Dr. Bishal Gyawali spoke with CBC The National for a news video and CBC News for an article about new research that suggests prostate cancer cases have increased after screening guidelines changed in the US. However, some experts dispute how this research has been interpreted, and whether guidelines should change.
You can watch both the video and read the article here.
A study published by Wilkinson and colleagues (2025) in Current Oncology investigated prostate cancer mortality, survival, stage, and incidence in Canada in the context of prostate-specific antigen (PSA) screening guidelines in the US. PSA screening is not officially recommended in Canada, but screening is often influenced by US practices and supporting Canadian guidelines. The study found that following US guideline changes advising against routine PSA screening, mortality reductions slowed in older men, while incidence increased in Canada.
Dr. Gyawali believes that even though mortality reduced at a slower rate following the change in screening guidelines, it is important that they are still falling regardless. He states, “that means this has probably more to do with all the advances in treating prostate cancer that we have achieved over the last few decades.”
Furthermore, experts argue that the PSA screening test is not very accurate, leading to false positive results that require an accurate test such as an invasive biopsy. Dr. Gyawali agrees with these claims, and thinks that the potential drawbacks of false positive PSA results must be discussed more – false positives can lead to overtreatment and anxiety for the patient. Recently, Dr. Gyawali published a paper in eClinicalMedicine investigating the congruence of cancer screening recommendations between USPSTF and the top ten cancer centers in the US. For prostate cancer specifically, they found that all cancer centers but one highlighted potential harms of prostate cancer screening, but lacked information on the strength of screening evidence, mortality gains, and number needed to screen (NNS) and number needed to harm (NNH) data to help patients understand the risks vs benefits of screening. Notably, divergence across screening recommendations were highest for prostate and breast cancer.
In his talk with CBC, Dr. Gyawali also mentioned the importance of differentiating between cancers that must be removed or not: “We need to differentiate between prostate cancer that’s going to take your life … versus prostate cancer that might just be there and grow slowly.” He expands on this thought in that “There are so many people who have these benign cancers who undergo these procedures [surgery], but some of them end up suffering the complications of those procedures for the rest of their life… But even these people will always look back upon their screening as something that was the right thing that they have done.”
Dr. Gyawali believes screening culture focuses on individual cases rather than population-level decisions, and people feel relief having taken the test regardless of whether something shows up or not. Greater transparency about the harms and benefits of screening, and unity across screening guidelines is necessary to enhance trust with the public and prevent overtreatment. Read Dr. Gyawali’s paper in eClinicalMedicine here, and his Medscape article where she shares his thoughts on this paper.
Dr. Bishal Gyawali 
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