Annual prostate exam important especially for older men

By Dr. Chris J. Morgan Friday December 02 2011 in Family
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November is increasingly becoming known as Movember. If you have noticed thicker, longer, perhaps more scruffy-looking moustaches and goatees on the faces of the men around you, they may be participating in Movember, a month dedicated to increasing awareness of men’s health, specifically prostate cancer, in part by men committing to grow their moustaches for the month of November.


Prostate Cancer Canada (PCC) and The Movember Foundation (TMF) are the men’s health partners of Movember in Canada.


The Canadian Movember initiative started in 2007 and, together, PCC and TMF raised $545,000 across Canada in the first year. Last year, the Movember campaign saw over 100,000 participants and was able to raise $22.3 million for prostate cancer research, education, support and awareness initiatives.


I only became aware of Movember last year, near the end of the month, and I did not notice a significant impact or exposure in the Black community. This year, I did notice greater participation in the general population but, still, not much change in the Black community.


Nonetheless, men’s health issues deserve a spotlight. Any initiative that increases awareness around men’s health and, in particular, actively gets men involved in discussing and informing themselves about their health with the goal of affecting health behaviour, is noteworthy.


A good place to start is prostate cancer. Prostate cancer rates in men are comparable to breast cancer rates in women, yet there is not nearly enough public education about the disease. Cancer generally describes a situation of uncontrolled cell growth. The cells of our body are continually going through a cycle of cell division, growth and death. Cancer actually grows out of normal cells in the body. Cancer appears to occur when the growth of cells in the body is out of control and cells divide too quickly or when cells forget how to die.


Cancer can occur in practically any tissue or part of the body. Prostate cancer occurs when cells in the prostate start to grow uncontrollably. In general, men with prostate cancer have several small tumors (clusters of abnormal cells) in the prostate.


The prostate is actually a gland located just below the bladder and behind the rectum (anus). It helps to control urine flow and contributes 20-30 per cent of the seminal fluid (semen) volume during sexual activity. The prostate gland continues to grow throughout life, but its growth typically slows down by age 25. Most men will have some form of prostate problem during their lifetime. Men under 45 may develop prostatitis which is inflammation of the prostate. Older men will typically experience Benign (non-cancerous) Prostatic Hyperplasia (BPH), or enlarged prostate.


According to Prostate Cancer Canada, prostate cancer is:


The most common cancer among Canadian men – it will afflict one in seven men and is a greater threat for those with a family history of the disease.

Turning up in men in their 40s.

Going to be diagnosed in about 25,500 men this year, not including cases that go undiagnosed due to men’s unwillingness to go for annual check-ups.

Develops as a result of dietary, environmental and heredity factors (more research is needed to identify its causes and prevent the disease).

New, preliminary research suggests pharmaceuticals may help prevent prostate cancer in men at high risk of the disease.

Often without symptoms in its earliest, most curable stage – making annual testing ever more important.

Treated by surgery, radiation and hormone therapy (among other treatments).

Thought to be a potentially preventable cancer in many cases, but more research is needed.


*Symptoms may include slow or painful urination, blood or pus in the urine, painful ejaculation and pain in the lower back or abdomen, pelvis or upper thighs. If experiencing any of these symptoms, please consult a doctor immediately.


Risk Factors


Ethnicity: According to PCC the disease is most common and deadly among those of African or Caribbean heritage, followed (in order) by White non-Hispanics, White Hispanics, Asians and Pacific Islanders, and Native Americans. Based on U.S. research, men of African or Caribbean heritage are 65 per cent more likely to develop prostate cancer than Caucasian-American men, and the risk of a man of African or Caribbean descent dying of prostate cancer is about 100 times that of a Chinese man living in China.


Further, some research suggests several genes that put men at a greater risk of developing prostate cancer are found more predominately in Blacks than Caucasians, and in Caucasians more than Asians. A nation-wide study is being carried out in the U.S. by the African-American Hereditary Prostate Cancer Study Network to find the gene(s) that put Black men at higher risk and to determine if heredity plays a role in the higher incidence of the disease in Blacks.


Family History: Like most diseases, if you have a family member – father, brother – with prostate cancer your risk increases. In fact, 10 to 15 per cent of men with prostate cancer have a family history of the disease. Men with a family history tend to develop prostate cancer at an early age (under 55 years old).


Age: Prostate cancer risk increases with age. It is rare under 40; over 80 per cent of cases are in men over 65 years of age.


Diet: Most evidence suggests that a high-fat – especially animal fat – diet increases the risk of prostate cancer.


Other Factors: Exposure to lead or insecticides – and obesity – are risk-increasing factors. There is some speculation that small differences in hormone levels, like testosterone between races, may predispose some groups to the disease.


Prostate Cancer Screening Tests: One of the most common methods for prostate screening is the PSA blood test. PSA stands for prostate-specific antigen. It is a protein produced by prostate cells. An enlarged prostate, or a prostate with cancerous cells, will produce elevated levels of this protein. Historically, there has been much debate over the effective interpretation and application of PSA tests results. However, most authorities recommend PSA screening and monitoring as an indicator of change in prostate gland function. In Ontario and in most Canadian provinces and territories, PSA is covered as a screening tool.


It is important to note that a single elevated PSA result does not confirm a diagnosis of prostate cancer. In fact, change over time may be a better indicator, which implies routine screening is critical, especially if one is over 40 and has other risk factors.


In addition to an elevated PSA result or a significant increase since the last PSA test, a manual or digital rectal exam (DRE) to palpate (feel) the prostate may be performed by a physician. In this case the physician uses his/her finger to feel the prostate gland for firmness, size and pain. If the PSA tests and the manual exam are of concern, a patient would be advised to get a biopsy, which is considered the gold standard for diagnosis of prostate cancer.


Good news and bad news: The good news is that, in most cases, prostate tumors grow relatively slowly. It usually takes years for tumors to become large enough to be detectable and it takes even longer for them to spread out of the prostate. This is why I have heard it said that more men die with prostate cancer than from prostate cancer.


The bad news is that a small number of men have aggressive prostate cancers that grow and spread quickly. At diagnosis, it is tough to know which category a man falls into and this can make treatment decisions hard.


Treatment: In the early stages, when the cancer cells are only in the prostate, the disease is very curable (cure rates of 90 per cent or better) with surgery or radiation. According to PCC, the expected 15-year survival for patients with prostate cancer confined to the prostate is about 80 per cent following radical prostatectomy (surgical removal of the prostate), 65 per cent following radiation, and 50 to 60 per cent with watchful waiting.


Unfortunately, during the early stages of prostate cancer there are few symptoms. In fact, many men in the early stages of prostate cancer have no symptoms at all. Without regular testing (PSA and DRE), it is very difficult to find early stage prostate cancer.


If untreated, prostate cancer cells can spread to other parts of the body and produce secondary tumors (metastases). At this point, the chances of a cure are much lower. Prostate cancer can spread to any part of the body but common areas for spread are bones (in particular the spine) and lymph nodes.


Debate on the Prostate: Whereas not all the answers are known surrounding the prostate, becoming more informed of your risk factors, making sure you participate in prostate cancer screening, adopting the helpful preventative measures (diet and exercise), asking questions of your physician, attending health fairs, seminars or groups where prostate cancer is being discussed, will help you feel more comfortable and confident in making your health decisions.


I must state, however, as I encourage everyone to be better informed about prostate cancer (and health in general), there are significant weaknesses in our provincial health care system that we must overcome. For example, we currently do not know the answer to the following critical questions: How many men of African and Caribbean descent age 45 – 65 had a prostate cancer screening test (PSA and/or a digital rectal exam) in Ontario in 2010? How many of these men screened had positive test results? How many were referred to an urologist? How many had a biopsy? What was the outcome? What treatment was provided? How do the answers to these questions compare with men from other communities?


Until we have appropriate legislation that allows for the systematic collection of health data that includes information on race and ethnicity, for example, linked to the health card, we will never have the robust heath data needed to truly confirm how well (or not well) we are serving Ontarians of all backgrounds.


Next week: Prostate cancer awareness in the Black community.


Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or



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