About Prostate Cancer
Prostate cancer is the most commonly diagnosed cancer among Canadian men. In 2017, it was estimated that over 800 men were diagnosed with prostate cancer on Vancouver Island, 3,800 men were diagnosed in total in British Columbia. If caught early, these numbers could be significantly lower.
- For men in British Columbia, prostate cancer is the most frequently diagnosed type of cancer.
- On average, 475 Canadian men will be diagnosed every week
- On average, 83 Canadian men will die of the disease every week
- 1 in 7 Canadian men will develop prostate cancer in their lifetime
- When caught and treated early, prostate cancer has a 90-95% survival rate
If you have been diagnosed with prostate cancer and/or have questions about the disease, we can help. We are an information and support centre that provides free programs and services for men and their families, made possible by generous contributions of time and money from individuals, businesses and foundations.
What is the prostate?
The prostate is a gland that is part of the male reproductive system. It contributes to the production of seminal fluid, which mixes with sperm from the testicles to make semen. The prostate is roughly the size of a walnut and is situated around the neck of the bladder, close to the rectum. The prostate surrounds the urethra – the tube that carries urine and semen through the penis.
Many men experience natural prostate enlargement as they age. If the prostate expands too much, however, the urethra narrows and urination problems can occur. The prostate is also at the center of a bundle of sexual nerves, which is why prostate problems can lead to temporary impotence.
Male reproductive system
What is prostate cancer?
In the body, cells are continually dying off and being replaced by new cells. This is a naturally occurring process. The genes inside each new cell tell it how to grow and what function it will perform in the body. Some cells grow into lung tissue and others grow into muscle or gall bladder tissue.
Sometimes, however, cells begin to grow in an uncontrolled, undifferentiated way. These cells are no longer able to perform their original functions, and they replicate too quickly. This produces a tumour. There are two kinds of tumors, benign (non-cancerous) and malignant (cancerous). Benign tumours are static and are usually not life-threatening. Malignant tumors, on the other hand, can grow into large masses and invade other parts of the body. It is important to identify and treat malignant tumours as soon as possible.
Prostate cancer is the name for cancer that begins in the prostate gland.
What are prostate cancer symptoms?
Common symptoms of prostate cancer are:
- Need to urinate often, especially at night (frequency)
- Intense need to urinate (urgency)
- Difficulty in starting or stopping the urine flow
- Inability to urinate
- Weak, decreased or interrupted urine stream
- A sense of incompletely emptying the bladder
- Burning sensation or pain during urination
- Blood in the urine or semen
- Painful ejaculation
If you have any of the above symptoms, you should visit your family physician for further examination; however, prostate cancer can often be present in the body without these symptoms. That is why the Island Prostate Centre recommends that men over the age of 40 familiarize themselves with the Prostate Specific Antigen (PSA) blood test and talk to their doctor about prostate cancer screening.
Early detection and screening
The combination of the PSA (Prostate Specific Antigen) blood test and the DRE (Digital Rectal Exam) is the most effective means we have of detecting prostate cancer. A biopsy procedure is required to confirm the presence of prostate cancer.
Digital Rectal Exam
The prostate is situated in front of the rectum and can easily be examined by a physician who inserts a gloved and lubricated finger into the rectum to feel its size and shape. He feels for lumps, irregularities or hardnesses. Not all irregularities of the prostate are cancer, and cancer can be present in a prostate that feels normal.
Prostate Specific Antigen Test
PSA is a protein produced by the prostate gland, and a PSA blood test is a simple test used to determine a man’s PSA levels. Most men with prostate cancer have an increased level of PSA in the blood. While it is sometimes the case that PSA levels are high when there is no cancer present, or that men with prostate cancer have low PSA levels, rising PSA levels have been clearly shown to indicate cancer growth. For this reason, we recommend that all men over the age of 40 create a baseline PSA and be tested annually for prostate cancer.
Knowing and tracking their PSA level helps men take a proactive step in fighting this disease. Every man’s PSA level is unique, and increases gradually as he ages. Establishing a PSA baseline makes it easier to track this gradual increase and to identify abnormal spikes in PSA levels. It is important to note that the PSA test is not a diagnostic tool, but rather an indicator that follow-up should be pursued with a specialist.
A prostate biopsy is a procedure that tests the prostate for the presence of cancerous cells. It is required to confirm the presence of prostate cancer.
If it isn't prostate cancer, what else could it be?
BPH (Benign Prostatic Hyperplasia):
Benign Prostatic Hyperplasia (BPH) is a relatively common non-cancerous enlargement of the prostate gland that typically effects men over the age of 65. BPH is characterized by reduced urinary flow and a weaker urine stream, as the prostate impedes the flow of urine from the bladder (if severe enough it can actually block the flow of urine). As symptoms can be similar to those of prostate cancer, it is recommended that you consult your healthcare team. You may be prescribed medication (finasteride or terazosin) to reduce the symptoms, or offered treatments to reduce the stricture such as a TURP or Greenlight Laser.
Prostatitis is the general term used to describe prostate inflammation. There are two types of bacterial Prostatitis, acute (sudden onset) and chronic (persistent).
Acute bacterial prostatitis is an infection of the prostate that is often caused by some of the same bacteria that cause bladder infections. Patients with acute bacterial prostatitis present with signs of an infection and may have a fever, chills, and shakes. Commonly there is urgency and frequency of urination and dysuria (painful or difficult urination).
Chronic bacterial prostatitis is an uncommon illness in which there is an ongoing bacterial infection in the prostate. Chronic bacterial prostatitis generally causes no symptoms; however, on occasion the low-grade infection may flare up and be associated with a bladder infection.
You probably have a lot of questions about what’s going to happen now.
We’ve tried to answer what you can expect if your PSA and DRE tests (see Early Detection and Screening, above) raise red flags about prostate cancer. If you have more questions please contact us.
- If your doctor suspects there is a problem, you’ll have another PSA test to verify the results of the first blood test. You will then be referred to a urologist.
- The urologist will do another DRE (to confirm your doctor’s findings) and examine the PSA results.
- If the Urologist suspects you have Prostate cancer, s/he will arrange for you to have a biopsy of the prostate (a tissue sample taken to assess for cancerous cells). This is done using a thin needle inserted through the rectum (transrectal biopsy). This can cause temporary discomfort, and there is a very slight chance of infection. In larger centers a TransRectal UltraSound (TRUS) biopsy may be done, which pairs ultrasound technology with the biopsy for increased accuracy in obtaining a sample of suspected tissue..
- The urologist will tell you the results of your biopsy and if possible your Gleason score (which measures the aggressiveness of the cancer).
- The urologist will discuss all the available treatment options with you.
- A Prostate Cancer diagnosis warrants a multi-disciplinary approach; this may include a Urologist, a Radiation Oncologist and perhaps (in the metastatic scenario) a Medical Oncologist. The Oncology team at BC Cancer Agency can offer advice regarding Radiation and Brachytherapy as well as other many other supports and recommendations. It is advised to discuss all options with your entire healthcare team prior to making a treatment decision.
- You will be treated for the disease after analyzing and discussing all the available treatment options and risk factors.
- After treatment, you will be monitored with a PSA test every few months. Eventually, you will only need to take the PSA test once a year.
Before starting a series of diagnostic tests or treatments, there are many things to consider. Prostate cancer is generally slow growing so it is sometimes a good idea to put off tests and treatments until you can discuss the risks and benefits of all options with your doctor and family. There is so much to consider, but keep in mind that the decision to treat is YOURS. If you are not ready to make a decision, please make your healthcare team aware.
More of your questions may be answered in these videos.
Treatment options overview
Your prognosis and treatment options depend on many things, including your age, overall health, PSA level and the grade and stage of your cancer. The grade of cancer is an assessment of its aggressiveness; the stage is a measure of how far it has spread.
If you have been diagnosed with Prostate Cancer, it is likely that you have already heard about some/all of the treatment options that may be available to you. For some, retaining this information can be difficult, and most of us require more than one explanation of each different option so that we can fully understand all of the details. The following treatment options described below are available on Vancouver Island, and for a more detailed discussion please contact Island Prostate Centre’s Resource Nurse (firstname.lastname@example.org) to discuss these options in more detail.
Our goal at Island Prostate Centre is to provide the most current, evidence based information to any man who may have prostate health concerns so that he can make an informed treatment decision.
Watch this video for a general overview of all treatment options as some local clients share their experience.
Experts Explain Brachytherapy, Cryotherapy, Combined Therapies and Side Effects
Treatment options: Active Surveillance
Prostate cancer tends to be a slow-growing disease and treatments do have side effects. Therefore, in some cases, it may be reasonable and safe to wait and carefully monitor the cancer’s progress before deciding to start treatment. This process is called “watchful waiting.” In general, only men with low-stage and low-grade tumours should consider watchful waiting.
Treatment options: Surgery
A radical prostatectomy is the surgical removal of the entire prostate gland and the surrounding tissues. It is the “gold standard” for treatment of disease that is believed to be contained within the prostatic capsule. The main reason for this is that when cancer is confined to the prostate, surgery completely removes the cancerous gland. Cure is the goal, and unless any cancer cells were left behind during this procedure, it is highly likely. When cancer is confined to the prostate, surgery completely removes it. In men with low-risk disease (that is to say localized cancer, a low grade, and an initial PSA of less than 10) the likelihood of a cure with radical prostatectomy is as high as 95%.
Treatment options: Radiation Therapy
Radiation therapy, also called “radiotherapy” uses high-energy rays to kill cancer cells. Radiation works by damaging the cells so that they eventually die. If the cancer has a low stage with a low PSA value and a low Gleason score radiation can be as curative as the surgery. That is to say a 95% cure rate.
There are two ways in which high-energy rays can be delivered. These are external beam radiation or a type of internal radiation called brachytherapy (implantation of radioactive seeds).
Treatment options: External Beam Radiation Therapy (EBRT)
With this therapy, machines focus radiation beams that go through the body from the outside. In Victoria, we use 3-dimensional conformal radiation therapy (3D-CRT).
3-Dimensional Conformal Radiation
The goal of 3D-CRT is to have the prescribed radiation dose conform to the shape of the area being treated so that there will be equal distribution of the radiation dose within that specific target.
The procedure employs the use of a CT scan to create a 3-dimensional representation or map of the tumor and surrounding area. This map, along with sophisticated treatment planning software, allow the Radiation Oncologist to devise a treatment field that accurately delivers high-energy radiation to the target area, while minimizing damage to the healthy surrounding tissues.
The delivery of the radiation takes only a few minutes and is completely painless at the time of delivery. Some uncomfortable side effects may occur as one progresses through their treatment plan, and if this should occur, do not hesitate to bring this up with the Radiation team. Some common side effects are changes to bowel habits (diarrhea), fatigue, and possibly burning on urination. Treatment is given 5 times each week (Monday through Friday) for approximately 7 weeks.
Treatment options: Brachytherapy
Brachytherapy is a form of radiation therapy where radioactive seeds are inserted directly into or adjacent to the tumors. This procedure reduces the amount of normal tissue outside the prostate that is exposed to radiation. It also allows for the delivery of a higher dose of radiation to the prostate than external beam radiation therapy. Sometimes, hormonal therapy is used prior to brachytherapy to downsize the gland. There are no age restrictions for brachytherapy but the candidate must be able to withstand a general anesthetic.
Treatment options: Hormone Therapy
Prostate cells grow and divide under the influence of testosterone. The testicles mostly produce testosterone, but approximately 5% is produced by the adrenal glands. When a man has prostate cancer, testosterone stimulates the growth of the cancer cells.
Hormone therapy either uses drugs to stop the testes from producing testosterone (LHRH analogs), or involves surgery to remove the testicles, which produce the bulk of the testosterone. The adrenal glands cannot be “shut down,” but there are drugs called anti-androgens that block the effects of the testosterone on the prostate cancer cells. Often both LHRH analogs and anti-androgens are used.
When testosterone production is stopped, the effects are dramatic: the PSA falls, the tumors shrink and symptoms abate.
In men with advanced prostate cancer, this form of therapy is effective in helping to slow the growth of the tumors and thus prolong life.
Depending on a man’s the initial PSA, cancer stage and Gleason score, radiologists may use hormonal blockade prior to radiation to shrink the prostate and therefore reduce the size of the radiation field. They also use the hormonal therapy to drive the PSA down. Research shows that men with locally advanced disease get much better results if the PSA is driven down to below 0.1 or lower prior to the radiation. It can take eight or nine months to get the PSA to this level. Once the man’s PSA reaches the lowest point that it will go he will receive his radiation treatments.
After surgery you should expect that:
• Any post-operative pain will be managed by your healthcare team (surgeon and nursing staff); this may include intravenous medications while in hospital and a prescription for pain medication upon discharge from hospital.
• You will be encouraged to walk the day of or the day after your surgery. Early ambulation after a surgery reduces the risk of blood clots and other surgical complications.
• You will likely go home the day after surgery with a urinary catheter in place. You will be taught how manage the catheter prior to your discharge as it will remain in place for approximately 5-10 days after surgery.
• You will have a follow up appointment with your Urologist to discuss the results of the surgery and to have the catheter removed.
Some Post-Operative Considerations:
• If you notice any signs of infection (heat, pain, swelling, discharge) at the incision site contact your Urologist. You may need to use antibiotics to treat an infection.
• Resume your activity level gradually. You will likely be back to your normal routine in approximately 4-6 weeks.
• You will not be able to drive for at least a few days after discharge; it is recommended that you refrain from driving until the catheter is removed and you are no longer using prescription pain medications. Consult with your healthcare team to discuss when you can resume driving.
Rick Sanderson – “Winning the lottery of life.”
I’ve always considered myself to be a lucky person. My family finds it simply amazing how often I win money in things like 50/50 draws, lottery tickets, and casino games. I’ve always said it’s not a matter of if I win big on the lottery, but when.
In June 2011, I was enjoying a cold beer and watching my son pay in a Shamrock lacrosse game when another player’s father said he’d been diagnosed with prostate cancer. I was shocked by this news, and immediately started asking questions. He said he’d undergone several tests including a Prostate Specific Antigen (PSA) blood test, and encouraged me to do the same.
I went to my doctor for a complete physical in July. The results of my PSA test came back high. A week later I underwent another PSA test, and once again the results were high.
Off to the urologist I went. He performed a biopsy, and the results came back positive: I had prostate cancer.
Again, I was in complete shock. I’d always been a lucky guy – how could this happen to me? More importantly, how was I going to tell my family?
Sitting down and telling my wife was extremely difficult, to say the least, but it turned out that that was the easy part. My daughter Rebecca took the news hard, but I reassured her that my plan was simple: I would remove my cancerous prostate, and then move on with my life.
Telling my son Nick was a little trickier. He was attending school in North Carolina, so my brother Darrin flew down to be with him while we told him about my diagnosis over Skype. It was comforting to have a member of my family right beside him, and my wife and I will be forever grateful to my brother.
With my entire family behind me, I booked the surgery. Dr. Kinahan and Dr. Pommerville successfully removed my prostate, and the road to recovery began.
I’ve been cancer free for a whole year now, and my family has been my biggest supporters throughout the entire process.
In December 2011 my daughter and I celebrated my success by getting matching tattoos of the Prostate Cancer Canada tie. The tattoo represents the unwavering support I received from my family, which is something that every person who is diagnosed with cancer needs.
We use the tattoos to share my story, to help educate people about prostate cancer, and to encourage other men to get tested.
I’m a lucky man. When my friend encouraged me to get tested, I was already at Stage 2B. I realize now that I won the real lottery – there’s no bigger lottery than the lottery of life.
Rick Sanderson, November 2012
Hugh McLeod - “I’d darn near left it too late”
My grandfather on my father’s side died of something. My only recollection was that I was told he died of stomach cancer. However my mother, who gave me this information when I was quite young, was a great one for “re-framing” things she didn’t want to talk about.
My father was diagnosed with prostate cancer sometime in his sixties though, again, because we didn’t talk about these things, I can’t be sure. The treatment at that time was not as advanced as it is now. The results of the treatment don’t need description, except to say they were not pleasant to watch.
We didn’t talk about these things.
With all the publicity about prostate cancer, I was aware that due to my family history, I was at risk. However, I thought it was something that would not occur until I was in my sixties. Time enough to worry about it then.
As a preparation for retirement, I began looking into general health issues. Getting my entire dental done while I still had the money, and getting my first full physical since, I don’t know when, forty years?
Anyway, my doctor told me, “Your prostate seems to be enlarged, and I want to send you to the urologist just to be sure.” I was 55 and so the information came as a surprise, because I felt it was at least 5, or preferably 10 years too soon.
To cut to the chase, I was found to have advanced prostate cancer.
Fortunately for me the cancer had not spread, and I was treated with hormone and radiation therapies. The hormone therapy didn’t bother me, although it was quite a surprise to discover that once you lose your libido you stop worrying about it. At least I did. Others might react differently.
The radiation treatment was not pleasant. It’s painless of course, but there can be effects that I had to learn to live with. It was all in the service of keeping me around to work and pay taxes and just plain enjoy life!
At the end of the treatment, which is now three years in my past, I was told, “You know for certain you’re totally cured when you die of something else. Unless you have problems, you don’t need to come back to see us for 10 years, and maybe not even then.”
Considering I’d darn near left it too late, I am a very lucky and grateful fellow. And, although I’ve said it before in person, I am truly amazed and impressed by the kind and thoughtful support provided to me by all the staff and volunteers I met over the two years of my treatment. I went through six weeks of radiation at the Cancer Clinic in Victoria. During this time, I stayed at the Cancer lodge, and traveled back and forth between the two facilities. With all the people they deal with, I never once found anyone short tempered and impatient.
As I said before, I’m not big on attention but I hope I can encourage other men to get checked before it’s too late.
Hugh McLeod & Kate Zealand, June 2013
Murray Tough – “My father’s story.”
After he retired, Dad went back to university where he earned his Master’s degree in Latin and Greek and received the Dean’s award for his high marks. He was then asked to teach a Latin course at Queen’s University. The calendar proclaimed him as Dr. Ian Tough. Even though the “Dr.” part was “medical Dr.” it made him look like a professor. I can’t tell you how proud we were.
Dad was really excited about teaching the course. However, as the semester approached, it became obvious that he was not going to be able to teach it. The cancer had spread to his back, which made it difficult for him to stand. He could not see teaching the course seated and, sadly, stepped down.
1 in 8 men will be diagnosed with prostate cancer. My Dad was one of them. 1 in 27 men will die of prostate cancer. Sadly, my Dad was one of those too.
Two years before Dad died, my young family and I sailed from Lake Huron to my parent’s home in Kingston, Ontario. The trip included crossing three of the Great Lakes as well as transiting the Welland Canal. It would have been the trip of a lifetime for Dad. He would have reveled in every aspect of the trip, trimming the sails, steering by compass, plotting the course, sailing through the moonlit night, the grandeur of the Welland Canal and the mighty ships that passed through it. My children would have had the best bonding experience with their Grandpa. But it was not possible. By then, the cancer was making walking difficult. Moving around a boat under sail would have been too painful.
What I miss most are the long, intellectual conversations we used to have. Those ended about a year before he died as the ever-increasing doses of morphine reduced Dad’s ability to focus.
Next year, I will be running in the Safeway Father’s Day Walk/Run in memory of my Dad, Dr. Ian Tough. On behalf of every man, I am asking you to consider participating, donating, or volunteering for the event.
100% of the money you donate stays on Vancouver Island to support education and research.
I can’t rewrite the ending of my Dad’s story but you can help me rewrite the ending for someone you love.
Murray Tough, June 2013
BC Cancer Agency
The BC Cancer Agency has a government-mandated constitution giving it the responsibility to operate a comprehensive program of cancer control for the people of British Columbia, in collaboration with diverse partners. The Agency’s mission is to reduce the incidence of and mortality from cancer, and to improve the quality of life for those living with cancer.
To learn about prostate cancer, go to the website and click on “types of cancer,” then click on “Prostate.”
To learn about prostate cancer and nutrition, click on “Coping with Cancer” under Patient/Public information, and click on the following sequence of links: Pamphlets and Handouts / Genitourinary Cancers / Nutrition / Nutrition Guide for Men with Prostate Cancer.
Prostate Cancer Foundation BC
Prostate Cancer Foundation BC is a Vancouver-based organization whose mandate is to improve knowledge, prevention and treatment of prostate cancer in BC. They promote research, awareness and support of prostate cancer.
The Canadian Cancer Society
The Canadian Cancer Society is a valuable advocacy group for cancer funding and research, and their website has useful information about prostate cancer and its treatment.
Toronto Prostate Centre
The Toronto Prostate Centre is a multi-disciplinary facility, providing men with a single location in which to receive advanced comprehensive treatment of prostate diseases. Located in downtown Toronto, on the 4th floor of the Princess Margaret Hospital, the Centre is a member of the University Health Network. A leader in research of prostatic disease, their specialists and researchers work closely to ensure that patients receive the best cancer care available. To get information about prostate related topics, go the home page, tick the box beside the topic of interest, then click the submit button at the bottom of the page. To read the “Our Voice” magazine, click on the link found on the right side of the homepage.
His and Her Health
The His and Her Health website is for men and women and is primarily about sexuality. A urologist heads it, and much of the information focuses on prostate cancer and related problems of incontinence and sexual dysfunction. It also features excellent papers about partners and sex, seniors and sexuality and prostate health in general. For information about men’s sexual health, click on the “Men’s Sexual Health” tab at the top of the homepage.
PSA Rising: Prostate Cancer Support
PSA Rising: Prostate Cancer Support provides prostate cancer news, information and support. Focus is on gathering and reporting information from a patient-centered, evidence based standpoint. To get information about prostate cancer and related topics, just click on the topic you want on the home page.
The Prostate Centre at Vancouver General Hospital
The Vancouver Prostate Centre (VPC) is the largest prostate cancer treatment facility in Canada. It includes an outpatient clinic and clinical trials facility, and is located in the Diamond Pavilion at Vancouver General Hospital. The Centre acts as a focus for prostate research and treatment activities for British Columbia.
To download the booklet “Information for Men Newly Diagnosed with Prostate Cancer,” click on “Patient Information” at the top of the page, and then click on the link in the text under the “Overview” section.
James Buchanan Brady Urological Institute
The James Buchanan Brady Urological Institute is a leader in the research and treatment of prostate cancer. Experts stay on top of the latest treatment and technological advances in urology. To get information about prostate cancer, click on the “prostate cancer” tab located to the left on the homepage. Other topic areas such as urinary incontinence and erectile dysfunction can be accessed by clicking on the tab of choice.
Canadian Continence Foundation
The Canadian Continence Foundation was formed in 1986 to address the needs of consumers experiencing urinary incontinence. Until that point there was very little help or information available to the general public about this topic. The Foundation provides consumers with information about urinary incontinence and encourages the public not to “suffer in silence.” To access information about incontinence, click on the “Consumers” tab at the top of the home page, then choose from the menu to the left of the next page.
Thank you to our generous sponsors.