Charlie Taylor wasn’t nervous walking into his doctor’s office that day. In fact, he was certain that the biopsy results would show no signs of prostate cancer that told his wife to wait for him outside the clinic. He had no reason to doubt himself: he was in good health, enjoying a career in automotive sales that required frequent travel across the country, and had only recently retired from his side gig as a basketball referee.
Taylor didn’t have any symptoms of the disease that affects about one in eight men, according to the Canadian Cancer Society. In fact, at the time of diagnosis, he was on a health kick – he had dropped 50 pounds and was feeling great. But over the course of three years, his blood work showed that his prostate-specific antigen (PSA) levels were steadily rising. Elevated or fluctuating PSA levels in the blood may indicate prostate cancer, but it can also be attributed to age and several benign conditions, including a urinary tract infection.
A PSA test can help save someone’s life, but even if cancer cells are detected in the prostate, it doesn’t necessarily mean that treatment is required. While the majority of people choose to have surgery or radical prostatectomy, and in some cases radiation, the reported side effects of treatment can significantly impact quality of life.
One such side effect: urinary incontinence. Most people do regain urinary control within a year after surgery, but one in five males may require bladder control pads on a long-term basis. Similarly, about 40 per cent of people may lose some erectile function, as any trauma to the area can impact sexual function. And those with advanced prostate cancer that has spread to the rectum may have permanent damage to bowel function, though less than one per cent of males experience this.
Dr. Daniel Vesprini, radiation oncologist at Sunnybrook Health Sciences, recommends annual PSA testing at age 50 or at age 40 if there is a genetic predisposition or family history of the disease – an annual digital rectal exam is another tool available to detect prostate cancer. He says that two decades ago, the controversy around PSA testing – two studies showed that it could lead to overdiagnosis and overtreatment – caused a “big lull in PSA testing” and in prostate cancer diagnosis in Canada. The decline in early detection wasn’t so problematic for those with early stage cancer or cancer that did not require any treatment, but was detrimental and deadly to males with advanced or metastasized cancer that has spread to other parts of the body, usually in the bones.
Vesprini recommends that people speak with their healthcare provider about the benefits and limitations of PSA testing. Starting cancer screening by age 50 mean can mean early detection, and “active surveillance of the disease,” which is being implemented at Sunnybrook Health Sciences, can save lives, he says.
A new report published by the Canadian Cancer Society appears to echo this sentiment and reveals that prostate cancer deaths have dropped by 50 per cent since its peak more than two decades ago, thanks to research, early detection and life-saving treatments.
“Precision surgery and targeted radiation treatment have played a major role in helping to cut the prostate cancer death rate in half,” says Elizabeth Holmes, senior manager of policy and surveillance at the Canadian Cancer Society. “Over the last 10 years, the Canadian Cancer Society, the former Prostate Cancer Canada that we amalgamated with, and the Movember Foundation have invested over $130 million in research focused on prostate cancer treatment and early detection.”
She says that ensuring equitable access to information, support and PSA testing as well as investing in research that focuses on early detection, better treatment, and survivorship can help people live better with and beyond prostate cancer. Ontario and British Columbia have yet to commit to cover the $30 cost of a PSA test under the provincial health plan, whereas other provinces and territories already cover the cost with physician referral.
“No one should have to pay for the test out of pocket when they have a referral,” says Holmes.
Taylor had lost his father to prostate cancer, only six weeks after diagnosis. When his own urologist shared the biopsy results, he wondered whether he would to make it to meet his first grandchild, whose due date was later that year.
Taylor went ahead with surgery. For the next six months, he completed a PSA blood test every six weeks to determine whether the cancer required further treatment. It didn’t. He felt relieved but anxious about the recovery process, and he worried about the possibility of erectile dysfunction or incontinence.
“You look at all the side effects and you have concerns,” he says. “After my surgery and some of my recovery, I reached out to a support group where I got to meet men my age and older.”
Taylor felt more at ease talking openly with others who were going through a similar experience. A year into his recovery, he was asked to lead the support group. He spent three more years in that role before “passing the baton” to someone else.
It’s been eight years since Taylor was first diagnosed with prostate cancer. He is still under the watchful eye of his healthcare team, undergoing yearly PSA testing, which continues to show stable levels and no detectable cancer. He has made some changes in his life since his diagnosis: he still enjoys his career but works less than he used to, and is spending more time with family and friends, including his three grandchildren. He’s also dedicated to raising awareness about the importance of early screening.
“Men don’t like talking about their health, especially if it’s below the belt,” says Taylor. “It’s so important to get the message out: get checked, because the alternative is not that great. You can live with the side effects, but if you don’t get checked, you’re not going to be around.”