening/testing is available if requested by designated health professional Does your province/territory have a program or strategy* for population-based prostate cancer screening? 6 July 2015 * Please note: Program = organized population based prostate cancer screening program; Strategy = guidelines, policies and/or recommendations for screening men for prostate cancer **No response provided by Nunavut in the July 2015 scan.

7. Prostate-Specific Antigen (PSA) Testing: Programs or Strategies Across Canada Cont’d Which is in place (program or strategy)? Details of program or strategy (who is targeted, what is recommended) OntarioStrategyNo 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 In 2015, Cancer Care Ontario released a position statement on prostate cancer screening and key messages for primary care providers. These are available at: https://www.cancercare.on.ca/pcs/primcare/pcresources/. https://www.cancercare.on.ca/pcs/primcare/pcresources/ Prince Edward IslandNoneNo program but testing is available if requested by physician or nurse practitioner at no cost to the patient. A Prostate Cancer Action Group will be formed in late 2015 with initial direction to provide guidelines for prostate screening in PEI and examine the patient pathway. QuebecStrategyNo program, but there is a policy to fund PSA testing when requested by a physician. The College of Physicians in Quebec, in collaboration with the Institut national d’excellence en santé 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 http://www.cmq.org/fr/RSSFeeds/~/media/Files/Depliants/Depliant-depistage-cancer-prostate- 2013.pdf SaskatchewanStrategyPSA 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 was developed and shared with the Ministry of Health to explore possible options to implement a risk management program. Yukon Does your province/territory have a program or strategy* for population-based prostate cancer screening? 7 * Please note: Program = organized population based prostate cancer screening program; Strategy = guidelines, policies and/or recommendations for screening men for prostate cancer

8. July 2015 Is the PSA test funded by your province/territory for routine screening (e.g. during routine physical exam, upon request from asymptomatic male)? If no, when is the test considered for funding (e.g. if they are symptomatic, have known risk factors)? Prostate-Specific Antigen (PSA) Testing: Funding Availability Across Canada When is funding available for PSA testing e.g. routine screening, other (specify below) If funding is available for other reasons other than routine screening, explain the funding details: 1.When can the test be ordered (e.g. asymptomatic/symptomatic males, risk factors) 2.Through which mechanism (e.g. physician referral, lab etc.) 3.Source of funding (e.g. insurance coverage) AlbertaThe Alberta Health Insurance Plan does cover it for “screening” i.e. testing of asymptomatic individuals. British ColumbiaPSA tests are funded for diagnostic purposes when ordered by a clinician but not for population-based screening. ManitobaPSA testing is an insured service when ordered by a clinician. New BrunswickPSA testing is an insured service when ordered by a Physician or Nurse Practitioner. Newfoundland & Labrador The cost for a PSA test is an insured service when ordered by a physician Northwest TerritoriesAppropriate use for PSA testing is for the following scenarios: follow-up for prostate cancer, prostatism or an abnormal DRE. The cost for a PSA test is an insured service when ordered by a clinician. Patients at higher risk for prostate cancer or those who express concern for developing prostate cancer should discuss risk: benefits with the clinician. 8

9. July 2015 Is the PSA test funded by your province/territory for routine screening (e.g. during routine physical exam, upon request from asymptomatic male)? If no, when is the test considered for funding (e.g. if they are symptomatic, have known risk factors)? Prostate-Specific Antigen (PSA) Testing: Funding Availability Across Canada When is funding available for PSA testing e.g. routine screening, other (specify below) If funding is available for other reasons other than routine screening, explain the funding details: 1.When can the test be ordered (e.g. asymptomatic/symptomatic males, risk factors) 2.Through which mechanism (e.g. physician referral, lab etc.) 3.Source of funding (e.g. insurance coverage) Nova ScotiaThe cost for a PSA test is an insured service when ordered by a Physician or Nurse Practitioner. Nunavut*PSA test is an insured service in Nunavut OntarioGovernment has policies for funding of PSA test; PSA testing is not insured for routine screening. Prince Edward IslandIf ordered by clinician. QuebecIt is funded if the test is requested by a urologist or a treating physician. SaskatchewanThe PSA test, no matter how it is used is fully funded. Yukon 9 * No response provided by Nunavut in the July 2015 scan.

10. July 2015 In light of the Canadian Task Force on Preventive Health Care’s updated 2014 Prostate Cancer Screening Guideline, are there any planned changes to prostate cancer screening programs or strategies*, or to funding for PSA testing in your province or territory? Changes to Prostate Screening Strategies or Programs or to Funding for PSA Testing Changes to prostate cancer screening programs or strategies Changes to funding for PSA testing AlbertaThere is a plan to update / revise the provincial clinical practice guidelines soon. The is no planned changes to funding for PSA testing British ColumbiaNo changes planned ManitobaN/ANo changes planned New BrunswickNo Newfoundland & Labrador No change Northwest TerritoriesNo changes plannedNone anticipated * Please note: Program = organized population based prostate cancer screening program; Strategy = guidelines, policies and/or recommendations for screening men for prostate cancer 10

11. In light of the Canadian Task Force on Preventive Health Care’s updated 2014 Prostate Cancer Screening Guideline, are there any planned changes to prostate cancer screening programs or strategies*, or to funding for PSA testing in your province or territory? Changes to Prostate Screening Strategies or Programs or to Funding for PSA Testing, cont’d Changes to prostate cancer screening programs or strategies Changes to funding for PSA testing Nova ScotiaNo Nunavut**Currently there are no planned changes to the current strategy; no plans to develop organized prostate cancer screening program No planned changes to existing funding/insured service Ontario No. CCO does not have any current plans for strategies/initiatives for prostate cancer beyond the release of the position statement and supporting materials (see slide 6). No. Funding is under the purview of the Ministry of Health and Long-Term Care, but as they do not currently provide funding for PSA for screening purposes. Prince Edward IslandPending work of the Prostate Cancer Action GroupNo QuebecNo SaskatchewanAs of February 2015 there are no planned changes to prostate cancer screening programs or strategies No changes to funding for PSA testing; all PSA tests are funded Yukon 11 July 2015 * Please note: Program = organized population based prostate cancer screening program; Strategy = guidelines, policies and/or recommendations for screening men for prostate cancer ** No response provided by Nunavut in the July 2015 scan.

12. Reference Slide July 2015 Please use the following reference when citing information from this presentation: Cancerview.ca. Prostate Cancer Screening Guidelines Across Canada: Environmental Scan. Toronto: Canadian Partnership Against Cancer; [enter date]. Available from: [enter URL link] 12