This Movember, what men need to know about prostate cancer screening

Prostate cancer is estimated to be the most common form of cancer in men one in eight Canadian men are expected to be diagnosed during their lifetime.

Experts like University of Alberta oncology professor John Lewis say the vast majority of men will have some form of cancer in their prostate at some point in their lives.

“For prostate cancer that remains localized to the prostate, the five-year survival rate is virtually 100 percent,” Lewis said. The dose host Dr. Brian Goldman.

Yet the Canadian Cancer Society estimates that by 2024, an average of 14 Canadian men are expected to die from prostate cancer per day.

“Some prostate cancers are extremely aggressive,” says Lewis.

As a researcher who promotes Movember – an annual campaign in which men grow mustaches every November to raise awareness about men’s health – Lewis says the key for doctors and patients is to understand the risks associated with prostate cancer, in order to determine how to screen for and treat the disease.

What is prostate cancer?

The prostate is a gland that is part of the male reproductive system and is located just below the bladder and next to the rectum.

Lewis says he views prostate cancer as two different diseases “with two completely different outcomes”: what is known as indolent cancer, which grows slowly and is less dangerous; and metastatic cancer, which spreads beyond the prostate and is extremely dangerous if not caught early.

“Indolent prostate cancer… is a type of cancer that we often say men could die from and not die from,” he said.

On the other hand about three percent of men will die by aggressive prostate cancer.

Is in its early stages people with prostate cancer may not experience this many – or some – symptoms.

However, once the tumor grows, symptoms include increased urination, blood in the urine or semen, difficulty urinating, painful ejaculation, as well as back, hip, and pelvic pain.

Who gets prostate cancer?

Anyone with a prostate – including men, transwomen and non-binary people – are at risk of developing prostate cancer. The risk of prostate cancer increases with age, but a family history of prostate cancer is also a risk factor.

Poor diet, lack of exercise and excessive alcohol consumption can also increase your chances of developing prostate cancer.

Surgeon Dr. Adam Kinnaird says US data shows black men are more likely to develop prostate cancer, and more aggressive prostate cancer, than men from other racial or ethnic backgrounds. In Canada, however, Kinnaird says black men do not have worse prostate cancer rates more aggressive disease.

“But on average, black men were diagnosed about two years earlier than other Canadians,” said Kinnaird, an assistant professor at the University of Alberta’s faculty of medicine and dentistry.

However, research indicates that they are indigenous men in Canada were probably more advanced and aggressive prostate cancer than other menperhaps because Indigenous men were less likely to be screened with a prostate-specific antigen test (PSA) and diagnosed at later stages of the disease.

The Canadian Cancer Society suggests that most men be screened for prostate cancer at age 50. Black and Indigenous men, as well as men with a family history of prostate cancer, should be screened around age 45.

Screening for prostate cancer

Doctors screen for prostate cancer using a PSA test or a digital rectal examination (DRE); the age screening starts depending on risk factors and where you live.

If the PSA test detects higher than normal levels of the antigen in a patient’s blood – typically higher than three nanograms per liter – it may be an indication of prostate cancer.

Lewis says the PSA test is quite sensitive, although it does not specify whether someone has indolent or metastatic cancer.

If high levels of PSA are detected in a person’s blood, Lewis says the only definitive way to confirm the presence of prostate cancer is with a biopsy.

“A biopsy involves a transrectal ultrasound, and then they insert about twelve needles between the legs into the prostate,” he said. Biopsies carry the risk of infections that can lead to sepsis. That is why Lewis is working on research aimed at improving less invasive screening for prostate cancer.

How do we treat prostate cancer?

Although there is no cure for metastatic prostate cancer, Kinnaird says radiation and surgery are currently the two main treatments for the disease if the cancer is localized to the prostate.

“The two first-line treatment options are to remove the entire prostate or to radiate the entire prostate,” he said.

Brachytherapy – a treatment in which small radioactive material is introduced into the prostate to kill cancer cells – is also sometimes used.

That being said, a 2024 study found that 6.4 percent of men treated with brachytherapy developed new cancer after 15 years of follow-up, increasing to 9.8 percent after 20 years.