When the male equipment fails

MARK NICHOLS February 22 1999

When the male equipment fails

MARK NICHOLS February 22 1999

Confronting the menace



Prostate cancer, the most common form among men, is spawning a network of support groups

Fred Norris’s words bring a smile to the young woman’s face. “I golf all summer, curl all winter and bowl twice a week,” says the 73-year-old former purchasing manager for a Montreal-based engines manufacturer. “What more could I do?” He and the woman, a nurse in her early 30s, spoke during a break in a recent meeting of a prostate cancer support group in the Toronto suburb of Brampton. She was there for the first time—her 65-year-old father had just been diagnosed with the disease, which kills about 4,300 Canadian men a year, second among cancers only to lung cancer’s toll of 10,600 annually.

Norris, who had his prostate removed in 1993, has been to dozens of meetings and has become practised at offering encouragement.

But he hasn’t forgotten the horror of being diagnosed. “I went home,” he says, “and my wife said,

‘How did it go?’ I said, ‘I’ve got prostate cancer,’ and I sat at the kitchen table and cried.”

That shock is becoming commonplace for men in their late 40s and older. According to the Toronto-based Canadian Cancer Society, more than 16,100 men were diagnosed with prostate cancer last year, up 25 per cent from five years earlier. And although it is not the leading killer, cancer of the prostate—a walnut-sized gland that produces a fluid used to carry semen—is now the most common form of cancer among men. Medical experts say it will only become more prevalent as the population ages because the disease primarily affects older men. “Once you hit 50, you’re in the high-risk group,” says Paul Rennie, director of the prostate research laboratory at Vancouver General Hospital. “There’s going to be a tremendous number of men crossing that age barrier in the next few years.” Increasingly, men going through treatment and those who have survived are turning to each other for support. Over the past five years, 80 prostate cancer groups have

sprung up across the country. Most meet monthly and give men a forum for sharing experiences, coping with fears and discussing what are frequently life-altering treatments. Prostate tumours, which are fed by male sex hormones, can be surgically removed or bombarded with radiation if detected early. Tumours that have spread to surrounding tissue can be treated only with drugs that suppress the hormones. In each case, impotence is a common side-effect. Many doctors recommend routine checkups for the disease, including the somewhat controversial PSA (prostate specific antigen) tests, which

measure the levels of factors that a diseased prostate releases into the blood stream to stimulate the immune system.

The support group movement is also producing prostate activists—survivors who are becoming more organized and vocal. Their objective: more government spending on research. Craig Asmundson, 51, a lecturer in kinesiology at Simon Fraser University in Burnaby, B.C., who was diagnosed ill 1996 and opted to have his prostate rémoved, argues that research funding for thè disease should be on the level of that for breast cancer, which is diagnosed in about

19,000 women, and kills 5,300, each year. Between 1993 and 1998, Health Canada and various private agencies, such as the cancer society, put $39 million into breast research. Last June, Health Minister Allan Rock promised another $45 million over a five-year period. By comparison, funding for prostate research over the past five years totalled $14 million. Last March, the Toronto-based National Cancer Institute promised another $3.8 million over three years. “There’s a major inequity here,” says Asmundson. “They’re not putting enough money into a disease that may kill me.”

Last November, Wally Seeley and two other representatives of the Canadian Prostate Cancer Network, a coalition of support groups, put their case to federal deputy health minister David Dodge, so far to no avail. ‘With sufficient money, we can probably beat this disease,” says Seeley, 64, a retired businessman from Lakefield, Ont., 125 km northeast of Toronto, “and we’ve got government sitting on its fanny.”

The federal health department, as well as funding agencies such as the Ottawa-based Medical Research Council, have traditionally avoided putting money into the study of specific types of cancer. Instead, they have supported basic or generic research on the grounds that any breakthroughs could be applied to all forms of the disease. But scientists like Rennie say findings from basic research are rarely applicable to prostate cancer because it has unique characteristics—the tumours are generally slow growing and their development is dependent upon male sex hormones. “That’s why we haven’t had any major advancements in treatment for 50 years,” he says. “The only way to deal with prostate cancer is to focus on the disease itself.”

The biggest development in recent years, medical experts say, has been the more effective detection resulting from the use of PSA testing since the early 1990s. The test is done after a

physician examining the rectum with a finger detects a hardening or nodules on the prostate indicating the presence of a tumour. A simple blood test measures the levels of antigens that a tumorous gland releases to alert the body’s immune system. “The PSA test is the single best tumour detector in all of cancer,” says Dr. Martin Gleave, a urologist at Vancouver General Hospital and a leading prostate researcher. “There is evidence to show that when the cancer is detected early, treatment can be very effective.”

Many physicians now support widespread used of PSA testing. Some, like Dr. Laurence Klotz, a urologie surgeon at Toronto-Sunnybrook Regional Cancer Centre, recommend that men in their 40s be tested if there is a family history of the disease. Otherwise, examinations should be done every two years between the ages of 50 and 70. Beyond that, there is much less urgency because any man developing prostate cancer at that age is likely to die of other causes before the slowgrowing tumour becomes terminal.

But some physicians question the value of widespread and regular screening. For one thing, patients can be needlessly alarmed because cancer is present in only one of three cases of elevated PSA levels. That is because the prostate also releases antigens as a result of a viral infection or hardening that occurs with aging. Dr. Peter Venner, a medical oncologist at the Cross Cancer Institute in Edmonton, points to a more basic problem with the tests. There is no conclusive evidence, he says, that early detection and treatment leads to a longer or more satisfactory life. Many men live with the disease for years without serious consequences because the tumour grows so slowly and does not always spread to surrounding tissue, says Venner. Yet most patients who are diagnosed will choose to be treated and accept the side-effects.

Doctors admit that the debate over the effectiveness of early detection will not be resolved quickly. But in prostate support groups across the country, there are survivors who made up their minds long ago. “I was just bloody lucky it was detected early,” says Asmundson, who was diagnosed after experiencing mild but unrelated pain in the pelvic area. And there is one other thing that many survivors agree on: the value of the support groups. “There’s no substitute to talking to other men,” adds Asmundson. “It’s not uncommon for new guys to say, ‘Oh, God, this has been great. I’m so glad I talked to you guys.’ ” □