HealthyCanada.com

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 7600 men were diagnosed with prostate cancer in 2002. In the same year 1600 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.

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.

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.

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.

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.

The Canadian Cancer Society

Prostate cancer support groups in Ontario

Other prostate cancer support groups

Insight on Cancer: News and information on prostate cancer is the first in a new series of publications providing the most current information about cancer and cancer risk factors in Ontario. (You will need Adobe® Reader® which you can download free of charge.)