Men’s Cancers
Living with Prostate Cancer: The Mental Battle
With September’s arrival, a new season can feel like a fresh start, but it also represents an annual opportunity to recognize one of the most common cancers impacting men globally.
In Canada, one in every nine men will be diagnosed with prostate cancer in their lifetime. Like many cancers, prostate cancer’s physical effects on the body can be detrimental, but men’s health charity Movember is reminding Canadians that it’s equally important to recognize the impact a prostate cancer diagnosis can have on a man’s mental health.
Many men continue to struggle with the concept of vulnerability, particularly so for older generations of men (aged 45 and over),
who represent the demographic most at risk of developing prostate cancer. Prostate cancer strips patients of their physical health, but the symptoms associated with the disease — erectile dysfunction, incontinence, and weight gain — can also contribute to feelings of depression and anxiety. For men who grew up during a time when they were expected to stay “strong and silent,” the mental health impacts can be some of the hardest to face.
September may be prostate cancer awareness month, but it also offers an opportune time to check in with the men in your life — not just reminding them to keep an eye on their physical health but to prioritize their mental health as well. By fostering an open and supportive environment, we can better support the men we love — whatever battle they may be facing.
In Canada, one in every nine men will be diagnosed with
Sonya Friesen, Movember Canada
Colorectal Cancer Screening Saves Lives – but How Soon Should You Start?
Health care experts now recommend that people at average risk for colorectal cancer begin screening at the age of 45.
Dr. Reid M. Ness
Associate Professor of Medicine, Vanderbilt-Ingram Cancer Center & Chair, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Colorectal Cancer Screening
Colorectal cancer (CRC) is the third most common cancer worldwide. According to the Public Health Agency of Canada, 1 in 14 Canadian men is expected to develop CRC within their lifetime, and more than 5,000 die from the disease every year (numbers are slightly lower for women).i
Yet, CRC can be one of the most preventable and treatable cancers thanks to screening.
The National Comprehensive Cancer Network® (NCCN®) publishes evidence-based expert consensus guidelines
that are used worldwide. It’s one of many health organizations that have recently moved the screening age for CRC to start at 45 in response to a small-but-significant increase in CRC cases in people under the age of 50.
Screening options include visual screening (such as a colonoscopy) and stool-based screening (such as a fecal immunohistochemical test [FIT]). These screening options are all effective for detecting CRC but have different levels of cost and invasiveness, and so people should talk with their doctor about which method is best for them.
Navigating Your Bladder Cancer Journey Together with BCC
Bladder Cancer Canada arms Canadians with the tools they need to navigate their cancer journey.
Rob Truscott’s cancer journey began with a routine medical visit when his doctor noticed an unusual reading. After going through a variety of tests, he was finally sent to Edmonton, Alta., where his urologist advised him to undergo emergency surgery, removing a large tumour from his bladder. A month later, he was diagnosed with high-grade Stage 1 bladder cancer. He was 43 at the time.
Bladder cancer is the fifth most common cancer in Canada and the fourth most common among men. Despite the median age of diagnosis being 72, younger Canadians between the ages of 20 and 40 are being diagnosed more frequently.
Bladder Cancer Canada (BCC) is a patient advocacy organization dedicated to driving awareness of bladder cancer. The organization offers educational resources and provides free programs and supports aimed at helping bladder
Recent data modelling suggests that lowering the screening age to 45 increases the number of life years gained across all screening methods.ii However, more than half of patients who develop CRC before age 50 start having symptoms even younger. Therefore, anyone experiencing iron deficiency anemia, rectal bleeding, or a concerning change in bowel movements should undergo a colonoscopy no matter their age. People with a personal or family history of CRC, ulcerative colitis, Crohn’s disease, or cystic fibrosis are considered at increased risk — and those with Lynch syndrome or inherited polyposis syndromes are at even higher risk — and should also begin screening sooner.
CRC screening is one of the most effective cancer prevention tools we have. I encourage everyone to learn more about their own risk and to work with their health-care team to figure out which screening approach is the best for them.
For more information, view the free CRC Screening guide at NCCN.org/patientguidelines
REFERENCES
https://www.canada.ca/en/public-health/services/chronicdiseases/cancer/colorectal-cancer.html
ii Peterse, Cancer 2018;124:2964-73
cancer patients and their families or caregivers feel less alone in their cancer journey. From initial diagnosis to coping with emotions surrounding it, BCC arms Canadians with the knowledge and awareness to better understand bladder cancer and the means to get diagnosed sooner.
From a discussion forum moderated by expert volunteers to a One2One Peer Support service that matches patients with a peer support volunteer, BCC’s funding allows for it to offer these programs free of charge. The support BCC provides and the awareness it creates through annual fundraising events have played a critical role in changing the conversation around bladder cancer.
Visit bladdercancercanada.org today to find out how your donations can fund life-saving research and help ensure BCC’s programs and services remain free.
Steve feels the support. So do Matteo and Alex. 80,000 bladder cancer patients across Canada feel it too.
Funding support groups, information-rich resources and life-saving research, your donation helps make a meaningful and lasting impact in the lives of patients and their families.
Sonya Friesen
Empowering Prostate Cancer Patients When It Comes to Treatment Options
Prostate cancer patients face a challenging journey, but the good news is that they have options when it comes to treatment.
Tania Amardeil
Prostate cancer significantly impacts Canadians. It’s the most common cancer among Canadian men (excluding non-melanoma skin cancers) and the third leading cause of death for Canadian men with cancer. However, prostate cancer patients have various treatment options available at different stages of the disease, which is both encouraging and empowering.
A range of treatment options
Different treatments are available for patients at each stage or state of prostate cancer. “The disease states of prostate cancer are critical because we have different clinical trials based on different disease settings,” explains Dr. Krista Noonan, a medical oncologist at the BC Cancer Agency and Clinical Assistant Professor at the University of British Columbia. “I often discuss the evolution of prostate cancer along a timeline with my patients and chat with them about what we call the localized and advanced settings.”
In early-stage prostate cancer, the tumour is localized, meaning it's only in the prostate. In more advanced stages, the cancer spreads to varying degrees. There are also different types of prostate cancer. The most common type is adenocarcinoma, and rarer subtypes
Early-Stage Prostate Cancers
Treatments include:
• surgical removal of the cancer with radical prostatectomy
• radiation therapy
• active surveillance treatment
include urothelial (transitional cell) carcinoma, squamous cell carcinoma, and small cell (neuroendocrine) carcinoma. Regardless of the type of prostate cancer, your specialist will discuss the appropriate treatment for you. For early-stage prostate cancers, the recommended treatments include surgical removal of the cancer with radical prostatectomy, radiation therapy, or active surveillance (monitoring frequently) without immediate treatment. For advanced stages, treatments may include androgen deprivation therapy (also known as novel hormone therapy), chemotherapy, radiopharmaceuticals (drugs that contain radioactive elements), and targeted therapy (drugs that zero in on cancer cells).
Understanding patients’ priorities
These treatment options — including new medications and personalized treatments — give more hope to prostate cancer patients for a longer and better-quality life. Doctors work with patients to select the best course of treatment based on the stage of the disease and the patient’s unique priorities.
Dr. Noonan stresses the importance of maintaining open dialogue and shared deci-
Advanced Prostate Cancer
Treatments may include:
• androgen deprivation therapy
• chemotherapy
• radiopharmaceuticals
• targeted therapy
sion-making. “Whenever I meet a patient, I like to hear what their goals of care are,” she says. “Oftentimes, as oncologists, we look at the data and determine ‘obvious’ goals, such as eradicating the cancer for localized disease or, in cases of advanced disease, extending length or quality of life. But everyone is different, and we should never assume.”
Dr. Krista Noonan Medical Oncologist, BC Cancer Agency & Clinical Assistant Professor, University of British Columbia
Patients can work with their health-care practitioner, caregivers, and loved ones to determine the course of treatment that’s best for them. When making a decision, they’ll want to consider their desired lifestyle and goals, including activity level, energy level, and sexual function, as well as potential drug interactions and side effects.
For Charlie Taylor, who was diagnosed with prostate cancer at age 50, what mattered most was being able to be there for his family. “Our daughter told us we were expecting our first grandchild,” he says. “My doctors were all very open and easy to talk to. They explained the treatment options, and I opted for surgery.”
If you or a loved one has been diagnosed with prostate cancer, talk to your doctor about the treatment options available and what things are most important to you and your caregivers. There are many resources available for patients and caregivers to find out more about stages of disease and treatment options, like procure.ca
Charlie Taylor (second from left) and his family.
Advancements in Bladder Cancer Treatment Are Providing Hope
Bladder cancer is the fourth most common cancer in men. It’s important to know the early signs and talk to your doctor.
Many men notice urinary symptoms as they age, such as needing to go to the bathroom more often or feeling like their bladder doesn’t completely empty. While these symptoms may indicate an enlarged prostate, a common condition for men as they age, they can also be a sign of bladder cancer.
“Men may assume that these symptoms are a normal part of aging and just live with them, but it’s always important to talk to your doctor about any new symptoms and advocate for yourself. Men should ask about their bladder health and prostate health,” says Dr. Nimira Alimohamed, a medical oncologist at the Tom Baker Cancer Centre in Calgary.
Knowing the risk factors
In Canada, bladder cancer is the fourth most common cancer among men and the eighth most common cancer among women.i It most commonly occurs in men in their 70s. Dr. Alimohamed says that it’s not known why bladder cancer is more common in men, but it’s likely due to hormonal factors. Other risk factors include smoking and exposure to certain chemicals that are commonly used in the textile and paint industries.ii
The most common early sign of bladder cancer is blood in the urine. Other signs include urinating more frequently, urinating small amounts often, not emptying the bladder, and feeling a burning sensation when urinating. Signs that could indicate that bladder cancer has spread to other parts of the body include back pain, pelvic pain, loss of appetite, unexplained weight loss, and fatigue.iii
Knowing the treatment options
“Treatment for bladder cancer depends on the type and stage,” says Dr. Alimohamed. “Early-stage bladder cancer, which has not gone beyond the first layer of the bladder wall, is treated with Bacillus Calmette-Guerin (BCG), which is an immunotherapy injected into the bladder. In advanced disease, where the cancer has gone into the bladder muscle, the patient’s bladder is removed, or they’re treated with chemotherapy and radiation.”
mechanism. Your body can then recognize the cancer as being foreign and work to find and attack the cancer cells.
A growing understanding of the disease
Dr. Nimira Alimohamed, Medical Oncologist, Tom Baker Cancer Centre
We’re seeing long-term survivors — it was rare to see that a few years ago. Immunotherapy is providing a lot of hope and optimism.
Dr. Alimohamed says that patients who stabilize after chemotherapy are treated with maintenance immunotherapy. Patients who aren’t responding to chemotherapy may also be treated with a different immunotherapy. Cancer grows by evading the body’s own immune system and figuring out how to hide from it. Dr. Alimohamed explains that immunotherapy unlocks that hiding
“We’ve come a long way in the options that we have to treat bladder cancer in all stages, but also in our understanding of the disease. There are a lot of research studies and clinical trials happening in this area. So, hopefully, we’ll have even better treatments in the future. That’s really encouraging,” says Dr. Alimohamed. “Immunotherapy has helped patients live a lot longer. In some patients, we’re seeing a complete response, where we can’t see any evidence of cancer that’s active on imaging and the patients are doing very well. We’re seeing long-term survivors — it was rare to see that a few years ago. Immunotherapy is providing a lot of hope and optimism.”
Talk to your doctor about treatment options.
REFERENCES
i Bladder Cancer Canada, https://bladdercancercanada.org/ en/bladder-cancer-facts/
ii Canadian Cancer Society, https://cancer.ca/en/cancerinformation/cancer-types/bladder/risks
iii Canadian Cancer Society, https://cancer.ca/en/cancerinformation/cancer-types/bladder/signs-and-symptoms
Abigail Cukier