prostate cancer in canada: risk factors, screening and treatment options
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many 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.
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.
importance of early prostate cancer detection and screening in canada
according 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.
fortunately, 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.
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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.
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.
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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
doctors 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 cancer
a 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.
a 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.
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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.
the 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 statistics
globally, 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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in 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 canada
in 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.
in 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 screening
prostate 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.
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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,
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