PROSTATE CANCER

THE PROSTATE

The prostate is a walnut-sized gland that is part of a male’s reproductive and urinary system. It is located just below the bladder.

The prostate gland has two main functions:

  1. The prostate produces seminal fluid (semen, ejaculate)
  2. The prostate gland controls the flow of urine as it surrounds the urethra

RISK FACTORS

Though there is no clear, known cause of prostate cancer, the following are risk factors that may increase your chances of developing prostate cancer. The more risk factors you have, the greater the likelihood that you will develop prostate cancer.

Age - The odds of developing prostate cancer increase with age. For example, the lifetime odds of a man developing prostate cancer in his 50’s is 1 in 111. The odds rise to 1 in 30 for men in their 60’s.

Race - It is not clear why, but African-Canadian and Caribbean-Canadian men are at the highest risk of developing prostate cancer.

Genetics - Having a family history of prostate cancer increases a man’s predisposition to developing prostate cancer. If a man has the BRCA2, or ‘breast cancer’, gene in his family, there is evidence that this also increases prostate cancer risk.

Diet and Obesity - High calorie and high fat diets, as well as obesity, may play a role in increasing prostate cancer risk.

SIGNS & SYMPTOMS

Prostate cancer is the most diagnosed and most prevalent cancer in Canadian men, accounting for 1 in 5, or 20%, of new cancer cases in men.

1 in 9 Canadian men are expected to be diagnosed with prostate cancer in their lifetime. Just under 23,000 men were expected to have been diagnosed in 2019.

Nearly all prostate cancer cases are in men over age 50 with incidence increasing with age.

Prostate cancer is the third leading cause of cancer death in males, following only lung and colorectal cancer. 1 in 29, or 4%, of males are expected to die from prostate cancer.

The five year survival rate of prostate cancer is 93%. For men diagnosed before age 75, survival is greater than 95%.

Statistics courtesy of:
Canadian Cancer Statistics Advisory Committee. Canadian Cancer Statistics 2019. Toronto, ON: Canadian Cancer Society; 2019. Available at: cancer.ca/Canadian-Cancer-Statistics-2019-EN (accessed [February 21 2020]).

DIAGNOSIS

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THE PSA TEST AND THE DRE

The DRE (Digital Rectal Exam) is a quick and easy diagnostic tool that can detect very enlarged prostates and more advanced cancers. Though it does not detect all cases, it can confirm suspicions of prostate cancer and can lead to further testing.

The PSA test is a simple blood test that measures the amount of a protein called PSA (Prostate Specific Antigen) in a man’s blood. Though all men have PSA in their blood, higher levels may be an indicator of prostate cancer or that something else is happening in the prostate gland. What is considered a ‘normal’ level, or number, depends on a man’s age and race. Though the PSA is the best blood test to test for prostate cancer, a high number alone does not indicate the presence of prostate cancer; rather, it indicates the possibility for the need for further investigation.

The use of the PSA test as a screening tool is contentious. The advantages and disadvantages should be discussed with a healthcare professional and researched before you have one done.

Prostate Cancer Foundation BC recommends that every man over the age of 50 start a discussion with their health care provider about having a DRE and a PSA test. Prostate Cancer Foundation BC believes PSA testing should be used as part of "smart screening" - a personalized approach in which men are tested to establish a baseline number. Subsequent tests can then be performed to monitor any changes to the baseline. If a change is detected, the patient and his health care provider should discuss a course of action based on his personal risk factors.

BIOPSY AND IMAGING

To confirm the presence of prostate cancer, if a DRE or PSA test indicates the possibility of prostate cancer, a biopsy and/or ultrasound will have to be completed.

At the time of biopsy, an ultrasound probe is usually inserted into the rectum to visualize the prostate (though some physicians may complete a finger-guided biopsy). A biopsy needle is then inserted next to the probe to remove a small piece of tissue for testing. The procedure is done under local anesthetic and is generally relatively pain-free for patients. In some situations, more extensive biopsies are needed.

GRADING AND STAGING

The following is a chart for your reference, adapted from the national bestselling book, The Intelligent Patient Guide to Prostate Cancer, a fabulous resource for understanding and navigating your diagnosis. This book is included in our REEF KNOT KITS, which you can order for FREE. Much more information on grading and staging may be found in the book.

RISK CATEGORIES

LOW
INTERMEDIATE
HIGH

T-SCORE

PSA

CANCER GROWTH

DIFFERENTIATION

GLEASON SCORE

GRADE

T1 to T2

Less than 10

Least Aggressive

Well Differentiated

6

Low Grade

T1 to T2

10 to 20

Average

Moderately Well Differentiated

7

Medium Grade

T3

20.1 or Higher

Most Aggressive

Poorly Differentiated

8 or Higher

High Grade

RISK CATEGORIES

LOW

T-SCORET1 to T2

PSALess than 10

CANCER GROWTHLeast Aggressive

DIFFERENTIATIONWell Differentiated

GLEASON SCORE6

GRADELow Grade

INTERMEDIATE

T-SCORET1 to T2

PSA10 to 20

CANCER GROWTHAverage

DIFFERENTIATIONModerately Well Differentiated

GLEASON SCORE7

GRADEMedium Grade

HIGH

T-SCORET3

PSA20.1 or Higher

CANCER GROWTHMost Aggressive

DIFFERENTIATIONPoorly Differentiated

GLEASON SCORE8 or Higher

GRADEHigh Grade

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TREATMENT OPTIONS AND SIDE EFFECTS

Information and videos on treatment and side effects can be found on www.ifiweretom.ca

Click HERE to go directly to the website to learn more about:

  • Active surveillance
  • Radical prostatectomy
  • Radiation therapy
  • Androgen deprivation therapy
  • Systemic therapy
  • Side effects