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Advancements in Cancer Care

Surviving Prostate Cancer Begins with One Candid Conversation

Four older men playing basketball
Four older men playing basketball
Dr. Stuart Edmonds

Dr. Stuart Edmonds

Executive Vice President of Mission, Canadian Cancer Society

Dr. Urban Emmenegger

Dr. Urban Emmenegger

Medical Oncologist, Sunnybrook Health Sciences Centre’s Odette Cancer Centre

While only men have a prostate gland, prostate cancer can affect us all. It’s the most commonly diagnosed cancer in Canadian men, impacting not only the patient, but also their loved ones. The good news is that advancements in prostate cancer screening are making it easier than ever to detect cancers before they become dangerous. Simultaneously, treatment options for men with more advanced stage disease are also expanding and improving.

“On average, 62 men are expected to be diagnosed with prostate cancer in Canada each day and 11 will die,” says Dr. Stuart Edmonds, Executive Vice President of Mission at the Canadian Cancer Society (CCS). “That’s the magnitude of the issue we’re dealing with.”

Dr. Edmonds was previously Vice President, Research, Health Promotion, and Survivorship at Prostate Cancer Canada. As of this year, however, Prostate Cancer Canada has amalgamated with the CCS in a move that looks to dramatically increase the capabilities of both organizations with increased investment in the services and support provided to patients, health care providers, and researchers. “The amalgamation is about creating a more efficient fundraising environment that directs more money to the research and programs that benefit people affected by cancer,” says Dr. Edmonds. “It’s really built on the successes of the Canadian Cancer Society’s merger with the Canadian Breast Cancer Foundation that happened in 2017.”

What we’re seeing more and more is that the PSA test is the best way to start the process of identifying prostate cancer.

Dr. Stuart Edmonds, Canadian Cancer Society

Cancer survival depends on early detection

With survival for localized early stage prostate cancer at nearly 100%, an important focus among organizations like the CCS is ensuring that cancers are diagnosed early enough to treat effectively. “By the most recent cancer statistics in Canada, 8.6% of men overall will have metastases at the time of diagnosis,” says Dr. Urban Emmenegger, Medical Oncologist at Sunnybrook Health Sciences Centre’s Odette Cancer Centre. “That goes up to 25% in men aged between 80 and 90. This definitely ties into the conversation about screening. There’s concern that if we do less screening, then the rate of metastatic prostate cancer diagnoses might go up. And metastatic prostate cancer is an incurable condition, while localized prostate cancer is a highly treatable condition.”

Fortunately, for the men whose cancer is detected later, prospects are improving as well. “We’re fortunate to have multiple efficacious treatment options now, even for men with more advanced disease,” says Dr. Emmenegger. “In addition to androgen (hormone) deprivation therapy, we also have chemotherapy, palliative radiation therapy, and new oral medications. The majority of patients are able to go on with their lives. They can travel, they can remain active, and they can maintain an overall pretty high quality of life.”

Effective screening depends on comprehensive funding and open dialogue 

Screening for prostate cancer is an evolving process. The most important screening tool right now is the prostate-specific androgen (PSA) test, which is a simple blood test that can reliably detect potentially cancer-related stress in the prostate. Suspicious PSA tests are then followed by more confirmatory tests like biopsies and MRIs.

Though the PSA test isn’t covered by public insurance in all provinces, doctors are increasingly recommending its use. “What we’re seeing more and more is that the PSA test is the best way to start the process of identifying prostate cancer,” says Dr. Edmonds. “It’s really vital that men have a conversation about the PSA test with their doctors starting at age 50.”

Unfortunately, that conversation is one that too many men are putting off until it’s too late. Prostate cancer may be an uncomfortable topic to discuss, but it’s essential that we break the stigma and talk openly. “Because prostate cancer is a below-the-belt disease, it can have health implications that are significant to our perceived or socially constructed ideas of masculinity, like erectile dysfunction and incontinence,” says Dr. Edmonds. “These are things that men really want to avoid, but also want to avoid talking about. In many ways, the prostate cancer world is 30 or 40 years behind the incredible work that has been done in breast cancer. The openness that people feel in talking about breast cancer really doesn’t exist yet when it comes to prostate cancer.”

Dr. Edmonds’ recommendation is that all men begin talking to their physician about prostate cancer screening by age 50. And, if you have a family history of prostate cancer or belong to a higher-risk group, he recommends starting that conversation by 45. Right now, thousands of Canadian men are dying each year of prostate cancer. An open and destigmatized dialogue is the key to saving those lives. 

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