Prostate Cancer: One Man's Story

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"You have prostate cancer"
Analyzing prostate cancer
Choosing a prostate cancer treatment
Life after prostate cancer
What is your risk of prostate cancer?

DRUGS
CONDITIONS

"You have prostate cancer"

Finding out
Doug is a real person. In 2002, he was 49 years old. When he went for his annual check-up, his family physician found a "pebbly" lump in his prostate with a digital rectal exam (DRE). The doctor assured him that he probably had nothing to worry about, but, being a thorough physician, he sent Doug for a follow-up prostate-specific antigen (PSA) test. Doug's PSA score was very low and safely outside the cancer range. Just to be sure, however, the doctor sent him to a urologist, who ordered a biopsy a month later. He had prostate cancer, and it was on the brink of spreading beyond his prostate.

Doug had had no warning signs, nothing more than a bit of feeling of urgency and frequency of urination. He was only 49; the average age a man is diagnosed with prostate cancer is 65. Nobody in his family has ever had prostate cancer. He was in total shock. "It can destroy your confidence when you get cancer," Doug explains. "Most of time you do a test and it comes back negative – you get used to getting the all-clear."

Prostate cancer is considered a slow-growing cancer, so screening is the number one way that a man can win the battle. Prostate cancer shares many of the symptoms of benign prostatic hyperplasia (BPH), a generally harmless condition, but it can often have no symptoms at all.

The DRE
The digital rectal exam (DRE) is a simple, painless examination. Your doctor inserts a gloved finger into the rectum to feel the prostate for changes in size, density, texture, and any other abnormalities. An enlarged prostate does not necessarily mean there are any cancer tumours present; it may just be a sign of BPH. BPH is not related to prostate cancer, and about half of all men over 50 have it. However, enlargements and other irregularities such as lumps and hardening should still be investigated and may require more tests. While digital rectal exams are still routinely performed, recent studies have found that they may not be accurate in predicting prostate cancer.

The PSA
The prostate-specific antigen (PSA) blood test is used to detect prostate cancer by measuring levels of PSA. Men with prostate cancer often have more PSA, so their score is higher. There are some cases where some men with prostate cancer will have normal PSA levels, like Doug. This test is considered a better indicator of whether a man may have prostate problems. However, there are other conditions that can cause elevated PSA levels. PSA testing can be done in conjunction with a DRE.

Biopsies confirm cancer
The next step of diagnosis is to perform a biopsy of the prostate. This is the only way to confirm cancerous tissue. A biopsy is a simple procedure that involves the removal of tissue so it can be further analyzed to determine if cancer cells are present and to estimate how aggressive it is. If cancer is present in the prostate, you will begin to discuss treatment options with your doctor.

Other tests are also available to help diagnose prostate cancer and/or rule out other conditions.

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Analyzing prostate cancer

The most common cancer
The cancer Doug was diagnosed with (see "You have prostate cancer" in this feature) is one of the most common cancers in Canada. 1 in 8 men will be diagnosed with it over their lifetime.

Prostate cancer is uncontrolled growth of the cells of the prostate gland. The prostate plays an important role in sexual functioning, urination, and reproduction. In prostate cancer, the cells within the walls of the prostate begin to multiply and eventually leave the prostate gland, spreading to invade the body parts close to the prostate – the lymph nodes and bladder – or elsewhere, particularly to the spine. 1 in 5 men diagnosed with prostate cancer will end up dying of it.

The Gleason score
When a biopsy shows that a man has prostate cancer, the pathologist will apply a "Gleason score" to it. The Gleason score is an important number, as it defines how aggressively the tumour is growing and will reflect the treatment options available. The lower the score, the better a patient's chance of survival. When Doug's cancer was biopsied, it was assigned a Gleason score of 7 – a score of 8 or higher is considered "very aggressive."

The stages of prostate cancer
Prostate cancer is also "staged" – assigned a stage based on the tumour's characteristics, such as its size and whether there is evidence that it has spread. Staging also helps determine the prognosis and treatment options.

In Stage T1, the cancer tumour is microscopic and actually can't be detected by a DRE. A biopsy is needed to find traces of the tumour or it may be found during surgery for another medical condition
In Stage T2, the tumour has grown but is still confined to the prostate itself and can be removed by taking out the whole prostate. The doctor can detect it at this stage by DRE and by imaging tests.
By Stage T3 or T4, the cancer is deadlier because it has spread outside the prostate gland to the seminal vesicles (which produce semen) or to the bladder (where urine is stored).

Choosing a prostate cancer treatment

Making the choice
When Doug was diagnosed with prostate cancer, his first response was to get information. He read countless books, articles, and studies on prostate cancer, which made him feel more prepared for the hard times that lay ahead. He also sought out a second opinion for peace of mind. His wife was of great support, connecting him with the "Man-to-Man" support group of prostate cancer survivors.

If you are diagnosed with prostate cancer, an oncologist (a doctor specializing in treating cancers) will give you your treatment options and will be responsible for your care. You may have to try more than one treatment, or combine treatments, depending on your age, medical condition, and overall health, and on the size, aggressiveness, and spread of the cancer.

Doctors gave Doug a choice between radiation and removal of the prostate. Both specialists told him surgery for total removal of the prostate, called a radical prostactectomy, was the best option, but it was his decision.

Making a decision about cancer treatment is tough. "The key is to do your research – no one choice is right, it has to be right for you. Do it, get on with it and don't ever regret," Doug reflects. In the end, he chose surgery.

What treatment(s) are available for prostate cancer?

Surgery (prostatectomy) – removal of the prostate gland. The entire tumour is normally removed in a one-time procedure. Surgery is often used when the cancer is limited to the prostate area.
Radiation/brachytherapy – tumour cells are killed by external beam radiation therapy (EBRT) or brachytherapy (surgical implantation of radioactive seeds).
Hormone therapy – blocks hormones such as testosterone from helping tumours grow. This therapy targets testosterone, which is known to help tumours grow; this therapy can thus help cause the tumours to shrink. It may also be used to treat prostate cancers that spread outside of the prostate or used in conjunction with other types of treatments.
Cryotherapy – freezing the tumour with liquid nitrogen to kill cancer cells. This treatment avoids surgery and may be more suitable for men who are not good surgery or radiation therapy candidates.
Chemotherapy – drugs that can target and destroy cell that grow rapidly, such as cancer cells. Chemotherapy travels in the blood stream and can reach cancer cells in distant organs that may have not been removed by surgery or may not be the target of radiation treatment.
Targeted therapy – drugs that target specific molecules in or on cancer cells. Targeted therapy helps to not only treat cancer, but avoids harming your normal cells. This option might be used if your cancer doesn't respond well to hormone therapy or if there are certain genetic mutations.

Prostate cancers that are detected and treated at the earliest stages are often cured, but often at the expense of some degree of continuing incontinence or impotence. Nevertheless, in some cases, the cancer can recur or spread to other organs in the body. Frequent physical exams and PSA blood tests are used to determine whether the cancer has returned.

Is treatment always necessary?
Some slow-growing early-stage prostate cancers may not require immediate therapy. Through regular testing, the progress of the disease and the level of your physical comfort can be monitored. For older men with other medical problems, this "active surveillance" may be less disruptive than starting cancer therapy. "Active surveillance" may also be an option for those where the cancer isn't causing symptoms or if you have health problems and cannot receive treatment.

Life after prostate cancer

During Doug's surgery on December 4, 2002, it was discovered that his tumour had grown to 40% of the weight of his prostate.

After the surgery
Radical prostatectomy is major surgery. Doug was in a lot of pain, but he returned to work six weeks after surgery. Life began to get back to a "new normal." By May 2003, he started exercising again, having lost 30 pounds.

But life never is the same. "The day after surgery I was elated," Doug says. "But once I got into February, I started worrying about recurrence – you don't think of this at first. But it creeps up and nags at your brain. Did they get it all?"

A changed life
Cancer takes a toll on you both physically and emotionally. Doug is frank: "There is an emotional recovery – my sense of immortality was shattered – with cancer, your body turns on itself."

Prostate cancer has changed Doug – his life has new challenges. He gets up two or three times a night to go to the washroom. He lost one nerve during the procedure, and it can take a while for complete function to return. "My body feels different. I am more aware of my symptoms – is this just a headache or back pain? You get in the habit of checking things out."

In many ways, though, Doug's life has become enriched.

"Am I lucky or unlucky to have had cancer? My focus now is that I survived cancer and I am stronger – I can do anything. I want to think I am lucky that I appreciate life more and what is important. I've stopped doing things that don't add value to my life. You have to choose: do you live life fully or not?"

What is your risk of prostate cancer?

Diet and Fitness

Prostate Cancer Risk Factor Quiz

Take this quiz to learn about what can affect your risk of developing prostate cancer. While we don't know the exact causes of cancer, there are trends that men with prostate cancer share.

How old are you?
The older you are, the greater your chance of developing prostate cancer. If you are a man under 55, you have a less than 10% chance of having prostate cancer. In your 60s, your risk of developing prostate cancer can be over 30%.

It is a good idea to get screened for any prostate problems as soon as you reach the age of 50. You may wish to start screening earlier if you have risk factors like a family history of prostate cancer.
Are you overweight?
Calculate your body mass index (BMI): BMI = body weight (kg) ÷ height² (m) (Example: if you weigh 150 lbs (68 kg) and are 5'8" (1.73 m) tall, divide 68 by (1.73 × 1.73), or 2.99, to make 22.74.)
If you are overweight (BMI 25 to 29.9) or obese (BMI 30 or higher), you you may be at a higher risk for developing prostate cancer compared to at a normal weight. That stands true for most types of cancer. As well, your body needs energy to fight off diseases and illnesses. An overweight body requires more of your body's resources to maintain itself in a normal state. That results in less energy for anything else.
Have any men in your family had prostate cancer?
Scientific studies have linked a specific gene to prostate cancer; if you carry that gene, you may be at a higher risk of developing prostate cancer. The risk may be even higher if you have a male first-degree relative on either side of your family who was diagnosed before the age of 65. A family history of other cancers, including breast cancer, can also increase your risk of prostate cancer.
What is your ethnic background?
Men of African or Caribbean descent have the highest percentage of prostate cancer incidence, followed by Caucasians. Asian and Indigenous people have the lowest risk. Why do we see these differences? Genetics and environment may explain it, at least in part, along with lifestyle differences and diet.
Do you eat the following foods regularly?
While food alone will not cure prostate cancer, you should take a look at your diet to see if you are getting enough of the following foods:

Foods rich in lycopene may help to lower your risk of developing prostate cancer. Lycopene is found in guava, papaya, red grapefruit, watermelon, tomatoes, tomato products, ketchup and vegetable cocktails.

Soy products are rich in naturally-occurring estrogen compounds that can help to counter the effects of testosterone and may help lower your risk of developing prostate cancer. Soy products can include soy beverages, tofu, and soybeans.

Avoid foods that are high in animal fats - they have been associated with increasing the likelihood of developing prostate cancer.
Do you drink coffee?
There's some research to suggest that your daily cup of java can decrease your risk of developing severe prostate cancers. While it's best not to overdo it, both regular and decaffeinated coffee might yield benefits in addition to kickstarting your morning routine.
Do you use painkillers such as ASA or ibuprofen?
If you are taking painkillers such as ASA or ibuprofen, you may actually be helping to keep prostate cancer under control. Speak to your doctor if you are thinking of taking an anti-inflammatory painkiller.