One in eight Canadian men will be diagnosed with prostate cancer in his lifetime.
Prostate cancer is the most common cancer (excluding non-melanoma skin cancers) and is currently the leading cause of death from cancer among Canadian men. It is estimated that approximately 27,900 new cases of prostate cancer will be diagnosed in Canada this year, about 22% of all cancer diagnoses for men. If caught early, the prognosis can be very good. The 5-year net survival rate (2015-2017) was 91%. Early detection is key.
The PSA test
Prostate-specific antigen (PSA) is a protein produced by the prostate gland as part of the male reproductive and urinary systems. It is found mostly in semen but can also be found in small amounts in the blood. An elevated PSA level may indicate that a man has prostate cancer, but it can also be a sign of prostatitis (inflammation of the prostate) or enlargement of the prostate gland (BPH or benign prostatic hyperplasia).
A PSA test may be ordered for several reasons. It can help detect early prostate cancer before signs or symptoms even occur, it can be used to help confirm a diagnosis of prostate cancer for people experiencing signs or symptoms, or it can be used by doctors to help monitor treatment for prostate cancer.
According to the Canadian Cancer Society, most men should consider PSA testing from age 50. Men at higher risk of prostate cancer should consider testing from age 45. Intervals for retesting are individualized based on the previous PSA level. Those with very low PSA levels might only be retested after 4 years, while those with higher levels might be retested every 2 years, or more frequently.
The PSA test is a blood test that can be done in a lab or at a hospital, with a lab requisition from a health professional. Often the PSA test is used together with a digital rectal exam (DRE) to increase the chance of detecting prostate cancer early.
Some medications can lower PSA levels and affect test results. Before testing, let your doctor know if you are taking medications for benign prostatic hyperplasia (BPH, or non-cancerous enlarged prostate), prostatitis, urinary problems, baldness, or transgender hormone therapy.
High PSA levels are not always a sign of prostate cancer. High PSA can also be caused by an enlarged prostate due to BPH, prostatitis, urinary tract infection, recent prostate biopsy, urinary catheter, bladder exam, sexual activity including ejaculation, bike riding often or recent long bike ride, or warmer climates. Your doctor will review your results with you and determine next steps.
Risk factors for prostate cancer
While the precise cause of prostate cancer is not well understood, certain factors increase a man’s risk of developing the condition.
- Age: Men over age 50 are at higher risk of prostate cancer and most diagnoses are in men in their 60s.
- Family history: Risk increases if a first-degree relative—father, brother, or son —has had prostate cancer. Risk increases further if more than one first-degree relative has been diagnosed.
- Ethnicity: Prostate cancer is more common among Black men, including those with African or Caribbean ancestry.
- Obesity or overweight: A high body mass index (BMI), a large waist measurement (larger than 94cm or 37 inches), or a high waist-to-hip ratio are risk factors for prostate cancer.
- Tall adult height: Tall men have an increased risk of prostate cancer, related to genetics and rate of growth in childhood.
- Inherited gene mutations: Researchers are studying the link between some inherited gene mutations and risk of developing prostate cancer. The most common gene mutations related to prostate cancer are HOXB13 and BRCA2.
- Other factors that may be linked to a higher risk of prostate cancer:
- Diets high in dairy products and calcium
- Low blood levels of vitamin E or selenium
- Working with certain chemicals like pesticides or cadmium
- Long-term prostatitis, Inflammation of the prostate
- Smoking tobacco
- High levels of androgen hormones such as testosterone
Symptoms of prostate cancer
Like most cancers, prostate cancer does not produce symptoms in its early stages and is often detected only after it has spread (metastasized) outside of the gland itself. Prostate cancer commonly spreads to the bones first. Sometimes bone aches, pains or tingling sensations can be the first symptoms of this cancer.
Signs and symptoms that should be checked by a doctor:
- Frequent urination, especially at night
- Strong or urgent need to urinate
- Inability to urinate or difficulty starting urine flow
- Weak or slow urine stream
- Interrupted urine stream that starts and stops
- Burning or pain when urinating
- Blood in the urine or semen
- Painful ejaculation
- Trouble getting an erection
- Discomfort when sitting due to an enlarged prostate
- Pain or stiffness in back, hips, or pelvis that doesn’t go away
- Fatigue
- Unexplained weight loss
If you have questions or concerns about your risk of prostate cancer, speak to your pharmacist or your primary care physician. Remember, early detection improves health outcomes.
