One in eight Canadian men will be diagnosed with prostate cancer in his lifetime.
Prostate cancer will kill close to 4,100 Canadian men in 2015, yet somehow most of us believe it to be the cancer a man dies with and not from. This simply isn’t true. The myth came about when autopsies showed that many older men have low grade cancers in their prostate glands. (Roughly 70 per cent of men between 70 and 79 years of age are diagnosed with prostate cancer after their death.) Low grade cancers can stay put for many years, even decades, and not give rise to metastases, and it is true that the type of cancer that affects senior men is usually low grade. However, many men, including those in their 40s and 50s, die from more aggressive prostate cancers that spread quickly to the bones, or soft tissues of the body. These types of aggressive cancers are becoming more prevalent.
How prostate cancers are graded
Following a biopsy, prostate cancers are graded according to the Gleason scale, from 6 to 10. Cancers with a Gleason of 6 are considered less aggressive (low-grade) and are likely to grow and spread slowly.
Cancers with Gleason scores of 8 to 10 are considered high grade. These cancers tend to be aggressive, meaning they are likely to grow and spread more quickly.
Cancers with a Gleason score of 7 are intermediate grade and tend to grow and spread at a rate that falls between the previous two.
If your doctor determines that you may have prostate cancer, it is important to establish the Gleason grade so that the most appropriate treatment protocol can be established. Cancers with a higher Gleason rating are normally treated more aggressively than those with lower ratings.
The PSA test
PSA or prostate-specifi c antigen is a protein produced by the prostate gland. An elevated PSA level may indicate that a man has prostate cancer, but it can also be elevated as a result of prostatitis (infl ammation of the prostate) or enlargement of the prostate gland (BPH).
In Canada, doctors generally consider a PSA level of 4.0 or under to be “normal” but any signifi cant rise in the PSA (an increase greater than 0.75 ng/mL in one year) should be a red ag. Since this is not always understood, it is important to know your PSA and to question any sudden rise. Patient advocacy groups recommend that any signifi cant rise in PSA, even if the total remains under 4.0, is cause for concern and should be investigated expeditiously.
In Canada and the USA, updated PSA test guidelines suggest that the PSA test, when used for screening, has little benefi t in men under the age of 50 and older than 69. This does not apply to the use of the PSA test for diagnostic purposes.
These new guidelines have caused some concern among advocacy groups, which point out that, early stage prostate cancer rarely produces symptoms, or anything that can be detected during a routine digital rectal exam (DRE). When urinary problems are present, they are often assumed to be due to an enlarged prostate, a common benign condition of middle age. While it is unusual to develop prostate cancer under the age of 50, it can happen, and these cases are usually more aggressive. Likewise, men of 70 and older can develop aggressive prostate cancers which could be detected by elevated PSA levels.
Prostate Cancer Canada advocates for “smart screening” which takes a man’s personal risk into account. This involves getting a PSA test at age 40 to establish a baseline number which then becomes part of the man’s risk profi le to determine when follow-up needs to occur.
Rather than testing every man annually, smart screening involves a tailored approach to prostate cancer screening with individualized follow-up and care as decided between a man and his doctor.
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. These include the following:
- Age: Risk increases in men over 50, with six out of 10 cases affecting men over the age of 65. Prostate cancer is rare in men younger than 40.
- Family history: Risk increases if a fi rst-degree relative—father or brother—has had prostate cancer. (The risk is slightly higher if a brother has the disease, than if the father has it.) Risk increases further if more than one fi rst-degree relative has had the condition.
- Ethnicity: Prostate cancer is more common among men of African or Caribbean descent. Men of Asian descent have lower risk.
- Being overweight: Achieving and maintaining a healthy weight reduces your risk.
- Unhealthy eating patterns: Men who eat a low-fi bre, high-fat diet are more likely to develop prostate cancer. Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher risk, however, men in this group also tend to eat fewer fruits and vegetables, making it diffi cult to determine which of these two factors increases the risk. (It is wise therefore to cut back on consumption of red meat and also to increase intake of fruits and vegetables.)
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 usually spreads to the bones before the soft tissues, and sometimes bone aches, pains or tingling sensations can be the fi rst symptom.
Benign prostatic hyperplasia (BPH) or enlarged prostate is a common condition which can give rise to the same urinary symptoms as prostate cancer. If you experience urinary problems that are attributed to BPH, you should request a PSA test. If detected and treated in its earliest stages (when cells are only in the prostate), your chances of survival are greatly increased.
Symptoms that need to be checked out include:
- Urgent need to urinate
- Frequent urination, especially at night
- Burning or pain when urinating
- Inability to urinate or diffi culty starting or stopping urine fl ow
- Painful ejaculation
- Blood in the urine or semen
i. Canadian Cancer Society http://www.cancer.ca/en/cancer-information/cancer-type/prostate/statistics/?region=sk [accessed September, 2015]