Medicine: The Prostate Project

WHEN DR. TOM SHORT FIRST BEGAN TREATING prostate cancer patients 20 years ago, his patients knew little about the condition and were reluctant to discuss it.

“Often they’d come to see me when the prostate cancer had already spread to the lymph nodes or bones,” he says. “Unfortunately, by that time, the cancer was not curable.”

Since then, much has changed. As more public figures come forward and openly discuss their experience with prostate cancer, the disease has slowly emerged from the shadows.

Dr. Short, now Chief of Surgery (Urological Oncology) at the Credit Valley Hospital in Mississauga, Ont, embraces this change — today, his pa-tients are better educated and more open to discussing their condition.

And that’s good news because the more men learn about the disease, the more they seek early detection — and the better their chances of survival.

Prostate cancer is the most common form of non-skin malignancy affecting men and is the second leading cause of cancer-related death for men in North America. One in seven men will develop prostate cancer over their lifetime. In this year alone in Canada, there will be 25,000 new cases and 4,400 men will die of prostate cancer.

The disease starts when malignant (cancer) cells form in the tissues of the prostate, a small gland that sits under the bladder. Left untreated, the cancer may spread to the bones and lymph nodes, with deadly complications.

Because it generally begins de-
veloping in men around the age of 50, with the risk increasing as they get older, doctors recommend that men initiate their screening for prostate cancer at this age.

In most cases, the tumours grow slowly. “Prostate cancer is highly treatable as long as it’s detected at an early stage,” says Dr. Short, noting that up to 80 per cent of cases that are detected at an early stage and treated appropriately, can be cured.

However, early diagnosis can be an elusive goal. In its formative stages, the disease may have no signs or symptoms. That’s why earlier detection is so imperative.

There are two tests your family doctor can do: a Prostate Specific Antigen (PSA) test helps detect prostate cancer by measuring a substance called prostate specific antigen made by the prostate; and a Digital Rectal Exam (DRE) allows the doctor to find lumps, irreg-
ularities or changes in size or con-sistency in the prostate.

Once a positive diagnosis has been made, treatment depends on several factors, including your stage, tumour grade, age, general health and your quality of life versus possible side effects of the treatment. There are different stages of prostate cancer progression:

1. Localized prostate cancer: In its early stage, the cancer is confined to the prostate and hasn’t spread to the bones or lymph nodes. Treatment options, which aim to completely eradicate the cancer, include various forms of surgery, radiation and, in some cases, active surveillance. Rad-ical prostatectomy (surgery) is the most common strategy with a high chance of a cure if detected early.

2. Recurrent Prostate Cancer: PSA levels rise, the cancer returns but there is no evidence it has spread to other parts of the body. Doctors monitor PSA levels and consider further treatment options including adjuvant radiation or hormonal therapy.

3.
Metastatic Prostate Cancer: The
cancer has spread into other org-
ans. Patients may be treated with hor-
monal therapy.

4.
Hormone Refractory Prostate Cancer (HRPC): After several years of treatment, some men become resistant to hormonal therapy. The
PSA levels rise and cancer progresses despite treatment. At this stage, chemotherapy is an option; however,
it is not a cure.
Right now, there are few proven therapies for men with HRPC and, even when all available tools are used, their prognosis is not always good. However, medical researchers are hopeful that they’ll soon be able to overcome this “treatment gap.”
“There’s a huge amount of research being done,” says Dr. Short. “There are drugs coming down the pipeline that are actively being worked on
that will modify or increase the quality and lifespan of those suffering from HRPC.”
Prostate cancer has a significant impact on men, not only due to the pain associated with the spread of the disease but also because of the side effects related to treatment, which may include urinary and bowel dysfunction, erectile dysfunction as well as the psychological impact.

While early detection is the main goal, there are steps you can take to reduce the chances you’ll develop the disease. New studies show that you can reduce your risk by modifying
your diet, including reducing the amount of fat and increasing the
amount of fruit and vegetables.

For more information, visit Prostate
Cancer Canada at www.prostatecancer.ca