Prostate Cancer

THE BASICS

INTRODUCTION
Understanding prostate cancer and all that it involves, can, at first, seem a bit overwhelming. Between the testing for prostate cancer, to treatments, to the disease itself, there is a lot of information to cover. In this pamphlet, we aim to explain the basics the who, what, where, when and whys of the disease.

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THE PROSTATE
Lets start at the beginning with answering the question, what is the prostate? The prostate is a part of the male reproductive system. Its main function is to add nutrients and fluid to the sperm. During ejaculation, the prostate secretes fluid that is part of

the semen. In fact, 98% of the volume of the ejaculate is made by the prostate. Normally the size of a golf ball, the prostate can be divided into at least two parts referred to as the right and left lobes. It is located close to the rectum just below the bladder at the base of the penis and also surrounds the urethra, the tube that carries urine and semen through the penis. The prostate is affected by male sex hormones. Not only do they stimulate the activity of the prostate, but also the replacement and growth of prostate cells. If your doctor discovers an enlarged, irregularly shaped, hard, lumpy or tender prostate, you may have a prostate problem.

are produced almost entirely by the testicles (95%),1 with only a small percentage (5%) being produced by the adrenal glands (small glands found just above the kidneys).1 In order to be considered cancerous, a prostate cell would have all of the following characteristics: uncontrolled growth, abnormal structure, and the ability to escape the prostate and move to other parts of the body. The latter is referred to as invasiveness.

WHAT IS PROSTATE CANCER?

Prostate cancer is a disease in which some of the cells of the prostate have lost normal control of growth and division. They no longer function as the healthy cells do. Although the cause of prostate cancer is not yet known, it is understood that the growth of all cells in the prostate, both healthy and cancerous, are stimulated mainly by testosterone. Male hormones, including testosterone, Its important to note that not all clusters of cells growing in a mass are cancerous, they could in fact be benign. It is also possible that a prostate with an irregular shape is not cancerous either. It could indicate a different problem with the

prostate, or in the case of an enlarged prostate, it could simply be a result of age. In other words, testing is the only way to be sure whether or not you have a problem with your prostate and whether or not the problem is cancer. Compared with other types of cancer, prostate cancer is often slow growing, sometimes to the point where a man may not ever require treatment for it in his lifetime. Most men that develop this type of cancer live many years without ever having the cancer detected. That being said, it is important to get tested early and often so that if you do develop prostate cancer, the appropriate action can be taken. Typically the first symptom of prostate cancer is difficulty urinating, or blood in the urine. But again, symptoms dont always present themselves in cases of prostate cancer, especially in the early stages. Testing is the best way to be sure of a diagnosis. See the Prostate Cancer Testing & Diagnosis for more information.

cancer, however, there are some factors that seem to increase the risk of developing it. Age is the strongest risk factor for prostate cancer. The chance of getting it goes up quickly after a man reaches age 50. And, almost two out of every three prostate cancers are found in men over 65.2

It is not known why, but prostate cancer is more common in men of African or Caribbean descent. It is also more common in North America and northwestern Europe than it is in Asia, Africa, Central and South America. A family history of prostate cancer is another factor that can increase the risk of developing the disease. If your

WHO GETS PROSTATE CANCER?

There is no single cause of prostate

father or brother had prostate cancer, or you are of African or Caribbean decent, the you may be advised by your doctor to get tested by age 40.3

When Does Prostate Cancer Happen?

You may be wondering at what time in your life should you be on the lookout for prostate cancer. Generally, men, once they turn 40, should contact their doctors about having an initial prostate-specific antigen (PSA) test, which is a simple blood test. This kind of test provides a baseline number/score for comparison in the future. It lets your doctor know what is a normal number for you, and then when that number changes, your physician can assess whether it is due to prostate cancer, some other prostate complication, or the regular enlargement of the prostate that occurs with age.

Men who eat a lot of red meat or high-fat dairy and have diets generally high in fat, also seem to have a greater chance of getting prostate cancer. Obesity, lack of physical activity, and working with a metal called cadmium are currently being studied as possible risk factors. Its important to remember that it is possible to develop prostate cancer even when none of the risk factors are present. Testing for it is the best way to be sure prostate cancer is or is not present. See the Prostate Cancer Testing & Diagnosis pamphlet for more information.

If there appears to be no issue with your PSA numbers, your doctor need only repeat the test once every five years until you turn 50. If you are over 40 and have not yet had a PSA test, talk to your doctor about arranging to have one done and whether or not the cost of the test is covered in your province. A digital rectal exam (DRE) is another quick screening test your doctor is likely to perform. Your physician will feel the size and shape of the prostate by inserting a gloved and lubricated finger into the rectum. The whole prostate cannot be felt during this exam, but the area where most prostate cancers are found, can be. A healthy prostate feels soft, rubbery, smooth, symmetrical, regular and even. Any signs of lumps, hard, woody or irregular areas of the prostate, may indicate the presence of prostate cancer and will require further testing. Men over 50 should consider being tested every year in order to catch prostate cancer in its earliest stages.

that concern the prostate with symptoms similar to prostate cancer, but that are not cancerous. The following describes some of the most common non-cancerous prostate conditions.

Prostatitis
This is an infection or inflammation of the prostate. It is not cancer. Nor is there evidence that it leads to cancer. Prostatitis can be categorized as acute or chronic and is either bacterial or nonbacterial. Treatments can include antibiotics and anti-inflammatory drugs.

Benign Prostatic Hyperplasia (BPH)

BPH is an overgrowth of cells in the prostate but is non-cancerous. Essentially it is an enlarged prostate, found in many older men. Some men wont experience any symptoms with this condition. Other

Why Is Testing Important?

It is important to get tested for prostate cancer, as there are other conditions

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men may find that their urine flow is reduced or stops altogether due to the enlarged prostate squeezing the urethra. This can lead to a gradual loss of bladder function. BPH can be treated with changes to diet and lifestyle, in addition to medication and/or surgery.

not seem to increase a mans risk of developing prostate cancer. However, high-grade PIN is sometimes considered a pre-cancerous condition. That doesnt necessarily mean that prostate cancer will develop. It does mean that men with this condition need to be monitored closely for prostate cancer. Biopsies are quite common in order to monitor this condition.

Prostatic Intraepithelial Neoplasis (PIN)

In the case of PIN, there is abnormal and uncontrolled growth of prostate cells. It is not a cancerous condition. The growth of these cells is contained to the ones that line the external and internal surfaces of the prostate gland. The most abnormal cells are classified as high-grade PIN and the ones that appear almost normal are classified as low-grade PIN. Low-grade PIN does

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Where Can I Learn More?

For more information on prostate cancer, please contact:

Tel: 416-441-2131 Toll-free: 1-888-255-0333 prostatecancer.ca

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Educational material made possible by AstraZeneca Canada Inc.

References:
1. Schellhammer PF. An evaluation of bicalutamide in the treatment of prostate cancer. Expert Opin Pharmacother 2002;3(9):1313-1328. 2. American Cancer Society. www.cancer.org. Accessed June 2010. 3. Canadian Cancer Society. www.cancer.ca. Accessed April 2010.

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Prostate Cancer Canada

prostatecancer.ca 1 888 255 0333