Dr. Krista Noonan
Oncologist, BC Cancer Agency & Clinical Assistant Professor, University of British Columbia
To mitigate the health implications of prostate cancer, patients and their physicians must maintain an open dialogue and participate in shared decision-making.
According to the Canadian Cancer Society, prostate cancer is the most common cancer among Canadian men excluding non-melanoma skin cancers) and the third leading cause of death for Canadian men with cancer.1 “While it tends to be a disease that has a higher risk as you enter your 70s and 80s, we do still see younger men, including men in their late 40s and 50s, who are diagnosed,” says Dr. Krista Noonan, a medical oncologist at the BC Cancer Agency and Clinical Assistant Professor at the University of British Columbia.
The good news is that prostate cancer is increasingly treatable, and its five-year survival rate is around 91 percent.2 But to achieve good results, shared decision-making and open dialogue between physicians and patients are essential.
Key monitoring and detection markers
Many prostate cancer patients are diagnosed thanks to prostate-specific antigen (PSA) screening. Although high PSA levels don’t always mean cancer, this testing is important especially since “by definition, screening is asymptomatic,” says Dr. Noonan. If patients aren’t screened appropriately, they may not notice symptoms — like pain or lower urinary tract issues — until the disease has spread, often to their bones.
PSA testing allows doctors to detect and monitor even low-grade forms of prostate cancer. “Some men with very low-risk prostate cancer may just receive active surveillance by their urologist, which consists of PSA values, physical examinations, MRIs, and periodic biopsy,” says Dr. Noonan. “If things start to progress to a higher risk group, then they may have surgery or radiotherapy.”
The value of open dialogue
Monitoring prostate cancer’s progression before jumping into treatment may be a good choice for many patients as treatments can impact a patient’s quality of life — for example, their energy levels and sexual functioning.
Dr. Noonan stresses the importance of maintaining open dialogue and shared decision-making. All patients have different desired activity levels and priorities when it comes to their health, and physicians must understand their patients’ goals.
Charlie Taylor was diagnosed with prostate cancer nine years ago, at the age of 50. His ultimate goal was simply survival. “My doctors were all very open and easy to talk to,” he says. “They explained the treatment options and I opted for surgery. What mattered to me most was just being able to be around for my family.”
With virtual care on the rise, especially since the pandemic, Dr. Noonan notes that some situations work well for virtual visits while others require in-person visits. “For our first meeting, when I do my initial consultation, I prefer to do it in person as it allows us to develop rapport, connection, and a therapeutic relationship,” she says. “After that, I ask patients what they prefer. It’s very patient-centred. And with prostate cancer specifically, virtual care tends to work better than with some other types of cancer where you really do need to do a physical exam at each visit.” Dr. Noonan does note that patients should come in if they have any new symptoms arise or feel as though anything is wrong.
Top Questions to Consider Before Deciding on a Prostate Cancer Treatment
If you have prostate cancer, here are some questions to consider before speaking to your doctor and deciding on a course of treatment.
What does your day-to-day life look like currently?
What kinds of activities bring you the most joy?
What is your health history, what medications are you currently on, and have you dealt with any health challenges in the past?
This is important because some medications may not be suitable for someone with a history of seizure disorder, for example.
What are your top priorities when it comes to your health and life?
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1 Canadian Cancer Society. Prostate cancer statistics. Available at: https://cancer.ca/en/cancer-information/cancer-types/ prostate/statistics Accessed May 3, 2022.