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Most of us are aware of the Movember campaign where men grow moustaches (for better or worse…) to raise awareness and tackle the men’s health crisis. Too many men are dying prematurely and Movember aims to reduce these deaths to 25% by 2030. One of the main health issues they focus on is prostate cancer – the second most common cancer in men worldwide. 1 in 9 men will develop prostate cancer in their lifetime and 1 in 29 men will die from it. To help reduce these numbers, it’s important to take action early. However, in order to do so, you must first understand what prostate cancer is, who is most at risk, what the signs and symptoms are, and how you can take a proactive role in early detection.
What is prostate cancer?
The prostate is a small walnut-sized gland that is part of the male reproductive system. It sits right below the bladder and surrounds part of the urethra, the tube in which urine and semen flow through. The gland cells of the prostate secrete mucus and fluids to help produce semen. When these cells start to grow abnormally, it can lead to adenocarcinoma – the most common type of prostate cancer. Other rare types of prostate cancer include urothelial carcinoma, sarcoma, small cell carcinoma, carcinoid tumours, and squamous cell carcinoma.
Who is more at risk?
Some men are more at risk of developing prostate cancer than others. The biggest risk factor is age, as the risk rapidly increases after age 50. For those with a family history of prostate cancer (especially first-degree relatives), the risk is then increased 2-3 fold. Further, men of African American descent are more likely to develop prostate cancer than other ethnicities.
Signs and Symptoms
Prostate cancer often shows no signs or symptoms in its early stages. However, as it progresses, men may commonly experience:
Frequent urination, especially during the night
Difficult or painful urination
Blood in urine or semen
Erectile dysfunction
Painful ejaculation
Bone pain (hips, back, or chest)
Early Detection
Cancerous tumours in the prostate can spread to other parts of the body, so it’s important to catch it early on for a better chance of successful treatment. When caught early, the 5-year survival rate is close to 100%. There are two common methods used to screen for prostate cancer.
PSA Test
The prostate produces a protein called prostate-specific antigen (PSA). By measuring PSA levels in the blood, it may help identify prostate cancer. It is important to note that higher-than-normal PSA levels could indicate one of many different issues with the prostate, not just cancer. That being said, the PSA test is subject to false positives (testing positive when there is actually no cancer) which may lead to overdiagnosis and unnecessary treatment.
Digital Rectal Exam
A digital rectal exam (DRE) is often done in addition to the PSA test. This is a physical examination in which a physician inserts a finger into the rectum to feel for lumps or tumours on the outer part of the prostate. However, this test has both low sensitivity and specificity for detecting prostate cancer, meaning its ability to correctly identify individuals with or without prostate cancer is low.
The Canadian Cancer Society recommends getting tested from age 50 if you are at average risk of developing prostate cancer, or age 45 if you are at high risk. There are both benefits and limitations of each of these tests, so it is best to speak with your doctor to see if screening is right for you based on your risk factors and medical history. If there are issues detected during either of these tests, your doctor may order additional tests to confirm the diagnosis.
Treatment Options
Treatment plans vary depending on multiple factors such as the type and stage of cancer, possible side effects of treatments, risk of recurrence, overall health, age, and life expectancy. Treatment options include:
Active surveillance
Surgery
Radiation therapy
Hormonal therapy
Chemotherapy
High-intensity focused ultrasound (HIFU)
Corticosteroids
Having a conversation with a specialist will help decide what kind of treatment is right for you.
The Pharmacist’s Role
As the most accessible health care providers, pharmacists play a key role in public health education. An large number of patients are starting to turn to pharmacists for counselling on signs and symptoms of cancer. While we do not replace visits to physicians, pharmacists can help educate and empower patients to make informed decisions about cancer prevention and early detection. Pharmacists also play an important role post-diagnosis by making sure that the medications that are part of the patient’s treatment plan are right for them and addressing any drug therapy problems that arise.
Take-Away
After learning a little more about prostate cancer, I encourage you to speak to the men in your life about taking control over their own health. Men often delay seeking help when it comes to their health, but doing so could add years to their life.
If you are interested in helping to fund prostate cancer research programs, you can also donate to the Movember foundation.
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References
Gronberg H. Prostate cancer epidemiology. Lancet. 2003;361(9360):859-864. doi: 10.1016/S0140-6736(03)12713-4.
Hoffman, R. Screening for prostate cancer. In: Post T, ed. UpToDate. Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed November 11, 2020.
Odedina FT, Warrick C, Vilme H, Young S. Pharmacists as health educators and risk communicators in the early detection of prostate cancer. Res Social Adm Pharm. 2008;4(1):59-66. doi: 10.1016/j.sapharm.2007.03.001.
Prostate cancer. Canadian Cancer Society. https://www.cancer.ca/en/cancer-information/cancer-type/prostate/prostate-cancer/?region=on. Updated 2020. Accessed November 11, 2020.
