About the disease
Prostate cancer is the most common type of cancer among men, but the survival rate has been steadily increasing since the 1990s. It is a slow-growing disease that primarily affects the elderly.
The prostate is part of the male reproductive system and is located under the pubic bones in the male pelvis. A normal-sized prostate is about the size of a walnut and is covered by a thin capsule. The urethra runs through the middle of the prostate and drains urine from the bladder and out the penis. Prostate cells produce seminal fluid which mixes with fluid from the testicles to form semen and secrete proteins into the bloodstream.
More than 2,100 Alberta men are diagnosed with prostate cancer every year, with a survival rate of over 90%.
Risk Factors
Risk factors are determined by analyzing the numbers of patients with cancer in a larger population and trying to find differences in the characteristics or behaviors between those individuals who develop cancer and those who do not.
Age is the greatest single risk factor for prostate cancer. The average age of diagnosis is 70 and the disease is rare in those under 40. For that reason patients living with prostate cancer will frequently die of other age-related disease.
Other factors that may increase the risk of developing prostate cancer include:
- Race – the disease is more common in black men and less common among Asian and aboriginal men
- Diet – high in animal fat
Factors that may decrease the risk of developing prostate cancer include:
- Diet – high in fruit and vegetables
Genetic Link
There is an increased risk of prostate cancer if a man’s father and/or brother has been diagnosed with the disease. A recent study of African-American men identified several parts of the humane genome that may indicate an increased risk of prostate cancer. Black Americans are at greater risk of developing the disease and are almost twice as likely to die of it. More information at: http://www.genome.gov/10002040.
Detection and Diagnosis
There are usually few if any symptoms of prostate cancer when it is in its early stage and 40 per cent of prostate cancers are not discovered until the disease has spread beyond the prostate. As the disease progresses, it can cause difficulties with urination, including trouble starting or holding back urination and the need to urinate frequently, especially at night. Some men experience pain or a burning sensation during urination, difficulty in having an erection, painful ejaculation, blood in the urine or semen and pain in the lower back.
If these symptoms are present, a doctor will typically begin with a digital examination of the prostate to check for hard or lump areas.
The next step may be a test to check the PSA levels in the blood. The prostate produces an enzyme called PSA or prostate specific antigen. The levels of PSA change naturally with age but in men with prostate cancer the amount of PSA increases noticeably. Generally speaking, the higher the level of PSA the more severe the cancer, although in rare cases the PSA level has been extremely low even in the presence of malignant cells. These tests are useful but not completely dependable in the diagnosis of cancer.
The only way to confirm the presence of cancer is with a biopsy to examine tissue under a microscope, which involves taking a cell sample by inserting a needle through the rectum to the prostate.
Treatment
Treatment options for prostate cancer include surgery, radiation and hormonal therapy, sometimes in combination depending on the stage of the disease. Doctors will sometimes suggest “watchful waiting” for early stage cancer that is progressing slowly or for elderly patients with other medical problems. In these patients, the risks of other treatments may outweigh the benefits so the patients are monitored with regular check-ups and proceed to active treatment if the symptoms get worse.
Surgery may include a radical prostatectomy or the removal of the prostate gland. This procedure is generally not performed in men that may have a shorter life expectancy because of other illnesses. Sometimes the surgeon will have to remove nearby lymph nodes.
Radiation therapy, concentrated beams of high-energy X-rays, are sometimes used in addition to surgery or hormonal therapy and as an alternative treatment when surgery is not an option. Radiation can also be used implanted into the prostate in selected cases, as an alternative to surgery. In the advanced stages of prostate cancer radiation may be used to relieve pain and other symptoms.
Hormonal therapy cuts off the supply of male hormones, or androgens, to cancer cells – hormones the cells need to survive. This therapy is often used when the cancer has spread to other parts of the body, or to decrease the risk of cancer reoccurring after surgery or radiation.
Links:
National Comprehensive Cancer Network (U.S.) guide to treatment decisions with links to other sites
Prostate Cancer Foundation (U.S.)
Mayo Clinic
The Prostate Cancer Charity
Factors Affecting Prognosis
Prostate cancer is a difficult disease emotionally as well as physically for men since side-effects of the cancer and treatment can include impotence and incontinence.
Although research has looked at vasectomies, exercise, smoking, dietary supplements, sexually transmitted diseases and enlarged prostates as risk factors for prostate cancer, so far there has been little evidence of a link. Similarly, studies have found little evidence that screening programs increase the chance of surviving prostate cancer. There is some evidence that a diet high in tomato-based foods may protect men against the disease, but it needs further study. The uncontrollable factors of age, family history and race make it difficult to influence developing or treating prostate cancer.
Learn more
Support for prostate cancer patients
- Psychosocial and spiritual support, Edmonton,
Cross Cancer Institute
- Phone: (780) 432-8703 or 8704
- Psychosocial and spiritual support, Calgary,
Holy Cross site of the Tom Baker Cancer Centre
- Compassion House
How you can help
Other Resources
Canadian Cancer Society
American Society of Clinical Oncology