Dr. Andrew Loblaw, Clinician Scientist Professor of the Department of Radiation Oncology of Sunnybrook Health Sciences Centre (Odette Cancer Centre) talks with OASES NEWS about PROSTATE CANCER .

OASES NEWS: What is Prostate?

Dr. Loblaw: Basically the prostate is an organ in the male body that is responsible or contributes to reproduction or having babies. Men’s ejaculate is made of two point the sperm which is the testicles and prostate fluid. 98% of the volume you ejaculate, is from the prostate. It produces fluid which protects and enriches sperm. The prostate is about the size of a walnut or plum and sits between the bladder and base of the penis and in front of the bowel.

OASES NEWS: What is Prostate cancer?

Dr. Loblaw: Cancer is abnormal cells in your body that grow but don’t know when to stop. If you cut yourself or hurt yourself in some way, your body can repair itself. For example, if I was to cut my arm a scar would form over a couple of days or weeks, would eventually fall off as the new skin underneath repairs itself.. But normal tissue knows when to stop growing. Cancer cells “forget” or evolve so they don’t have braking mechanisms to know when to stop. Cancer has the ability to get past our bodies’ normal defense mechanisms and spread elsewhere in the body. I must emphasise that when a prostate cancer is found early (when there is no evidence of spread), with the best treatments, it is highly curable with the cure rates approaching 95% these days. This is much better when I started working 15 years ago, when only 50% of men could be cured.

OASES NEWS: Is prostate cancer curable?

Dr. Loblaw: When prostate cancer is found early it is curable.

OASES NEWS: What is PSA?

Dr. Loblaw: PSA is Prostate Specific Antigen shortened to PSA. It is a protein produced by the the prostate gland and is secreted into seminal fluid. Prostate cancer cells make higher amounts of PSA than normal prostate cells, so it’s a useful test for diagnosing and following patients with prostate cancer.

OASES NEWS: How is the PSA test carried out?

Dr. Loblaw: The PSA test is a simple blood test, taken from the arm, which measures the amount of Prostate Specific Antigen (PSA) protein in the blood. It is common for PSA to be found in the blood in very small concentrations.

OASES NEWS What does high level of PSA in the blood indicates?

Dr. Loblaw: Higher levels of PSA may indicate the presence of cancer, but can also be an indicator of other prostate conditions. More tests will be done to find out the presence of cancer. Hence the PSA test is not the only test to be done to find out prostate cancer. Other associated tests will be done along with it.

OASES NEWS: How often should men go for checkup on Prostate?

Dr. Loblaw: For a man with a family history (someone with a father, uncle or son with prostate cancer), we usually recommend getting checked 10 years, before that person was diagnosed. If you are in your 50s and diagnosed with prostate cancer then your son should start the screening process in his 40s. For the average man we usually suggest getting screened between the ages of 50 and 70. Some experts suggest getting a baseline PSA test in their 40s and using the value to determine what the next step should be. If the PSA is high, then one needs further testing. If it is low

OASES NEWS: What are the signs and symptoms of Prostate cancer?

Dr. Loblaw: Prostate cancer has no signs until it is advanced. The symptoms you should look for are: dramatic changes in urinary function, e.g. if your urination significantly worsens compared to six months ago; or severe pains in the bones which interferes with activities and requires strong pain killers to cope with.

OASES NEWS: How do we diagnose Prostate Cancer?

Dr. Loblaw: The only way to diagnose prostate cancer is to do a needle biopsy (usually of the prostate) and have it read by a Pathologist. We determine who should get a prostate biopsy by looking at each man’s risks of having prostate cancer:

1. Prostate Specific Antigen (PSA): This is protein released by the prostate. Normally, PSA is present in the blood, higher protein concentrations indicate prostate enlargement and much higher concentrations indicate prostate cancer and metastasis.

2. Digital Rectal Exam (DRE): If your doctor can feel a nodule in the prostate, this is a warning sign of prostate cancer. Note that the DRE is not critical to do for screening and shouldn’t dissuade men from getting PSA testing.

3. Family History: People whose father, uncle or son had prostate cancer, are at a higher risk than those without a family history.

4. Ethnicity: Black African and the Black Caribbean have a higher risk than Caucasians.

OASES NEWS: Are there risk factors associated with Prostate cancer?

Dr. Loblaw: Gender (being a male), getting older,, family history, ethnicity (African and Caribbean men are at higher risk)

OASES NEWS: At what age should men go for the screening?

Dr. Loblaw: Early age between 40 -45 average without family history. Earlier if there is family history.

OASES NEWS: What are the things that increase the chances of someone getting Prostate cancer?

Age, family history, ethnicity.

OASES NEWS: Is Prostate cancer hereditary?

Dr. Loblaw: 5 – 10% of prostate cancer is hereditary. This means that one or more genes that cause prostate cancer are passed down from a patient’s parents. It is different from familial prostate cancer which means that one or more genes that increase one’s risk of getting prostate cancer, are passed down.

OASES NEWS: How can Prostate Cancer be treated?

Dr. Loblaw: There are several standard management options:

(1) Radical prostatectomy: this is the surgical removal of the prostate

(2) Radiation Therapy: this can be given by external beam radiation therapy (radiation is focused from outside the body), or with brachytherapy (placement of radioactive seeds into the prostate) or a combination;

(3) Active surveillance which is watching the prostate cancer to see if it shows signs of aggression. Treatment can be avoided in about 75% of men.

(4) Hormone and chemotherapy. These are treatments that work through the bloodstream and therefore can attack the cancer wherever it is in the body.

OASES NEWS: Which of these is the best treatment?

Dr. Loblaw: The good news is that the treatments are getting more effective, are more convenient and have fewer side effects than ever before. It is hard to know which one is the best because it depends on the individual patient. We recommend that a patient hear about the advantages / disadvantages of each treatment from their doctor.

OASES NEWS: After the prostate cancer treatment can men have active sex life?

Dr. Loblaw: Each treatment has different effects on a man’s sex life. Our goal is to help the patient have a normal sex life after treatment and there are a number of medications and options available if help is needed.

OASES NEWS: Are there any recommendations on how to lower the risk of Prostate cancer?

Dr. Loblaw: There’s nothing we know that can do to lower the risk of clinically significant prostate cancer. Some medications can prevent low risk prostate cancer but these cancers don’t need treatment anyway. They don’t prevent intermediate or high risk cancers that do require treatment. Some say eat fruits and vegetables, tomatoes, drink red wine, but none of these have proof that they work.

OASES NEWS: Are there vaccines to prevent Prostate cancer?

Dr. Loblaw: There are no vaccines proven to prevent prostate cancer.

OASES NEWS: Some men have phobia to go for prostate test, why?

Dr. Loblaw: There shouldn’t be any fear, the early detection of prostate cancer the better to commence treatment instead of allowing prostate cancer to metastasize due to late detection. Early detection can save lives. Also after the treatment the patient will live normal life.

OASES NEWS: What is Metastatic Prostate cancer?

Dr. Loblaw: Metastatic prostate cancer means that the cancer has spread beyond the prostate to other parts of the body.

OASES NEWS: What happens if prostate cancer is left untreated?

Dr. Loblaw: If prostate cancer is left untreated it can cause:

1. Local problems: pain in the pelvis, bleeding, blockage of bowel, blockage of urinary flow.

2. Distant problems: the cancer can spread elsewhere in the body and can cause bone pain, loss of appetite, weight loss or swelling of legs. A very serious problem is called spinal cord compression where the cancer presses on the spinal cord and causes paralysis, numbness, loss of control of bowel or bladder, and feet and weight loss.

3. It can result in death

“Our goal is to help the patient have a normal sex life after treatment”

OASES NEWS: what should physicians know, in helping identify those with more aggressive disease of prostate?

Dr. Loblaw: Doctors should know that there are a number of risk calculators that can help estimate a patient’s risk and outcomes. The Sunnybrook Prostate Risk calculator is one which incorporates all known risk factors and tumor markers for prostate cancer and calculates an individual’s risk for prostate cancer. The following factors must be known about yourself or your patient; current age, ethnic background, family history or any relatives diagnosed with prostate cancer, presence of urinary symptoms, Total PSA value, Free total PSA ratio value and digital rectal Exam results (DRE).

OASES NEWS: It is known that Africans or the blacks have prostate cancer than other race, what is your suggestion to the health care industries in Africa on how to lower the risk of prostate cancer?

Dr. Loblaw: We would suggest that generating awareness, setting up programs for PSA screening and ensuring timely access to effective treatment programs would really help a lot of men minimize the impact of this potentially deadly disease.