Prostate cancer: What you should know

In recent years, many high profile men like Jack Layton and Colin Powell have gone public with their prostate cancer diagnoses, but for many of us the battle hits closer to home. Prostate cancer is the most common type of cancer among men, and chances are it will touch someone in our lives. Luckily, most men can beat the disease if it’s found early and treated effectively.

If you’re not sure where the prostate is or what it does, this walnut-sized gland is located near the rectum just below the bladder and it surrounds the urethra. A part of the male reproductive system, its role is to produce the fluid that gets mixed with sperm to create semen. Prostate cancer starts in the cells of this gland.

Just how common is it? According to the Canadian Cancer Society, prostate cancer accounts for more than one quarter of new cancer cases among men. In 2011, an estimated 25,500 new cases will be diagnosed — that’s an average of 70 Canadian men every day. One in seven men will develop prostate cancer some time during his lifetime. Despite a five year survival rate of 96 per cent, over 4,100 men will die from prostate cancer this year.

Warning signs

Like many other types of cancer, prostate cancer can sneaks up on men as there are no warning signs in the early stages. Doctors often first detect trouble with a prostate specific antigen (PSA) test or digital rectal examination. However, these tests aren’t specifically for cancer — rather, they detect problems with the prostate. Further testing is needed to pinpoint the problem.

It isn’t until a tumour is big enough to cause the prostate gland to swell — or the cancer spreads — that symptoms appear. These signs can include:

– A need to urinate often, especially at night.

– An intense or urgent need to urinate.

– Difficulty in starting or stopping the urine flow.

– Inability to urinate, or inability to urinate standing up.

– Weak, decreased or interrupted urine stream.

– A feeling of incompletely emptying the bladder.

– Burning or pain during urination or ejaculation.

– Blood in the urine or semen.

Sounds familiar? Don’t panic — these symptoms don’t necessarily point to cancer. It’s the swelling of the gland that causes symptoms, not the tumour itself. Common prostate conditions could also be the culprit, like an enlarged prostate (a condition known as benign prostatic hyperplasia) or an infection (prostatitis). Experts warn these symptoms should be checked out by a doctor.

When the cancer spreads, more serious signs appear such as:

– Pain or stiffness in the pelvis, lower back, ribs, or upper thighs.

– Weight loss, loss of appetite, nausea, or vomiting.

– Swelling of the lower extremities.

– Weakness or paralysis in the lower limbs.

If you have symptoms or a high PSA result, doctors will likely order other diagnostics like blood tests, imaging (such as x-rays or a CT scan) and a biopsy to determine the cause.


Risk factors — and prevention?

Like many other cancers, it’s important to understand the risks to help make decisions about how soon to start screening. Experts know these factors can increase risk:

Age. The chances of developing prostate cancer increase with age, and a man’s risk is highest after age 65. Prostate cancer is rare among men under the age of 40.

Family history. Men who have a father or brother who has had prostate cancer are at a higher than average risk of developing the disease. About 5-10 per cent of cases are thought to have a genetic link.

African ancestry. Experts aren’t sure why, but men of African descent are at the highest risk — and the disease tends to develop earlier and grow faster than in men of other races.

You may also have heard in the news that cadmium, diets high in fat and diets high in calcium could also be risk factors — but right now there isn’t enough evidence to prove either way. Exposure to pesticides could be another factor, but more research is needed.

Remember, risk factors aren’t guarantees. In fact, experts say that most men who have risk factors don’t develop the disease. However, men who don’t have any risk factors can still develop the prostate cancer.

What about prevention? You may have heard that certain foods like garlic, green tea extract and soy are associated with a lower risk of prostate cancer. Certain nutrients may also help the fight, including vitamin C, vitamin D, lycopene (an antioxidant found in tomatoes and watermelon) and selenium (a mineral found in fish, nuts and seeds). There is still more research needed, and experts still recommend eating a balanced diet is the best strategy to get the good stuff — not loading up on one or two foods or taking supplements.

What about other lifestyle habits? According to the National Cancer Institute, studies haven’t found an increased risk due to alcohol consumption, obesity, smoking, sexually transmitted diseases, lack of exercise or a diet high in animal fasts. (However, these are known risk factors for a number of other conditions.)

When to talk to a doctor

There is some controversy about diagnosing and treating prostate cancer, but that shouldn’t stop men from talking to their doctors about this top health concern. If you’re a man, it’s time to talk to your doctor when:

You’re approaching age 50. Now’s the time to have a conversation with your doctor about the risks. (If you’re already over 50 and haven’t done so, you should have a chat too.)

You have some risk factors. For instance, if you have a family history of prostate cancer, you doctor may want to start screening sooner.

You’re experiencing symptoms. It may not be easy to discuss such personal matters, but symptoms shouldn’t be ignored. Early detection greatly improves treatment success.

While PSA tests aren’t perfect, experts still advocate the benefits out weight the potential harms. Today, there are more treatment options available than ever before, and sometimes surgery isn’t required. Certain drugs and treatments (like hormone therapy) can slow tumour growth, but radiation therapy and chemotherapy are other options used to beat tumours.

Sometimes a diagnosis isn’t a crisis: doctors may employ “active surveillance” — that is, watch how the cancer develops and monitor it regularly using tools like PSA tests or a biopsy. Some prostate cancers grow so slowly that they don’t impact men’s daily lives, and may not require immediate treatment.

A diagnosis of cancer is never easy to cope with, but the message of experts continues to be to stay informed and talk to your doctor. Prostate cancer may be common, but also has one of the highest five year survival rates when treated early.

For more information about prostate cancer, see:
The Canadian Cancer Society
National Cancer Institute (U.S.)
Prostate Cancer Canada
PubMed Health (Part of the U.S. National Center for Biotechnology Information)
Prostate Cancer Foundation

Additional sources:, MedlinePlus (U.S. National Library of Medicine), WebMD.

Photo © Mark Bowden

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