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Paying Attention To Prostate Cancer
It's very important to know how early detection and treatment for prostate cancer can be the difference between life and death among men diagnosed with that illness.
Prostate cancer is the second most common cancer among men after nonmelanoma skin cancer. This year, prostate cancer is expected to claim the lives of about 34,700 men in the United States, according to cancer.Net. In 2023, it's estimated that approximately 288,300 men will be diagnosed with prostate cancer.
One simple step men can take to detect prostate cancer in its early stages, when it's most treatable, is through an annual PSA (prostate-specific antigen) blood test, said Dr. Reza Goharderakhshan, chief of urologic surgery at Kaiser Permanente South Bay Medical Center.
While the general guidelines recommend PSA tests starting at age 55, men may need PSA screening between the ages of 40 and 54 if they have at least one first-degree relative (such as a father or brother) who has had prostate cancer. The same goes if they have at least two extended family members who have had prostate cancer.
"A PSA blood test is simple and noninvasive and can be the difference between life and death as far as prostate cancer is concerned," Dr. Goharderakhshan said. "This type of test is critically important, especially for men with a family history of prostate cancer, and for Black men, whose mortality rate from prostate cancer is twice that of men of other races."
Men with prostate cancer typically do not exhibit any symptoms until in its later, more advanced stages of the disease, Dr. Goharderakhshan said. Those symptoms include back pain, swelling of the legs, weight loss and difficulty urinating.
Get the latest news from San Fernando delivered directly to your inbox!"That's why early detection by having a PSA blood test is so critical," he explained.
According to the Centers for Disease Control and Prevention, out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer. The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer. However, if detected early — and with proper treatment — most men can survive prostate cancer.
Dr. Goharderakhshan noted the following factors can elevate the risk of prostate cancer among men:
1) Presence of close male members of the family who had prostate cancer.
2) Inherited genetic mutations, such as BRCA1/BRCA2 genes and Lynch syndrome.
3) A diet high in red meats, processed foods, high-fat dairy and low in fruits and vegetables.
4) Obesity in some studies has been linked to more aggressive forms of prostate cancer.
Dr. Goharderakhshan noted African American men and Caribbean men of African ancestry are also more likely to be diagnosed with prostate cancer. He added the risk of prostate cancer rises among men after age 50.
"As you get older, it becomes more critically important for men to get screened for prostate cancer, regardless of any symptoms," Dr. Goharderakhshan said. "The good news is that prostate cancer is highly treatable when detected early, with an excellent chance of cure. That's why I encourage men to not delay discussing with their doctor if a PSA blood test is needed to protect their health."
Prostate Cancer: Epidemiology, Diagnosis, And Treatment
Key Points
"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.
Prostate cancer is the second most common cancer in men worldwide. An estimated 288,300 new cases of prostate cancer will be diagnosed in the U.S. In 2023 and 34,700 men will die from the disease, according to the American Cancer Society (ACS). The incidence of prostate cancer is more than 70% higher in Black men than in white men, for as yet unknown reasons.
The annual incidence rate for prostate cancer in the U.S. Is 112.6 per 100,000 men, according to data from the NCI's Surveillance, Epidemiology, and End Results Program. In the U.S., a man's lifetime risk of the disease is estimated to be 11.2%, with a median age of diagnosis of 67. Prostate cancer is rarely diagnosed before age 45, although the incidence rises steadily from age 45 through 70, and then declines after 70.
Incidence rates of prostate cancer in the U.S. Almost doubled from the late 1980s into the early 1990s with the introduction of prostate-specific antigen (PSA) testing, which mostly detects early-stage disease. The overall incidence then declined sharply from 2007 to 2014, coinciding with reduced PSA testing due to a revision in the screening recommendations of the U.S. Preventive Services Task Force.
The 2023 ACS report on cancer statistics shows that after two decades of decline, cases of prostate cancer rose by 3% per year from 2014 to 2019 and by about 5% per year for advanced-stage diagnoses.
Prostate cancer mortality has been trending down. The death rate peaked in 1993 (39.3 per 100,000 men) and was cut in half by 2013 (19.3 per 100,000 men), largely due to earlier detection through PSA testing and advances in treatment. The pace of decline has since slowed -- most likely related to an increase in diagnosis of advanced-stage disease. From 2016 to 2020, the mortality rate decreased by 0.6% per year, from 19.4 to 18.5 per 100,000 men.
"Prostate cancer is a disease that is very survivable when diagnosed early. Screening is the best way to find cancer early, but for prostate cancer we need to focus on finding and managing potentially fatal disease," said Timothy R. Rebbeck, PhD, professor of Cancer Prevention at the Harvard T.H. Chan School of Public Health and professor of Medical Oncology at Dana-Farber Cancer Institute in Boston. "Because Black men suffer disproportionately from fatal prostate cancer, special attention needs to be paid to their screening and management."
Risk Factors
The risk factors for prostate cancer include older age, African American ancestry, family history of the disease, and certain inherited genetic conditions, such as Lynch syndrome and BRCA1 and BRCA2 mutations. Smoking and excess body weight may increase the risk of aggressive or deadly disease.
Genetics plays a central role in prostate cancer risk and outcomes, contributing to more than half of all prostate cancers. "Prostate cancer has very few non-genetic risk factors, and is probably the most genetically driven of all common cancers," said Rebbeck, who is also director of the Zhu Family Center for Global Cancer Prevention at the Chan School of Public Health. "There are now a number of 'high penetrance' prostate cancer genes -- for example, BRCA2 -- and over 450 'low penetrance' prostate cancer genes. And family history is one of the major prostate cancer risk factors."
Men with a close relative with prostate cancer may be twice as likely to develop the disease, and those with two or more relatives have nearly four times the incidence. The risk rises if family members were diagnosed before age 65.
Genetic variation also differs substantially by race/ethnicity. Black men in the U.S. And the Caribbean have one of the highest documented prostate cancer incidence rates in the world. "However, when we think about disparities, it is not yet clear how much genetics contributes. More likely, social determinants play a prominent role, but research is required to understand the relative contribution of genetics/biology compared with non-genetic causes," he said. Black men are vastly underrepresented in clinical trials for prostate cancer.
"Where someone lives is a factor: your neighborhood can impact stress and access to healthcare, and is a reflection of social position in our society," Rebbeck noted. He is co-leading a study to investigate what it is about neighborhoods that may increase a Black man's risk of dying from prostate cancer. Use of nationwide cancer registry and patient survey databases will allow researchers to identify generalizable predictors of screening use and survival, while also allowing them to dig deeper into the local neighborhood, behavioral, and sociodemographic characteristics that influence access and risk of prostate cancer in Black men.
"By understanding the influence of neighborhood factors on prostate cancer, we may be able to understand -- and then change -- the circumstances that affect prostate cancer risk differently across racial and ethnic groups," Rebbeck explained.
Early Detection
Currently no major medical organization endorses routine screening for men at average risk of prostate cancer in order to avoid the potential of overdiagnosis and the serious side effects associated with prostate cancer treatment. The ACS recommends that beginning at age 50, men who are at average risk of prostate cancer and have a life expectancy of at least 10 years discuss the benefits and limitations of PSA testing with a physician.
This informed decision-making should begin at age 45 for Black men and those with a close relative diagnosed with prostate cancer before age 65, and at age 40 for those at even higher risk, including men with a close relative who was diagnosed at an early age and men who are BRCA mutation carriers.
Signs and Symptoms
Early-stage prostate cancer usually causes no symptoms. The first sign of prostate problems is often found during a routine screening exam.
Prostate cancer screening tests include digital rectal examination and PSA testing. A high PSA score may increase the suspicion of prostate cancer; further testing usually includes imaging and a biopsy to determine the presence of cancer. Blood and urine tests are available that may provide additional information.
Uncommonly, prostate cancer may present with nonspecific lower urinary tract symptoms (LUTS), hematuria, or hematospermia. In particular, LUTS such as frequency, urgency, nocturia, and hesitancy are more often related to benign conditions such as benign prostatic hyperplasia rather than prostate cancer. These symptoms may also be due to bladder outlet obstruction, urinary tract infection, prostatitis, interstitial cystitis, or chronic pelvic pain syndrome.
Late-stage prostate cancer commonly spreads to the bones, which can cause pain in the hips, spine, ribs, or other areas.
Treatment Approaches
Many advances in prostate cancer treatment have been made over the past 20 years due to improved tumor characterization and disease management. The approach to treatment is influenced by age and coexisting medical conditions. Side effects, including urinary and erectile difficulties, of various forms of treatment should be considered in selecting appropriate management.
Many patients simply require careful monitoring of the disease (active surveillance) -- particularly patients with early-stage disease and less aggressive tumors, and those who are older. New biologic markers for prostate cancer can help identify which early-stage cancers are less likely to progress if left untreated.
The most common treatment options for early-stage disease include surgery, external-beam radiation, and brachytherapy (radioactive seed implants). Focal therapy ablates small tumors located in only one area of the prostate. In locally advanced disease, hormonal therapy may be appropriate, along with surgery or radiation.
Late-stage prostate cancer may require systemic therapies, including hormonal therapy, chemotherapy, and immunotherapy. Some men with advanced prostate cancer who no longer respond to hormonal therapy may be candidates for a cancer vaccine designed to stimulate the immune system to attack prostate cancer cells specifically.
Targeted drugs, such as PARP inhibitors, may be prescribed for men with BRCA mutations. Treatment with bisphosphonates or denosumab can help prevent complications related to bone metastases, such as fractures. Bone metastases occur in 85-90% of metastatic cases.
Long-term Survival
Prostate cancer tumors may grow very slowly or moderately rapidly, and some patients may have prolonged survival even after their cancer has metastasized to distant sites, such as the bone. Many men, particularly those with localized tumors, may eventually die of other illnesses.
The 5-year relative survival rate for men diagnosed in the U.S from 2012 to 2018 with local or regional disease was greater than 99%, and the rate for distant disease was 32%. For all stages combined, the 10-year survival rate is 98%.
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Understanding Prostate Cancer In Canada: Risk Factors, Screening And Treatment Options
Breadcrumb Trail LinksProstate cancer is the most commonly diagnosed cancer among men in Canada (excluding non-melanoma skin cancers) and the third leading cause of cancer deaths for this group.
Published Jul 05, 2023 • Last updated Jul 05, 2023 • 8 minute read
In 2022, it is estimated that around 24,600 Canadians received a prostate cancer diagnosis and 4,600 died from the disease. GETTY Article contentMany men in Canada are reluctant to get screened for prostate cancer — or even discuss the risk factors — despite the fact the disease claims the lives of nearly 5,000 Canadians every year, according to the Canadian Cancer Society. Around 67 Canadian men are diagnosed with prostate cancer every day and 13 die from it, making it the fourth most-common cancer in the country and the one most frequently found in men.
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While there are a number of reasons men find prostate cancer difficult to discuss, studies have shown the disease is prone to "significant stigmatization" because of the potential for embarrassing physical and sexual issues. The symptoms of the disease, when they appear, can be easy to conceal from others, a reality that can make discussion significantly less likely. But the inability to broach the subject does a disservice to men because the unique nature of this slow-moving disease makes it one of the most survivable cancers.
Article content Importance of early prostate cancer detection and screening in CanadaAccording to the Public Health Agency of Canada, if prostate cancer is detected early through appropriate screening the probability a patient will survive for more than five years from the day they are diagnosed is an impressive 91 per cent. Screening for prostate cancer is essential, however, as symptoms of the disease — which include difficulty urinating and blood or pain during urination — may only begin to appear once tumours have already formed. By this point, treatment can become more difficult and the disease may have been given an opportunity to spread to other areas of the body. If the disease is diagnosed late, just three in 10 patients are expected to live another five years.
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Article contentFortunately, prostate cancer can move so slowly that doctors often recommend "active surveillance" of a patient's condition instead of surgery or other forms of therapy. In either event, it's vital to be aware of the issues affecting your prostate and when you need to consider getting checked out.
What is the prostate?The prostate is a walnut-sized gland that is located below the bladder and in front of the rectum. It plays an integral part in the male reproductive system by producing some of the seminal fluid that helps sperm travel and survive. It also contains muscles that contract and push semen into and out of the urethra during ejaculation.
The prostate also has a role in the urinary system as the urethra (the tube that transports urine and semen out of the body) passes through it. If the prostate enlarges, as can happen with age, cancer or other conditions, it can begin to exert pressure on the urethra and decrease or prevent the flow of urine out of the bladder.
Understanding prostate cancer: What is it and how does it develop?Prostate cancer, the most common cancer among men in Canada, occurs when the cells in the prostate undergo a change that prevents them from dying and causes them to multiply faster than they should. As they increase in number, these cells combine to form tumours that can damage surrounding tissue or break off and spread (or metastasize) to other parts of the body. Prostate cancer moves more slowly than other cancers, however, and tumours are usually detected before the disease is able to invade other areas of the body.
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Article content Risk factors of prostate cancer: Who does it affect most in Canada?Prostate cancer is the most commonly diagnosed cancer among men in Canada (excluding non-melanoma skin cancers) and the third-leading cause of cancer deaths for this group. The risk of developing the disease increases with age and it is estimated that one in eight Canadian men will be diagnosed with prostate cancer at some point in their lives. Roughly one in 29 will die from it.
The disease is more prevalent in black men, with one study showing the incidence and lifetime risk of prostate cancer for this group to be double that of white men. The research points to a number of reasons for this discrepancy, including structural barriers (such as insufficient health education), reduced access to treatment and underrepresentation in clinical trials.
According to the study, implementing targeted screening may help correct some of this imbalance but true change will not be possible without accounting for systemic racism and the role it plays in patient outcomes.
Prostate cancer screening methods in Canada: DRE & PSA tests Advertisement 5This advertisement has not loaded yet, but your article continues below.
Article contentDoctors in Canada typically look for prostate cancer by performing a digital rectal exam (DRE) or a prostate-specific antigen (PSA) test, but recent research has revealed the former screening method may not be as effective as previously believed. According to the study, this is because a DRE "simply isn't effective enough to detect early stage cancers." Among the 46,495 45-year-old subjects included in the screening study, PSA tests detected four times more prostate cancers than DREs.
A PSA screening is a blood test that looks for a specific protein that is produced by prostate cells. A small amount of this protein in the blood is not unusual but if a test returns a large quantity, a patient may be referred for further testing. Eight provinces and three territories currently cover the cost of a PSA test without requiring the presence of symptoms. Only Ontario and B.C. Do not.
When and how often to get screened for prostate cancerA PSA test has its strengths and weaknesses. Although the test is good at detecting prostate cancer early in Canadian men — and before it has a chance to spread — it can also result in false-positives, false-negatives and overdiagnosis. A false-positive, which suggests you may have cancer when you do not, occurs frequently with PSA screening and can lead to other invasive (and unnecessary) tests. Only one in four abnormal PSA results are attributable to prostate cancer.
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Article contentA false-negative, on the other hand, happens when the test finds PSA levels to be normal when a patient actually has prostate cancer. This is usually because not all cases of prostate cancer result in high PSA levels. It is estimated that around 15 per cent of prostate cancers go undetected by a PSA test.
Overdiagnosis occurs when a PSA test leads to further testing or treatments when the cancer does not pose a serious risk to the patient. Studies have shown that 23 to 42 per cent of prostate cancers that are detected through a PSA test spread so slowly that treatment may never be required. However, when given the choice, most men will opt for treatment that can put them at unnecessary risk of a range of side effects, such as urinary incontinence and erectile dysfunction.
A recent study found that personalizing an individual's PSA test so that it accounts for any genetic factors that may affect their PSA levels might improve the accuracy of the screening process. By applying these adjustments, researchers demonstrated the potential to reduce the number of unnecessary biopsies performed while improving the detection of aggressive cancers.
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Article contentThe best way to decide if you need a PSA test is to discuss these issues with your doctor and consider the risks. If your doctor believes you are at average risk for prostate cancer, you may want to wait until age 50 to get a PSA test. If your risk is greater than average, due to family history or ancestry, you may want to start at age 45. The results of your test will help your doctor determine how often you need to repeat the procedure.
Prostate cancer prognosis: Canada vs. Global statisticsGlobally, prostate cancer is the second-most common cancer among men (after lung cancer), according to the World Cancer Research Fund International, with more than 1.4 million cases diagnosed in 2020. Guadeloupe (a French-administered territory) had the highest rate of prostate cancer that year, followed by Martinique (another overseas region of France), Ireland, Barbados and Saint Lucia.
In Canada, the number of men who lose their lives to the disease on an annual basis has been decreasing since 1994, a trend that is likely attributable to more efficient methods of treatment and screening.
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Article contentIn 2022, it is estimated that around 24,600 Canadians received a prostate cancer diagnosis and 4,600 died from the disease. One in five cancer diagnoses among men were for prostate cancer and one in 10 cancer deaths were attributable to the disease.
Ontario was estimated to have led the way in diagnoses and deaths in 2022 (10,200/ 1,750), followed by Quebec (4,700/1,050), B.C. (3,600/670), Alberta (2700/450), Nova Scotia (770/160), Manitoba (750/190), Saskatchewan (720/170), New Brunswick (620/110), Newfoundland/Labrador (400/85) and P.E.I. (130/120).
Treatment options for prostate cancer in CanadaIn Canada, options for men with localized, low-risk prostate cancer typically include active surveillance, radical prostatectomy (surgery to remove the gland), external beam radiation therapy and brachytherapy (a form of internal radiation therapy). These treatment options are diverse, each with their own set of pros and cons. One study with access to six provincial cancer registries found that, although treatment varied by province, surgery was the option most commonly employed. Use of this treatment option ranged from 10.9 per cent of cases in P.E.I. To 37 per cent in Nova Scotia. The second most common form of primary treatment was determined to be radiation therapy, which ranged in use from 12.7 per cent of cases in P.E.I. To 29.5 per cent in B.C.
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Article contentIn the U.S., a recent study found that the number of low-risk prostate cancer patients who opt for active surveillance over surgery has increased from 16 per cent to 60 per cent since 2010. For patients with favourable intermediate-risk cancers, the number rose from eight to 22 per cent over the same period of time.
Prostate cancer in Canada: Reducing risks and the importance of early screeningProstate cancer in Canada may currently be unavoidable but the best way to lower your risk of the disease is to talk to your doctor or health-care provider about your personal risk factors. According to Cancer Care Ontario, a man's chances of developing the disease increases after age 50 and peaks before the age of 75. Beyond age 75, risk decreases slightly but still remains significant. If you have a genetic link to prostate cancer or are from an ethnicity that is disproportionately affected by the disease, your risk of prostate cancer may be greater and it may be necessary to consider getting screened earlier.
Research has also shown that maintaining a healthy weight and lifestyle may improve the risk and prognosis of the disease.
To learn more about prostate cancer, including the latest news and research, visit the Canadian Cancer Society.
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