By Dr. Jiang
September is Prostate Cancer Awareness Month, which is a good opportunity to talk about the most common cancer found in men.
The prostate gland is a walnut-shaped organ that sits just below the bladder and surrounds the urethra. It produces nutrients and fluid to support sperm. One in seven Canadian men is diagnosed with prostate cancer in their lifetime.
The most important risk factors for developing prostate cancer is age, family history, smoking, obesity, and African ethnicity. Age is the strongest risk factor, with the majority of cases diagnosed in men over 65. Signs and symptoms of prostate cancer can include urinary symptoms, like increased frequency of urinating, difficulty starting or stopping urine flow, pain with urinating, and blood in urine or semen. Sometimes when the cancer is caught early, there may not be any symptoms.
The two most common tests for prostate cancer is a blood test for the prostate-specific antigen (PSA), and the digital rectal exam (DRE). The PSA is a marker for the size and activity of the prostate gland. The DRE is done in the office where a physician feels for the size and shape of the prostate gland by inserting a finger into the rectum. If the results of these tests are concerning for cancer, further tests can be done, like scans such as ultrasound, CT, and MRI, and prostate biopsy.
Once prostate cancer is diagnosed, it is graded and staged to help determine the best treatment options. Treatment can include a combination of surgery, radiation, chemotherapy, and hormone-blocking therapies. The treatment for prostate cancer has come a long way, so much so that the success rate has been increasing steadily year by year.
I regularly talk about prostate cancer screening with male patients in my family practice. It’s an area of medicine that is not so clear cut in Canada. The current guidelines do not recommend screening for prostate cancer in men with low to average risk and who are symptom-free. The reasoning behind this recommendation is that the harms of screening can outweigh the benefits. Screening can lead to false positives and over-diagnosis, where patients undergo further testing and treatment that they don’t need, which also carries its own set of risks and side effects.
The decision to be screened for prostate cancer is ultimately up to you and your family physician to decide together, after considering the potential benefits and risks. If you have urinary symptoms, have risk factors for prostate cancer, or have questions about being screened for prostate cancer, you should make an appointment with your family physician and have a discussion with them about which tests are right for you.