frequent monitoring and new therapies can improve outcomes for men living with prostate cancer
part of a simple round of blood work, the psa test screens for signs of prostate cancer, a very real threat for men as they reach their fifties.
4 minute read
laurent proulx, president and ceo, procure wearing a "bowvember" tie, outside their offices in montreal, quebec
(christinne muschi / national post)
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this story was created by content works, postmedia’s commercial content division, on behalf of a client.
for men of a certain age, a medical check-up often contains an extra, familiar component beyond the usual sugar or cholesterol checks: the psa test. part of a simple round of blood work, the psa test screens for signs of prostate cancer, a very real threat for men as they reach their fifties.
psa stands for prostate-specific antigen, which is a protein made by every man’s prostate. while it is normal for men to have these antigens in their system, elevated levels of the protein can sometimes indicate prostate cancer’s presence.
every day 12 men in quebec learn they have prostate cancer, which accounts for a quarter of deaths from cancer in canadian men. with such stark statistics, we often assume an aggressive treatment path is always best. our own language perpetuates this conception, framing cancer as an enemy to “beat.” but that is not always the case; sometimes, treatment requires what cancer specialists call “watchful waiting,” in which a close eye is kept on the progression of the cancer.
physicians do this in a variety of ways, including monitoring psa levels. a measurement called the psa doubling time allows physicians to check how quickly a tumour is advancing, and crucially, whether it is at risk for spreading to other parts of the body. regular and active monitoring of psa levels every three months is therefore an important part of prostate cancer treatment.
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this monitoring isn’t just about keeping an eye on things; treatment of prostate cancer is rapidly advancing, says dr. fred saad, a professor and chief of urology at the university of montreal.
according to dr. saad, who has dedicated the last 25 years to developing new therapies for prostate cancer, male hormones known as androgens fuel prostate cancer. cutting off supply of those hormones can be vital to treatment. “it used to be a surgical castration, but now we have a medical castration that does the same job,” says dr. saad.
medical castration is called androgen deprivation therapy (adt), and is a common course for men living with prostate cancer. injections suppress the body’s natural production of hormones, which can cause the disease to regress or go into remission, sometimes for months or in some cases, even years. for some patients, however, the disease does not respond to adt; until that cancer spreads to other parts of the body, it is called non-metastatic castration resistant prostate cancer (nmcrpc).
while nmcrpc used to be difficult to treat, new therapies are available, though the relative success of these treatments can depend on recognizing nmcrpc early. despite this, the perceived urgency of monitoring psa doubling time, which can track the tumour’s growth and likelihood of spreading, remains low for many men with prostate cancer.
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this lack of urgency to track is unfortunate, says dr. saad, since new treatments are available which can delay cancer’s progression to an advanced stage.
in advanced prostate cancer, quality of life can be severely reduced. patients endure weight loss and fatigue, and can experience difficulty controlling the bowel and urinary tract. the cancer often spreads to the hips and pelvis, causing pain, swelling and risk of fracture. but new treatments can now slow prostate cancer’s development to that advanced stage in which quality of life is greatly reduced.
while it is true that advances in screening, monitoring and treating cancer do not cure the disease, dr. saad believes that too much emphasis is placed on a cure. instead, treatment should take quality of life into account. “we’re now able to delay the appearance of metastases very significantly, and canada has played a major role in those discoveries.”
it is all part of an attempt to change how the medical community approaches the treatment of prostate cancer.
“our attempt is to make prostate cancer a chronic disease, rather than a lethal disease,” he says. “i think we have to look at what we can do to make this disease a livable, chronic one, like diabetes, like high blood pressure.”
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the idea is echoed by laurent proulx, the president and ceo of procure, a charitable organization dedicated to the fight against prostate cancer through research, outreach, education and support to the one in seven men who will be diagnosed with this disease during their lifetimes and their loved ones. proulx is also a prostate cancer survivor.
“a lot of evolution has come on the side of treatment. we’re able to extend lives because of research,” he says. “if you’re getting an extra month, year or decade, i think it’s important for a man who’s been diagnosed with cancer. i think there’s value in that.”
at the core of this idea is maintaining quality of life; to let patients live in as comfortable and enjoyable a way as possible while still having the disease.
effective management is an ideal that seems far more achievable than a generic “cure for cancer.” but at its heart, it’s also a dream that is what medicine is supposed to be about: focused on the patient, and meant to reduce pain and suffering. for men with prostate cancer in particular, it’s part of a trend that gives what was once missing: hope.
to learn more about the importance of ongoing psa testing in prostate cancer, visit www.procure.ca.
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this story was created by content works, postmedia’s commercial content division, on behalf of janssen inc.
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