November 09, 2016

Prostate cancer screening: What you need to know

By Anna Sharratt

While there’s been some debate around screening for prostate cancer, it’s wise to talk to your doctor about whether testing is right for you.

For Jim Sullivan, a writer living in Caledon, Ont., a gut feeling that he was unwell saved his life. “It was a series of little things: No sleeping, loss of appetite, occasional issues with urination — things like that,” he says. “I just knew something was not right within me ... it was a voice that just kept at me.”

Sullivan, 45 at the time, went prepared to an appointment with his doctor. Having done some online research, he convinced his reluctant GP to do a prostate antigen (PSA) test. Despite his doctor’s initial unwillingness to order the test, which can help find cancer, because he was “too young,” the screening revealed that Sullivan had a high PSA score, so his doctor ordered a biopsy.

PSA is a protein made by the prostate that is measured by a blood test. When it is present in abnormal amounts, it may indicate the presence of prostate cancer. A PSA score of less than 10 is favourable, while a PSA greater than 20 is considered unfavourable. Factors such a recent digital rectal exam, benign prostate conditions such as prostatitis and a recent prostate procedure can alter PSA levels.

In Sullivan’s case, the biopsy following his high PSA score confirmed prostate cancer, a disease that 24 000 Canadian men were expected to be diagnosed with in 2021, according to figures from the Canadian Cancer Society. Its symptoms include:  

  • Changes in bladder habits
  • The need to urinate frequently, especially at night, or urgently
  • Trouble starting or stopping urine flow
  • An inability to urinate
  • Weak, decreased or interrupted urine stream
  • A sense of incompletely emptying the bladder
  • Burning or pain during urination
  • Painful ejaculation
  • Blood in the urine or semen

Testing has benefits — and risks

PSA tests are helpful in diagnosing the presence of cancers, but they can also lead to false positives — situations in which it may seem as though there is cancer when it isn’t. This in turn can lead to anxiety, additional tests and, in some cases, unnecessary treatment.

For that reason, men under 30 are only urged to consult a doctor about a PSA test if they are at high risk of the disease, while men in their 40s are encouraged to get a baseline PSA test to be able to track how their level changes thereafter, according to Prostate Cancer Canada. “With the results of a baseline PSA test, the physician can then discuss tailored clinical follow-up with the patient,” says Jillian Hermansen, manager, marketing and communications at Prostate Cancer Canada, who says her organization clarified its position recently as there was confusion over when to get tested. “Early detection is key — when caught early, the survival rate associated with prostate cancer can be over 90%,” she says.

The Canadian Cancer Society recommends men in their 40s and 50s talk to their doctors about the need for prostate cancer screening.

Risk factors include:

  • Being over 50
  • Eating a diet high in saturated fat and low in fibre
  • Leading an inactive lifestyle and having a high body mass index, meaning a high level of body fat in relation to your height
  • Having close family members, such as a father or brother, who have been diagnosed with the disease
  • Being of African or Caribbean descent

Like many men, however, Sullivan never saw prostate cancer coming. “I had no family history or other risk factors that would indicate I was a candidate for prostate cancer,” he says.

Treatment options are many

But as Sullivan found out, prostate cancer can strike at younger ages when no known risk factors are present. In his case, brachytherapy, in which radioactive seeds are implanted into the prostate to kill malignant cells, proved effective.

Other treatment options include:

  • Radical prostatectomy, which involves the complete removal of the prostate as well as the seminal vesicles and part of the urethra within the prostate. This procedure is aimed at removing all cancer cells. Its side effects can include temporary incontinence and erectile dysfunction.
  • High-intensity-focused ultrasound, a procedure in which ultrasound beams burn off cancerous tissue within the prostate.
  • External dose radiation, in which radiation is administered externally to the prostate.
  • Hormone therapy, which involves the use of drugs to reduce male hormones in the body.
  • Chemotherapy, which is the administration of potent anti-cancer drugs to slow the spread of cancer and manage pain.

Or, your doctor may opt for a watch-and-wait approach when your PSA score is elevated, waiting until you have symptoms before beginning treatment. Another option is active surveillance involving more frequent doctor visits, PSA tests, biopsies and bone scans. This can be effective in cases where the prostate cancer is small and slow-growing or your doctor decides aggressive treatment may be more harmful than the cancer itself.

“The death rate associated with prostate cancer has declined significantly by almost 4% per year between 2001 and 2009, likely due to detecting prostate cancer earlier and better treatment options,” says Hermansen. But Sullivan says more men have to get over the “tough guy” stance and get a PSA test done. “Men are fortunate that we have a simple blood test that can provide information to doctors that indicates if something more needs to be done.”

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