Men’s Health A-Z

Prostate Cancer

Prostate Cancer

What is prostate cancer?

Prostate cancer is a malignant tumour that forms in the prostate gland. A man may not experience any symptoms, especially in the earlier stages of the disease. Prostate cancer may be found by a PSA test or digital rectal examination. A PSA test is a simple blood test that measures the amount of the protein prostate-specific antigen. During a digital rectal examination, the doctor feels the prostate gland with a gloved index finger for any irregularities.

“The prostate gland sits below the bladder. The urethra, which drains the bladder of urine, goes right through the middle of the prostate,” says Dr. Peter Black, a urologist active in the Men’s Health Initiative of BC. “The gland itself is important to making semen.”

The exact cause of prostate cancer is unknown, but some of the risk factors include age, genetics, hormonal reasons, and environmental toxins. “Prostate cancer is the most common cancer in men,” says Dr. Black. “Overall, a man’s lifetime risk in Canada of getting prostate cancer is one in six. And, of those men that get it, the chance of dying from prostate cancer is also one in six.”

What are common symptoms of prostate cancer?

The most common symptoms of prostate cancer involve urination. A man may experience:

  • a need to urinate often
  • an inability to urinate
  • an urgency to urinate
  • difficulty in starting or stopping the flow of urine

“Prostate cancer becomes more common the older a man becomes. If you really looked for it carefully and did biopsies in all men at the age of 80, you’d probably find about half of them have prostate cancer,” says Dr. Black. “Only a very small percentage of those men will actually die from prostate cancer, however, because it tends to be a fairly slow-growing disease.”

While it’s fortunate that prostate cancer is a slower-growing type of cancer, it can spread (metastasize) to other parts of the body such as the lungs, bones and liver. If you experience any symptoms of prostate cancer, or you’re due for prostate testing, discuss your options with a men’s health provider.

Stages of Prostate Cancer diagram
The Stages of Prostate Cancer
What causes prostate cancer?

We’re constantly hearing news about cancer-fighting foods and supplements that can reduce your risk of developing the disease. But, with so many different reports and recommendations, how do you know which preventative measures are safe and effective, and which ones aren’t? The answer: proven research.

“One of the most common questions asked in regards to prostate cancer is “what can I do to reduce my risk of getting the disease?” says Dr. Peter Black, a urologist active in the Men’s Health Initiative of BC. “And, there are a lot of things that are being explored. There’s good data that some things, for example, lycopene, which is in tomatoes, and may help reduce the risk of prostate cancer.”

A study of over 40,000 health professionals showed that men who ate more than 10 servings of tomato-based foods daily (like cooked tomatoes and tomato sauce) had a 35 percent lower risk of developing prostate cancer than men who ate fewer than 10.

“There’s a new idea that a group of medications may help, and they’re called 5-alpha-reductase,” says Dr. Black. “They affect how testosterone is metabolized in the prostate. A couple of very new studies indicate that taking this medication may reduce the risk of getting prostate cancer, and that’s something men have to talk to their general practitioner about and see if it’s the right thing for them.”

However, remember that you can’t believe everything you read! There was a large study published recently that looked at the effectiveness of vitamin E and selenium in preventing prostate cancer.

“The general thinking is that something like that can’t harm, but the study actually showed that maybe it does cause harm,” says Dr. Black. “There’s an increased risk of prostate cancer in men getting vitamin E, and an increased risk of men getting diabetes in men taking selenium. So you have to be careful, and it’s wise to take things only where there’s good evidence that it actually helps.”

Discuss safe and effective prostate cancer prevention with a men’s health provider.

How do you prevent prostate cancer?

One of the most common discussions people have with their health care provider is about lowering their risk of developing certain diseases. Your doctor might recommend making diet and lifestyle changes, or prescribe preventative medication. If you have a higher-than-normal risk of developing a disease, chemoprevention may be a viable option.

“Chemoprevention is the ability to use medication to either prevent a process from starting, or prevent a process from progressing,” says Dr. John Warner, a urologist active in the Men’s Health Initiative of BC. “It’s a term that’s been used for many years in different areas. Some of the areas we’ve seen it in, for example, are lipid metabolism and heart disease – the use of lipid drugs will prevent heart disease. Or, even something as simple as the use of fluoride for cavities.”

Chemoprevention in Urology

“Chemoprevention is a new term that’s used in urology, because of several different papers and several different publications, which have come out recently that show that the use of these medications will prevent prostate cancer,” says Dr. Warner. “The two papers that have come out are known as the PCPT study and the REDUCE study. Both of these show that there is a 25% reduction in prostate cancer patients that take either finasteride or dutasteride.”

The Prostate Cancer Prevention Trial (PCPT) was a study done in men 55 years and older, to determine whether or not the drug finasteride could prevent prostate cancer. The PCPT was funded by the National Cancer Institute (NCI), and looked at 18,882 men over a three-year-period.

The Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study was an international clinical trial that looked at 8,200 men ages 50 to 75, from 250 sites in 42 countries. Men younger than 60 needed baseline PSA values of 2.5 to 10 ng/mL, while men older than 60 needed values of 3.0 to 10 ng/mL to participate.

A great deal of research is needed to understand chemoprevention, which is why it is still in its early stages. Find out more about chemoprevention from health care providers near you.

How do you screen for prostate cancer?

Do the benefits of testing for prostate cancer outweigh the potential harm? Even experts can’t agree on the issue of medical testing for prostate cancer, so how do you make an informed decision when it comes to your health?

“There’s a lot of controversy about prostate cancer screening,” says Dr. Peter Black, a urologist active in the Men’s Health Initiative of BC. “We do have a couple of tests: one test is the PSA—the prostate-specific antigen, which is a protein made by the prostate that is in the blood. Then, we have a rectal exam where the physician feels the prostate. Now, these tests do pick up prostate cancer, but they’re not very exact, so there’s a lot of controversy whether prostate testing is actually helping men, or just leading to more tests that may actually harm men.

“In general, the urologic community supports it, because we’ve seen with more prostate cancer screening that the death from prostate cancer has decreased. And, we’re finding more patients with lower-risk prostate cancer, so we’re finding it sooner.”

Traditional guidelines have been that after age 50, men should have a PSA test and a rectal exam each year, until they’re at least in their early 70’s. “At that point it becomes debatable again what the value is as a man gets older,” says Dr. Black. “The newer ideas are that you actually test your prostate-specific antigens at age 40 to establish a baseline. We know that that baseline level predicts the risk of getting prostate cancer later in life. So if it’s high at age 40, then you have regular testing thereafter. If it’s normal at 40, then you check it again at 45 and 50, and then go into routine screening.”

Men who are considered at high risk of developing prostate cancer should also consider PSA testing. Men at high risk include those with brothers, uncles, a father or grandfather with prostate cancer, and African-Canadian men. Research suggests that eating a diet high in fat may also increase a man’s risk of developing prostate cancer.

Are you at risk? Discuss PSA testing with a men’s health provider near you.

How is prostate cancer treated?

If you’re diagnosed with prostate cancer, what’s your prognosis? The prognosis for prostate cancer depends on a number of factors, but in general it is quite good, as it doesn’t spread as quickly as other more aggressive forms of the disease. In some cases, prostate cancer may not even need treatment.

“Prostate cancer is a very curable cancer,” says Dr. Peter Black, an urologist active in the Men’s Health Initiative of BC. “Only one in six men who get it dies from it. That is, in part, a reflection of the long course that prostate cancer takes; it’s a slowly-developing disease.”

The prostate gland is a small organ found in males, and one of its main functions is to help produce semen. The prostate is located right under the bladder and in front of the bowel, and the urethra runs through it, which is why many men with prostate cancer experience urinary problems.

What are the treatment options for prostate cancer?

Active Surveillance

Active surveillance, also called “watchful waiting,” involves monitoring a patient closely, without starting any other type of prostate cancer treatment. However, this doesn’t mean just ignoring the disease; active surveillance will include regular PSA testing and digital rectal exams, and the patient may have to make dietary and lifestyle changes.

Surgical Removal of the Prostate

Also called a “radical prostatectomy,” surgical removal of the prostate gland may be done by open surgery or laparoscopic surgery through small incisions.

Radiation Therapy

Radiation therapy is the most common prostate cancer treatment option. “We use either external beam radiation, where the radiation waves are targeted at the prostate from the outside, or brachytherapy, where we put little radioactive seeds into the prostate,” says Dr. Black.

There are fewer side effects after external beam radiation, and you won’t need anesthesia, but seed therapy can be done in just one visit, and higher doses of radiation can be used.

Could you benefit from PSA testing?

Incontinence in Prostate Cancer Surgery

Prostate cancer is the most common male cancer, and one in six in men will develop the disease in his lifetime( Prostate cancer starts in the cells of the prostate gland, which is part of the male reproductive system. Read more about the prostate and prostate cancer here.

Urinary incontinence can be caused by many different things, and is a common problem, especially among older adults. Incontinence can also be caused by prostate cancer surgery, although this is not usually a symptom.

“Incontinence is actually quite uncommon after radical prostate surgery,” says Dr. John Warner, a urologist active in theMen’s Health Initiative of BC. “Seventy-five percent of patients have excellent urinary control and don’t require any pads, while 25% of patients have some degree of incontinence, but the vast majority it’s either one pad or less. A very small number, less than 5%, have total incontinence.”

If a man has a prostate surgery called a radical prostatectomy, there are two approaches: retropubic and perineal. During a retropubic prostatectomy, an incision is made above the pelvic bone, in the lower part of the stomach. If a man has a perineal prostatectomy, an incision is made through the perineum, which is located in front of the anus.

“The degree of incontinence is based on the patient but it’s also based on the physician,” says Dr. Warner. “The experience of the physician will impact a large amount on the incontinence of the person.

The greater the experience of the surgeon, the greater the chance that that patient is going to have excellent urinary control.”
In most cases, urinary incontinence after prostate cancer surgery resolves over time, with most men regaining urinary control within one to three months. Men can improve urinary control by practicing Kegels, which are pelvic muscle exercise that strengthen the pelvic floor. Kegel exercises are beneficial both before and after prostate cancer surgery.

“Discussing urinary incontinence is a very difficult thing for patients to do,” says Dr. Warner. “However, they shouldn’t be shy, and they need to make an appointment with their family physician or their urologist. There are many things that can be done both in the management of this problem and in the treatment of the problem, but until the physician knows and understands what the issue is, it’s difficult to proceed.”

Incontinence after Prostate Surgery

Urinary incontinence after prostate surgery is one of the potential side effects of prostate cancer surgery. The prostate gland affects urination because it sits right below the bladder, and surrounds the urethra. When urine is formed in the kidneys, it flows down the ureters, which are two thin tubes that empty into the bladder. The process of urination is controlled by the urinary sphincter, which tightens and closes around the neck of the urethra and the bladder. Urinary incontinence can occur when the urinary sphincter is damaged during prostate surgery.

“Statistics show that after radical prostate surgery most people have some degree of incontinence for the first few weeks after the catheter is removed,” says Dr. John Warner, a urologist active in the Men’s Health Initiative of BC. “Incontinence will continue to improve for up to a year to 18 months after the surgery.”

Urinary incontinence is usually a temporary condition that resolves itself within one to three months. The rate for complete continence 18 months after surgery is about 93%. (Walsh et al 2000). Only a very small percentage of men will have long-term or permanent incontinence.

Dr. Warner has the following tips for men following prostate cancer surgery:

  • Make sure you keep your bladder empty
  • Watch your fluid intake and monitor how much caffeine and alcohol you take in
  • Most importantly, do Kegel exercises before, during and after the operation to improve the control of urine.

Kegel exercises are done by tightening and clenching the pelvic muscles, and if performed regularly, they can strengthen the pelvic floor and the external sphincter, which is responsible for holding urine.

“If the incontinence is there, it’s best to discuss it with your urologist and understand what the mechanisms are that are causing it,” says Dr. Warner. They can give you some options to try.”

What’s my 10-year outlook for Prostate Cancer and other health concerns?

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