Men's Health

Prostate Cancer

Prostate cancer is the most common cancer in Canadian men and is the second largest cause of male cancer deaths in Canada. Each year around 23,600 new cases are diagnosed in Canada and close to 4,000 Canadian men die of the disease every year, which exceeds the number of women who die from breast cancer annually. Despite these figures, the level of awareness, understanding and support for prostate cancer lags significantly behind that of women’s health causes.

•    1 in 7 men will develop prostate cancer during his lifetime and 1 in 28 will die of it.
•    A man dies from prostate cancer every 22 minutes.
•    In 2013, 23,600 new cases of the disease will be diagnosed and 3,900 men will die of prostate cancer.
•    Prostate cancer is the most frequently diagnosed cancer in men.
•    The incidence rates are nearly double in African Canadian men.
•    If detected and treated early, there is a 95 percent survival rate associated with prostate cancer.





OVERVIEW

What is the prostate?


The prostate is a gland forming part of the male reproductive system. It is located immediately below the bladder and just in front of the bowel. Its main function is to produce fluid that protects and enriches sperm. In younger men the prostate is about the size of a walnut. It is doughnut shaped as it surrounds the beginning of the urethra, the tube that conveys urine from the bladder out through the penis. The nerves that control erections surround the prostate.

What is prostate cancer?
Prostate cancer occurs when some of the cells of the prostate reproduce far more rapidly than in a normal prostate, causing a tumour. If left untreated prostate cancer cells may eventually break out of the prostate and invade distant parts of the body, particularly the bones and lymph nodes, producing secondary tumours, a process known as metastasis. Once the cancer escapes from the prostate, treatment is still possible but a “cure” becomes impossible.

Provided appropriate treatment commences while the cancer is still confined to the prostate gland, it is possible to prevent the progression of the disease.

One of the most worrying aspects of the disease is that most prostate cancers develop without men experiencing any symptoms.

What are the risk factors?
•    Gender: prostate cancer affects men only as women do not have a prostate gland
•    Age: the older a man is the more likely he is to be diagnosed with prostate cancer
•    Family History: a man with a father or brother who developed prostate cancer before age 60 is twice as likely to develop the disease
•    Ethnicity: increased occurrence in black African males
•    Lifestyle: poor diet and lack of exercise

What are possible symptoms?
Note: the majority of prostate cancers have no symptoms, and it is really only advanced cancers that have spread throughout the prostate (and beyond) that cause urinary symptoms such as:
•    Slow flow: urine flow is slow and difficult to stop
•    Hesitancy: difficulty starting flow of urine
•    Frequency: need to urinate more frequently
•    Nocturia: need to urinate during the night
•    Urgency: urgent need to urinate
•    Blood in the urine or semen
•    Reduced ability to get an erection
•    Painful ejaculation

It’s important to talk to your doctor about prostate cancer testing, as there are advantages and disadvantages of testing. It’s important to note that these symptoms are common to many different conditions, not just prostate cancer.




TESTING

Talking to your doctor about prostate cancer testing
Men should talk to their doctor about prostate cancer testing. There are advantages and disadvantages to PSA testing. Understand the prostate cancer risk factors, discuss these with your doctor and decide if prostate cancer testing is right for you.

What tests are available?
The purpose of testing is to detect prostate cancer at its earliest stages, before any symptoms have developed. 
There are two tests:
•    Physical Examination (DRE: Digital Rectal Exam)
•    Blood Test (PSA: Prostate Specific Antigen)



The PSA blood test (PSA)

The PSA blood test looks for the presence in the blood of a protein that is produced specifically by prostate cells called Prostate Specific Antigen (PSA). The presence of an elevated PSA does not necessarily mean prostate cancer is present as there are other medical conditions that can lead to a PSA result outside the normal range.  These include enlargement of the prostate (Benign Prostatic Hyperplasia or BPH) and inflammation of the prostate (prostatitis).

The Digital Rectal Exam (DRE)

The DRE involves the doctor inserting a gloved finger in the anus, where it is possible to feel part of the surface of the prostate. Irregularities include swelling or hardening of the prostate, or lumps on the surface that may indicate development of a tumour or other problems. The drawback to this test is that the doctor can feel only part of the prostate, so some irregularities may be beyond reach.

If the results of the test are abnormal your doctor would refer you to a specialist (i.e. Urologist) to take a tissue sample in the form of a biopsy. A biopsy is the only way to determine if cancer is present. A doctor typically diagnoses prostate cancer after closely examining biopsy cells through a microscope. There are several types of cells in the prostate and each contributes in its own way to the prostate’s development, architecture and function. Cancer cells look different than normal prostate cells. Pathologists look for these differences first to detect the presence of cancer and then to determine the cancer grade. Doctors will perform various tests to stage the cancer, determine its risk and develop a treatment plan.

To test or not to test?
The question of testing is a personal and complex one. It’s important for every man to talk with his doctor about whether prostate cancer testing is right for him.

There is no unanimous opinion in the medical community regarding the benefits of prostate cancer testing. Those who advocate regular testing believe that finding and treating prostate cancer early, offers men more treatment options with potentially fewer side effects.

Ultimately, decisions about testing should be individualized based on a man’s level of risk, overall health, and life expectancy, as well as his desire for eventual treatment if he is diagnosed with prostate cancer.

Our recommendation is you discuss your situation with your doctor to decide if testing is right for you. Together, you can choose the best course of action for you. As an aid to having this conversation, we've been working with the Société Internationale d'Urologie on a tool to help men and their families navigate the decision making process.


Download the PSA overview here.














NAVIGATING PROSTATE CANCER

Newly Diagnosed

If you or someone you know has just been diagnosed with prostate cancer you may be experiencing a number of feelings; disbelief, fear, anger, anxiety and depression. There are many treatment options and support resources that can help you and your family through this difficult time and on toward a normal, healthy life.

Dealing with a new prostate cancer diagnosis
1.    Learn more about prostate cancer and the available treatments is the first step towards improving the outlook and relieving some of the anxiety and stress caused by diagnosis.
2.    Be an empowered patient and feel comfortable getting a second opinion. The doctors work for you, not the other way around.
3.    Be prepared with a list of questions for your doctor.
4.    Bring along your partner, a family member or friend for support and an objective observer who can help translate what occurred and what information has been offered in the doctor’s office.

Visit the Prostate Cancer Canada website for extensive post-diagnosis information.

Treatment Decision
If you have been diagnosed with prostate cancer the message is don’t panic.  Many prostate cancers are slow growing and may not need surgery or other radical treatment.  Active surveillance – regular monitoring – is now a common treatment option for men with low risk, low grade prostate cancer.  Take the time to learn about the various treatment options and to make an informed decision about what to do. Take action and seek advice from medical professionals and from reputable sources such as Prostate Cancer Canada.

Remember also that because the side effects of treatment include erectile dysfunction, prostate cancer can have a serious impact on intimate relationships. As many people who have been through the journey will tell you, prostate cancer isn’t just a man’s disease, it’s a couple’s disease.  Make sure you involve your partner as you think through the various treatment options.

Many men and their partners find talking to someone who has already been on a similar cancer journey can be invaluable. PCC has a network of support groups in every province  across Canada that provide group, individual, and in some cases telephone, support.  

Visit www.prostatecancer.ca for up to date details of a support group near you.

Your decision-making process will likely include a combination of clinical and psychological factors, including:
•    The need for therapy
•    Your level of risk
•    Your personal circumstances
•    Your desire for a certain therapy based on risks, benefits, and your preferences

Treatment Options
Active Surveillance
Many prostate cancers are slow growing and may not need surgery or other radical treatment. Active surveillance (which is regular monitoring) is now a common treatment option for men with low risk, low grade prostate cancer.

During active surveillance, prostate cancer is carefully monitored for signs of progression. These tumours can be safely watched, using biannual PSAs and yearly or second-yearly biopsies to ensure that they do not progress. If symptoms develop, or if tests indicate the cancer is growing, treatment might be warranted.

Click here for more information on active surveillance.

Prostatectomy


A surgical approach to treating prostate cancer will remove all of the prostate gland. Typically, men with early-stage disease or cancer that’s confined to the prostate will undergo radical prostatectomy – removal of the entire prostate gland, plus some surrounding tissue. Advances in surgical technique allow men to stay in the hospital one to two nights on average. Other surgical procedures may be performed on men with advanced or recurrent disease.

Click here for more information on prostatectomy.

Radiotherapy
Radiotherapy involves the use of various types of X-rays (radiation) to treat cancer.

External beam radiotherapy has been the traditional method of delivering the radiation. Short pulses of tightly focused beams of X-rays are delivered from outside the body into the prostate for a few minutes each day. Treatment continues five days a week for seven weeks.

Brachytherapy is a more recent development in which radiation is delivered from inside the prostate. Low Dose Brachytherapy employs radioactive seeds that are permanently placed within the prostate to kill the tumour. The procedure is done under anesthetic and usually requires a stay in hospital.

Click here for more information on radiotherapy.

Hormone Therapy


Prostate cancer cells are like other living organisms, meaning they need fuel to grow and survive. Because the hormone testosterone serves as the main fuel for prostate cancer cell growth, it’s a common target for therapeutic intervention in men with the disease.

Hormone therapy, also known as androgen-deprivation therapy or ADT, is designed to stop testosterone from being released or to prevent it from acting on the prostate cells. Although hormone therapy plays an important role in men with advancing prostate cancer, it is increasingly being used before, during, or after local treatment as well.

The majority of cells in prostate cancer tumors respond to the removal of testosterone. But some cells grow independent of testosterone and remain unaffected by hormone therapy. As these hormone-independent cells continue to grow unchecked, hormone therapies have less and less of an effect on the growth of the tumor over time.

For this reason, hormone therapy is not a perfect strategy in the fight against prostate cancer, and it does not cure the disease. It also carries some unwanted toxicities. But it remains an important step in the process of managing advancing disease, and it will likely be a part of every man’s therapeutic regimen at some point during his fight against recurrent or advanced prostate cancer.

Click here for more information on hormone therapy.

Side Effects
It is important to understand that it is possible to deal with the two most common side effects of treatment for prostate cancer – incontinence (involuntary leakage of urine) and erectile dysfunction (difficulty achieving or maintaining an erection). The prostate is situated just under the bladder and is surrounded by the nerves that control erections, which is why surgery, radiotherapy and other treatments commonly cause these side effects at least temporarily. If the problems don’t go away there are now many medical and surgical treatments available to cure incontinence and erectile dysfunction.




RESOURCES

Prostate Cancer Canada (PCC) is the peak national body for prostate cancer in Canada. PCC publish helpful information and additional resources to help connect men and their loved ones to the latest prostate cancer research and survivorship information.

For Movember’s list of men's health sources, please email: info.ca@movember.com