Whether you're growing a moustache, or throwing a few dollars at someone brave enough to go full Magnum P.I. for a month, Movember isn't just a time to raise money for a good cause. It's also a chance to learn more about a disease that will afflict one in seven Canadian men in their lifetime.
Here's what men need to know about prostate cancer.
Fact or fiction: Prostate cancer is an older man's disease.
Fact (mostly): This one is fairly accurate. While experts are quick to point out that some men develop the disease at a young age, the bulk of patients are first diagnosed in their 50s and 60s. Cancer is a "disease of aging, and it's no different with prostate cancer," notes Dr. Stuart Edmonds, vice president of research, promotion and survivorship at Prostate Cancer Canada.
The average age for men first diagnosed with the disease is about 67, adds Dr. Laurence Klotz, chair of prostate cancer research at Sunnybrook Health Sciences Centre and a professor of surgery at the University of Toronto. He explains that the likelihood of a man developing an aggressive cancer increases with his age. But the average age of death from prostate cancer is 80, meaning many men live full lives, and it's not uncommon for a man to die of a cause other than his prostate cancer.
With prostate cancer, there are prostate cancers that a guy will die of, and there are prostate cancers that a guy will die with. So the critical piece is to separate the two: the ones we need to treat, and the ones we need to monitor.Dr. Stuart Edmonds
Fact or fiction: The only way to treat cancer is aggressively.
Fiction: This is definitely a myth. "There's a huge spectrum of risk with this cancer, more than with most," Klotz says.
About 40 per cent of newly diagnosed patients are classified as low-risk, and Klotz has been among the leaders in the development of what is known as "active surveillance." Patients with a non-aggressive disease can be managed with consistent monitoring and little, if any, treatment. The doctor adds that some treatments can have long-term side effects such as incontinence and erectile dysfunction.
"With prostate cancer, there are prostate cancers that a guy will die of, and there are prostate cancers that a guy will die with," Edmonds says. "So the critical piece is to separate the two: the ones we need to treat, and the ones we need to monitor."
Holding off on treatment has benefits beyond maintaining a patient's quality of life. It gives time for better, less-invasive options to be developed. As Klotz notes, MRIs are now being used to detect cancers that require treatment, particularly in the hard-to-biopsy front part of the prostate where more aggressive cancers used to sit undetected.
Klotz also says a procedure called a partial gland ablation — the men's version of the lumpectomy some women have to remove a cancerous tumour from their breast — is just emerging and, when it's adopted more widely, will go even further to preserve a patient's quality of life.
Fact or fiction: I don't need a PSA test, I'll just wait for symptoms.
Fiction: PSA, or prostate specific antigen, is a protein created by the prostate, and elevated levels in a PSA test are the first signal that there's something wrong. A few years back, the PSA test got a bit of a bad rap because it led to over-treatment for non-aggressive disease.
Now, however, medical practice is beginning to shift, with the PSA test being followed up by less-invasive tests, such as a genetic test or an MRI, to help determine how concerning the cancer really is and whether a biopsy is even needed.
While age 50 is the widely accepted age for a first PSA test, Klotz recommends that a man have his first one in his mid-40s. If the PSA level is low, then the test only has to be repeated every five years until about age 60 if it remains so.
As for symptoms, early signs of a problem with the prostate are also normal signs of aging in men, such as frequent urination, meaning the PSA test is the best place to start.
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Fact or fiction: There's nothing I can do to prevent prostate cancer.
Fact: If prostate cancer is really a disease of aging, then it's true that there's little to be done in the way of specific preventive measures.
"We are still looking at causes of prostate cancer, and particularly the modifiable risk factors and modifiable causes," Edmonds says. Numerous studies have tried, but have failed to identify environmental triggers. And research into whether vitamin E might might have a preventive effect came up empty.
While some genetic links are being identified, there's little doctors can say in terms of lifestyle choices that can mitigate chances of developing the disease. Men should talk to their doctors about their risk, but otherwise all the rules for general good health apply, Klotz notes: regular exercise, maintaining a healthy weight and avoiding obesity, and consuming less animal fat.
"The heart-healthy advice is the prostate-healthy advice," he says.
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