- Guidelines for treating this cancer have been developed by the Genitourinary Tumour Group.
- For health professional information on treating this cancer, please see our Cancer Management Guidelines.
- The prostate gland is found only in men. It produces a milky fluid that is a large portion of semen.
- The prostate is located under the bladder and it wraps around the urethra. The urethra is the tube that carries urine from the bladder through the penis.
- After age of 40, the prostate gland is at risk for a number of non-cancerous conditions including benign enlargement.
- Cancer of the prostate is rare in younger men.
- It is the most common form of cancer among Canadian and American men.
- Most prostate cancers are very slow growing, but some can grow and spread quickly. Research is being done to see how to detect the difference between slow and fast growing prostate cancers.
- If the cancer is discovered before it spreads beyond the prostate gland it is potentially curable.
What causes it and who gets it?
Some of the known risk factors for this cancer are listed below. Not all of the risk factors below may cause this cancer, but they may be contributing factors.
- The exact cause of prostate cancer is unknown.
- Prostate cancer is very unusual under the age of 50. As men age, their risk increases, and most prostate cancers are diagnosed after age 70. The risk of prostate cancer rises more rapidly with age than any other cancer.
- The risk of this cancer is twice as high in black men as in white men. North American Asian men have a lower risk than white men.
- Family history can play a role in prostate cancer. If a number of male relatives on one side of your family have prostate cancer, especially if they were younger when they got it, you may be at higher risk for prostate cancer. Testing for hereditary risk for prostate cancer is not yet available.
- High levels of testosterone may increase risk.
- In the past, questions have been asked about a possible relationship between vasectomy and prostate cancer. The evidence suggests this is coincidence and that vasectomy is not a risk factor for prostate cancer.
Can I help to prevent it?
- Researchers suspect that diet may be associated with the development of prostate cancer. The American Institute for Cancer Research has published information that pulls together the evidence.
- Eat a wide variety of fruits and vegetables each day.
- Be physically active.
- Maintain a healthy weight.
Screening for this cancer
- No effective screening program exists for this cancer yet.
- Digital rectal examination by a doctor during routine physical check-ups are a common way to check for these cancers.
- There has been interest in the PSA (prostate specific antigen) test as a screening tool. The BC Cancer Agency has produced a pamphlet which discusses the issues, called the Pros and Cons of PSA Screening for Prostate Cancer.
Information about the PSA Test and its use in Prostate Cancer from the BC Cancer Agency
By R. Gallagher, Genitourinary Tumour Group, BC Cancer Agency
The PSA test is a blood test that measures a substance produced by the prostate calledprostate specific antigen
(PSA). There are 3 potential uses for PSA:
- PSA may be used for monitoring of established prostate cancer and metastatic disease (spread of prostate cancer) or detection of early recurrence of prostate cancer, where prostate cancer is already known.
- PSA may be used as a diagnostic adjunct in combination with other tests for early detection of prostate cancer in symptomatic men.
- As a screening tool.
Two randomized clinical trials, the 'gold standard' for evaluating screening tests have recently been published. One, the American PLCO trial shows no reduction in mortality from prostate cancer with screening. However, there are a number of potential problems with this trial. The European trial (ERSPC) shows a 20% reduction in prostate cancer mortality with screening. However, the authors have noted that the use of PSA screening results in over-treatment of many cancers which might not have otherwise been problematic. Because of the potential for both over-treatment of otherwise clinically non-significant tumours, and quality of life issues associated with the test the authors recommend that these issues be resolved before organized screening programs are contemplated.
Fit men, age 50-70 (men with at least 10 years life expectancy) should be made aware of the potential benefits and risks of early detection so that they can make an informed decision as to whether to have the test performed.Additional Information about PSA
PSA levels of less than 4 are generally considered normal, however a prostate cancer may exist even though levels are normal. The upper limit of normal depends on age and race, so for example, the 'normal' for a 50 year old man is 2.5
PSA levels higher than normal may indicate benign disease or prostate cancer. The higher the level, the more likely the presence of cancer. Refinements of the PSA test such as the percent free ratio, or the PSA velocity may increase its sensitivity for prostate cancer detection.
If a PSA level is elevated, further investigation and referral to a urologist is indicated.
If healthy men with no symptoms want a PSA test, they should speak to their family physician about the possible advantages and disadvantages of being tested. The cost is approximately $35.00. The PSA test may be covered by the medical plan if a physician has reason to suspect the patient may have cancer and feels the test is necessary due to suspicious symptoms.
Many prostate tumours can be felt with a rectal exam. However, small localized tumours are more likely to be detected by a combination of PSA and DRE (digital rectal exam).
Signs and symptoms
- In the early stages, there may be no symptoms.
- Sometimes prostate cancer is found coincidentally after surgery for benign (non-cancerous) prostate enlargement.
- Prostate cancer is usually found during a routine physical examination.
- As men age, the prostate can become enlarged for a number of reasons. Enlargement of the prostate can lead to difficulties with urination (peeing). These symptoms don't mean that cancer is present, but they should be checked with a physician.
- starting or stopping urination is a problem
- slow stream
- painful urination or ejaculation
- frequent urination
- loss of urinary control
- blood in urine or ejaculate
- night-time voiding
- In advanced cases of prostate cancer, symptoms can include:
- Weight loss
- Backache or sciatica-like pain, or swelling of the legs that doesn't go away