After losing his wife in January, Toronto retiree David Hastings thought things couldn’t get much worse. But when Hastings, 56, went for a regular checkup with his family doctor, it was discovered that his prostate specific antigen (PSA) blood levels were triple the normal range. Soon, he was facing a diagnosis of cancer. Now, he is all too aware of the importance of regular screening.

“I had my first PSA [blood] test about four or five years ago, but never got around to repeating it,” says Hastings. “If I had gone every year since then, they probably would have seen my PSA levels climbing and caught it earlier.”

Early detection and improved treatments, as with many cancers, are among the reasons that prostate cancer death rates have declined significantly since 1995. According to a report from the Canadian Cancer Society, mortality rates declined by 2.9% a year from 1995 to 2004.

“Most men hear so many things about prostate cancer and the stigmas attached to it that they tend to avoid having the checks done,” says Leah Jamnicky, urology clinical co-ordinator at the University Health Network in Toronto and co-author of the Canadian Guide to Prostate Cancer. “The simple screening of the DRE [digital rectal exam] and PSA tests helps us to diagnosis them early — and the earlier you are diagnosed, the more treatment options you have.”

Prostate cancer is one of the more treatable cancers. Yet, it is still the second most common cause of cancer deaths among men, after lung cancer. In 2008, an estimated 24,700 Canadian men will be diagnosed with prostate cancer and an estimated 4,300 will die from the disease, according to the CCS. Prostate cancer also tends to develop slowly, making it more common among older men. The lifetime risk factor is now calculated at one in seven Canadian men. But while that rate is high, the typically slow course of the disease’s development means that it can often be cured.

Still, it’s crucial to spot it early. Prostate cancer, which starts in the cells of the prostate gland, may not show any signs or symptoms until it is well developed. It may even be present despite negative DRE and PSA tests. Symptoms may appear if the tumour makes the prostate larger than normal, causing it to press on the urethra. That in turn, can make passing urine more difficult, painful or more frequent. Signs and symptoms of prostate cancer may also include an intense need to urinate; difficulty in starting or stopping the flow of urine; inability to urinate; weak, decreased or interrupted urine stream; a sense of incompletely emptying the bladder; burning or pain during urination; blood in the urine or semen; or painful ejaculation.

Symptoms should not be ignored and tests are usually required to determine the cause. Most enlargements of the prostate gland are not cancer, and even PSA levels higher than usual can be for reasons other than cancer. Benign prostatic hyperplasia, urinary tract infections or a recent prostate biopsy can all cause test results to come back with higher PSA levels.

Men over the age of 50 should discuss the possibility of being tested with their family doctors. There is no single cause of prostate cancer, but there are factors that appear to increase the risk: if you have a family history of prostate cancer, are over the age of 65 or are of African ancestry. If you are among those at high risk, then you should start discussions with your doctor at the age of 40.

“Certainly, overall deaths have been decreasing from prostate cancer,” says Heather Campbell, senior manager, cancer control policy, for the CCS. “That is probably due mostly to improvements in treatment, detecting it earlier and men being more aware of changes in their bodies.”

For those men who are diagnosed with cancer, there are various treatment alternatives. Active surveillance, removal of the prostate, radiation therapy, hormonal therapy and chemotherapy are all options. Support and therapy groups are also widely available. The CCS provides a cancer connection service that helps patients deal with the struggles that may lie ahead for them during treatment.

Hastings, for his part, continues to fight six months after he was diagnosed: “I was prepared for what lay ahead, and I figured nothing could be as bad as losing my wife. So, I just said to the doctor, ‘What do I have do? Because I’m prepared to do it’.”

@page_break@In May, Hastings had surgery to remove his prostate and received news that cancer cells had been found on the outside of the prostate. In addition, his PSA levels had not dropped to a safe level. It was not the news he was hoping for, but he has decided to proceed to radiation therapy. His treatment will be complete at the end of October. IE