In their lifetime, one in seven Canadian men will be diagnosed with cancer of the prostate – the walnut-sized part of the male reproductive organ in a man’s abdomen. If diagnosed early, there is an excellent chance the disease will be successfully treated: the five-year survival rate is 100 per cent. In fact, over the last 25 years – thanks to early detection and improved treatments – the mortality rate from prostate cancer has decreased by 50 per cent.
Still, each year, approximately 4,000 men in Canada die from the disease. The challenge with prostate cancer, as with most cancers, is that it may metastasize, or spread, to other parts of the body. Once that happens, the five-year survival rate drops to 28 per cent. “If you looked beyond five years, the survival rate would go down considerably more,” says Dr. Stuart Edmonds, Vice-President of Research, Health Promotion and Survivorship at Prostate Cancer Canada, a national health charity dedicated to eliminating the disease through research, advocacy, education and support. “While we’ve done a really good job over the past 25 years, we’re still losing an awful lot of men and it’s unnecessary.”
“Unnecessary” because one of the main ways of diagnosing prostate cancer is a simple blood test. The test measures Prostate Specific Antigen, or PSA, a protein naturally produced in the prostate. Higher levels of PSA may indicate the presence of cancer and/or other prostate conditions. “We still have the situation in many parts of the country where one in nine men are getting diagnosed with a late-stage disease,” Edmonds adds. “And we know how dangerous that can be.”
Thanks to innovations in therapies over the past 10 years, there are treatment options through every stage of the disease – even for non-metastatic castration-resistant prostate cancer. Until recently, this was an anxiety-producing and difficult stage – a virtual no-man’s land for the patient because the cancer is still confined to the prostate but with a high likelihood that it will spread.
“Hormonal therapy which reduces testosterone levels, was the only option for men with incurable prostate cancer,” explains Dr. Geoffrey Gotto, Urologic Oncologist at the Southern Alberta Institute of Urology. “For men who failed hormonal therapy but did not yet have metastatic disease, there really was no option available. As a physician, it was frustrating to look at these patients progressing and tell them their cancer needed to spread before we could offer them other types of therapy.”
However, Gotto adds, advancements in research and treatment have delayed the spread of the cancer for as much as two years. “While it’s too early to tell whether that will have an impact on overall survival,” Edmonds says, “actually delaying it from spreading elsewhere in the body is a good indicator of helping in the long term.”
The prudent thing is for men to discuss the PSA test with their family doctors. “The last thing you want to do is to have that conversation too late and then be diagnosed with a metastatic disease,” says Edmonds. And if there is a diagnosis of prostate cancer, doctors should closely monitor PSA levels as frequently as every three months for signs of progression. PSA doubling time is used to predict how aggressive the cancer is and how likely it is to spread. A faster doubling time indicates a shorter time to spreading – making regular PSA tests essential in order to initiate or alter treatment strategies.
While the steps forward in the treatment of prostate cancer have been rapid and impressive, there is still no cure. Now, at least, there are many more effective options. “We’re still looking for that magic bullet,” says Edmonds. “But the incremental breakthroughs we’re making are significant enough that we’re extending men’s lives by years and years.”
For the best possible outcome, early detection is key. Talk to your doctor about the PSA test and come to a shared decision about the right approach for you. For a full selection of health education resources about prostate cancer for men and their families, visit Prostate Cancer Canada at prostatecancer.ca or on social at Facebook or Twitter.