Prostate Cancer

Dear Dr. B: Pierre Trudeau died of prostate cancer. At the age of 58, Preston Manning is diagnosed to have prostate cancer. Can you please tell me something about prostate cancer – especially prevention and early detection? Yours: Mr. Worried.

Dear Mr. Worried: Let us start with bad news first. Every man, who lives long enough, will develop prostate cancer. The risk of getting prostate cancer increases rapidly after the age of 50. In fact, by age 75, the risk of getting prostate cancer is 30 times higher than age 50. But the good news is: if the prostate cancer is detected early then it can be cured.

How common is prostate cancer? If you take 100 men age 50 or older, 30 will have prostate cancer, 10 will be diagnosed with and treated for prostate cancer, and three will die from it. According to the National Cancer Institute of Canada (1996), prostate cancer is the most frequent cancer and the second leading cause of death from cancer in men, exceeded only by lung cancer.

According to Alberta Clinical Practice Guidelines, there are four major risk factors for prostate cancer: age, race, diet and family history.

Age: this has been discussed earlier. Race: African-American men have a 30 percent greater incidence of prostate cancer compared with white men. Diet: a high intake of dietary fat also seems to be associated with a higher risk for developing prostate cancer. Family history: there is an increased risk for the development of prostate cancer in men who have first-degree relatives with the disease.

How do I know I have prostate problems?

If the prostate is large enough to partially block the flow of urine, then there is diminished urine flow (Doc, I cannot hit the wall!); delay in onset of urine flow (honey, don’t rush me!); and frequent urination (sir, when is the next bus stop!) especially at night (oh boy, a man has to go when he has to go!). The enlarged prostate can be due to benign prostatic hypertrophy (BPH) or prostate cancer.

Does it mean that if I don’t have any symptoms then I do not have prostate cancer?

No, that is not true. You may be harbouring cancer in the prostate gland without any symptoms. That is why there is a big drive to screen asymptomatic men over 50 with digital rectal examination (DRE) and prostate specific antigen (PSA) blood test.

Although digital rectal examination has a cancer detection rate of only 0.8 to 7.2 percent, it remains an important test that can be done easily in a doctor’s office. It also checks for anal and rectal tumours. So it has a double advantage. PSA blood test has a false positive rate of 20 to 50 percent and false negative rate of 25 to 45 percent. That is means 30 to 50 percent of the time the test is wrong! So, why do them? The reason is simple – this is the best shot we have to get an early diagnosis!

What about prevention? Preventive strategies for prostate cancer are same as any other cancers. The Canadian Cancer Society recommends the following: stop smoking, eat low-fat, high fibre foods, and exercise regularly, limit salts, alcohol, and caffeine intake.

DRE and PSA is the best we have to make early diagnoses. So, Mr. Worried, talk to your doctor and get yourself checked out!

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