Prostate Cancer
Overview
Prostate cancer is the most common cancer in Canadian men. The Prostate Cancer Research
Foundation of Canada says some 5-million men are in their prostate cancer-risk years. But, as male baby
boomers age and more men are tested, the number of new cases is expected to double over the next
decade. In Ontario, an estimated 7,600 men were diagnosed with prostate cancer in 2002. In the same
year, 1,600 men in Ontario died of prostate cancer. The good news is that with early detection the
survival rate is very high, about 87 per cent.
Causes
Prostate cancer starts in the prostate gland, which is part of the male reproductive system. It is the size of
a large walnut and is located just below the bladder at the base of the penis. The main function of the
prostate gland is to produce seminal fluid. Prostate cancers start in the glandular tissue of the prostate
and are called adenocarcinomas. The exact cause of prostate cancer is unknown. What is known is that
cancer of the prostate most often occurs in men over the age of fifty, with married men being at higher
risk than single men.
OTHER RISK FACTORS
Family History
Research shows you have at least twice the risk of developing prostate cancer if your father or brother
has been diagnosed with the disease. If more than one close family member has been diagnosed with
prostate cancer or if it was diagnosed at a relatively young age, (under 60) the risk may be further
increased.
Ethnicity
Prostate cancer appears to be more common in men of African ancestry as compared to Caucasian men.
Asian and Aboriginal populations seem to have the lowest rates of prostate cancer.
Diet
Research shows that a high fat diet may increase a man’s risk of developing prostate cancer.
Symptoms
Prostate cancer may produce no symptoms, but when symptoms do appear they can include problems
with urination including:
difficulty in starting or stopping the urinary stream
the inability to urinate
a frequent need to urinate
pain or burning while urinating
blood in the urine (rare)
consistent pain in the lower back or pelvis
If you experience any of these symptoms, you should see your doctor.
Treatment
There was a time when surgery was the only hope for men with prostate cancer. But today, there are a
number of options available:
Surgery
Surgical removal of the prostate, known as radical prostatectomy, is available to many men with localized
prostate cancer. It involves removal of the prostate and surrounding tissues, a portion of the urethra, and
the seminal vesicles. When the surgeon is removing the prostate he will try to save nerves surrounding
the prostate that are responsible for erections. Success will depend on how close the cancer is to the
nerves.
Brachytherapy
Involves placing radioactive seeds directly in the prostate where they remain permanently. The radiation
given off is tightly localized to the prostate.
External beam radiation
Radiation therapy is one of the main treatment options available to men with localized prostate cancer.
Beams of high-energy radiation “external” to the body are directed toward a target inside the body.
Recent advances in radiation therapy allow radiation oncologists to direct the radiation beams more
precisely and give a higher dose of radiation using a technique called conformal radiation.
Observation
Observation, or "watchful waiting" as it is sometimes called is a treatment option that includes periodic
PSA tests and digital rectal exams to carefully observe the behaviour of the cancer. In considering
observation as a treatment, it's important to understand that it is not a means of delaying more aggressive
treatment.
Hormone therapy
One of the oldest means of treating prostate cancer. Prostate cancer is dependent upon hormones, and
by depriving the prostate of hormones the cancer is reduced. Hormone therapy may be administered on
its own or in combination with other therapies. On its own, hormone therapy is not a cure, but a means of
slowing the growth of prostate cancer.
You can find details of these and other treatment options at the Prostate Centre website run by Toronto’s
Princess Margaret Hospital. This is a superior resource, which includes numerous multi-media
presentations from medical professionals.
Prevention
Prostate cancer can't be prevented, but you can take steps to reduce your risk and/or possibly slow the
disease's progression.
The Canadian Cancer Society recommends that men over the age of 50 discuss with their doctor the
potential benefits and risks of early detection of prostate cancer through a PSA, a simple test that
measures the amount of prostate-specific antigen in a man’s blood. The PSA offers the possibility of early
detection, but it is not perfect and you should understand this before testing.
Although the amount of PSA in a man's blood generally increases with age, higher-than-normal PSA
levels can be one clue that cancer has developed within the gland. However, high levels of PSA also can
be found in other conditions that are non-cancerous, including prostatitis (inflammation of the prostate)
and benign prostatic hyperplasia, or BPH, (an enlargement of the prostate which affects many older men).
How accurate is the PSA test?
No test is right all the time, and this is especially true of the PSA test.
For every 100 men between the age 50 and 70, with no symptoms, who have the PSA test approximately:
Ten will have a higher than normal level of PSA (usually >4 ng/ml). These men must then go through
other tests and examinations. At the end of these tests three of the men with a higher than normal PSA
level will be found to have prostate cancer. Seven of the men with a higher than normal PSA level will be
found not to have prostate cancer at the time of screening.
Ninety of the men will have a normal PSA level. (A PSA level of under 4 ng/mL, is considered normal.) Of
these 90 men, 87 of the men with a normal PSA level will not have prostate cancer. Most data shows that
at least three of the men with a normal PSA level will actually have prostate cancer, although it will go
undetected by the test, however, a recent study that included more elderly males (62-91 years of age)
found as many as 27% had signs of prostate cancer.
Consequently, the test will identify some men who don't have cancer, creating unnecessary anxiety. It will
also miss some men who do have cancer, giving them a false sense of security about their health. Some
men do not want to open this “Pandora’s box”, while others are very keen to detect any problems as early
as possible, even if it means unnecessary testing. This is why the current recommended approach is to
discuss the pros and cons of the test with your doctor before making a decision.
The most important steps you can take to maintain prostate health are to eat well, keep physically active
and see your doctor regularly. Tell your doctor if you have a family history of prostate cancer, as this will
influence any decisions going forward.
Diets that are rich in certain fruits and vegetables that contain lycopene may be protective or decrease
the risk of developing prostate cancer.
Some general dietary recommendations to consider include:
Eat less dietary fat
Eat more fruit and vegetables, including tomatoes, tomato sauce or tomato juice, and pink grapefruit,
papaya, and watermelon
Eat more dietary fibre
Eat more soy protein, such as tofu, tempeh, and soymilk
Regular exercise has been shown to strengthen the immune system, improve circulation and speed
digestion — all of which may play a role in cancer prevention. Exercise also helps to prevent obesity,
another potential risk factor for some cancers.
