Prostate Cancer

There are many known risk factors for cancer.  For example, smoking is estimated to be responsible for 30% of all cancer deaths and one third of cancers can be linked to diet, obesity and lack of exercise.   Incidence of cancer can be reduced through healthy lifestyle choices.  Learn more about cancer, how to reduce the risk, and take part in cancer screening programs.

Screening is available in North Bay through the North Bay Parry Sound Health Unit.

Availability: Local

This is the most common testing done to identify risk of prostate cancer and can be completed by your Family Doctor, Nurse Practitioner, or Urologist. A digital rectal exam (DRE) is a physical exam where the doctor uses a gloved, lubricated finger to check the prostate gland and determine if there are any lumps or bumps that might indicate cancer.

Availability: Local

PSA (prostate specific antigen) is a hormone in the blood that the prostate makes. There is no one number that absolutely indicates prostate cancer. So, we look for high numbers or a jump in your numbers between screening.

• Low PSA result: then there is a low risk that there is prostate cancer. Your primary caregiver will decide if you just continue to do screening in which case you may repeat the test in a couple of years.
• High PSA result: then it could indicate an infection,  a prostate cancer or an activity that impacts the prostate. This can be activities like snowmobiling, riding on your lawn tractor or biking where there is impact or pressure on the prostate. The PSA may be high for a short time afterwards. Based on the level of PSA your primary caregiver will decide what the next step is. This may be simply to repeat the blood test again or to arrange for more in depth testing or referral to a urologist.

Availaibility: Local - North Bay Regional Health Centre

A biopsy involves taking small samples of prostate tissue to check for cancer. It’s typically done if tests like the PSA or MRI suggest there is risk. Local freezing is used and the procedure is completed while the patient is awake. A prostate biopsy does carry a small risk of infection and for this reason typically antibiotics are provided.  Patients will be asked to reduce activity level for a few days following biopsy. If there is any evidence of infection (fever / chills / shakes) or significant bleeding then a person should seek medical attention immediately. 

Availaibility: Local - North Bay Regional Health Centre

These scans check if cancer has spread outside the prostate. They look at the soft tissues and bones. Both are imaging tests. CT scan and Bone scan are typically only ordered following the diagnosis of prostate cancer after a biopsy or in situations where the PSA blood test is so high that it is extremely unlikely that cancer is not present. 

Availaibility: Local - North Bay Regional Health Centre

This test may not always be required in the assessment of prostate cancer. 

Cystoscopy is done by a urologist and involves moving a camera through the urethra (pee pipe) to look at the urethra, the inside of the prostate, and the bladder.  This test can be helpful in assessing if the cancer is affecting the bladder or urethra. This test can also sometimes provide useful information as to why a PSA number could be high in the absence of cancer. 

Availaibility: Remote - Health Sciences North (Sudbury or down south currently)

An MRI provides detailed images of the prostate and can detect suspicious areas. It’s usually done if the PSA test or DRE show something abnormal. An MRI can help avoid unnecessary biopsies by identifying areas that need closer inspection. Your urologist will recommend whether or not this would be of value to you.

Availaibility: Remote - Health Sciences North (Sudbury or down south currently)

This is an advanced scan that uses a radioactive substance to detect prostate cells throughout the body. It helps doctors see if cancer has spread beyond the prostate. Your urologist will recommend whether or not this test would be of value to you. 

Availability: Local

For low-grade prostate cancers, immediate treatment might not be needed. Regular monitoring by your urologist with blood tests, exams, and sometimes repeating the MRIs and biopsies is essential to watch for changes.

Availability: Local & Remote

If cancer is confined to the prostate but is more aggressive, surgery to remove the prostate may be recommended. There are two main methods: open surgery and robotic surgery. Both have risks  including urinary incontinence (leaking) and erectile dysfunction. These may be temporary or permanent and have different treatment options.

Open surgery: availability local - North Bay Regional Health Centre

Robotic: availability remote - Ottawa or Toronto

Availability: Local - Health Sciences North Cancer Centre in Sudbury

Radiation therapy can treat prostate cancer by targeting cancer cells with high-energy rays. It can be done externally or by placing radioactive materials directly near the cancer (brachytherapy). Radiation therapy side effects may include: urinary incontinence (leaking), erectile dysfunction, inflammation of the rectum or bladder and strictures (narrowing of the pee pipe). This requires a referral from your urologist to a radiation oncologist.

Availability: Local & Remote

Since prostate cancer often relies on male hormones (androgens) to grow, hormone blocking therapy can slow its progression. In advanced cases, chemotherapy and other medications may be used. Hormone therapy alone doesn’t cure prostate cancer but slowing it down may be all that is needed. Cancers can become resistant to hormone therapy over time so monitoring is done to track the effectiveness of your treatment. These treatments are available locally in our district and are prescribed by your urologist.  

Continued research has continued to produce new specialized chemotherapy agents that may work better in specific situations. Your urologist may refer you to a Medical Oncologist if they feel you may benefit from these. These medications are often given in advanced (metastatic) prostate cancer. Medical Oncologists are available at Health Sciences North Cancer Centre in Sudbury or one of the major centres.

Availability: North Bay, New Liskeard

Pelvic floor physiotherapy (PFP) can be very helpful with urinary leakage.  This is where a trained pelvic floor physiotherapist helps to recruit and train the pelvic floor musculature to improve urinary control. There is very little risk to PFP but the success requires practice and work!. 

North Bay 

• Symmetrics: Ali Provost 
• Baas Physiotherapy: Kaili Baas

New Liskeard 

• Pelvic Health Solutions: Alyssa Macdonald

Online video resources can also be very helpful:

• Michelle Kenway (YouTube)

For some men, the use of disposable pads is the simplest solution to leakage. Disposable pads are available at grocery stores, pharmacies and walmart. They can also be ordered online. Sometimes irritation can occur with ongoing use of pads and a barrier cream can assist with this. 

A few of the options are: 

• TENA mens 
• Depend Shields for men
• Attends Guards for men

Cost can be a significant issue. Typically purchasing in bulk can provide cost savings.  

Coverage:

• ODSP - if you are on ODSP,  ask your ODSP caseworker for a Mandatory Special Necessities benefit request form. Have your doctor complete the form and return to your caseworker for approval.
• Private plans: will also provide coverage for incontinence products. Contact your insurance provider about what coverage they may have.

For other men, the option of protective underwear that is re-usable is another option. Again, there are many different products that exist on the market for this and often requires a trial-and-error approach to see which works for a given man.  

A few options that exist are:

• Paceycuff.com 
• Wearevercanada.ca
• Amazon.ca – men’s washable incontinence briefs.

For some men the use of a reusable penile clamp can provide the ability to resume normal activity with a reduction / elimination of pads and no need for surgical intervention.  Some men do extremely well with penile clamps while others can experience some irritation / discomfort.

Some options that exist are:

• Dribblestop (our experience is that more men have success with dribblestop compared to others)
• Weisner clamp
• Paceycuff

For severe incontinence surgical options do exist.  These can include the surgical placement of a urethral sling or the placement of an artificial urinary sphincter (AUS). 

These options are now available locally in our district.

Availability: Local

These are the preferred choice by both the doctor and patients for ease of use.

Available through all pharmacies by prescription.

Availability: Local (Robinson’s Pharmasave / Algonquin Pharmasave )

Injections can be tried at any time but are typically only used after trying oral medications. 

Availability: Remote

This option  is typically only used after trying pills and injections as this requires a surgery. It involves the surgical placement of inflatable tubes into the penis to obtain an erection 

Not available locally. This requires a referral to a surgeon in one of the major centres.

Availability: Local

This is not a formal organization but a small group of men who have gone through prostate cancer have expressed interest in being patient contacts for people newly diagnosed with prostate cancer. 

This sort of support can make a big difference. 

If you would wish to be put in contact with this group, the Urology North office can help you with this. 

Availability: Local

There are many psychologists in town that provide counseling. This is not an OHIP funded service. It is self pay or by private insurance.

This is a comprehensive survivorship program developed at the Vancouver Prostate centre for prostate Cancer patients, their partners and family from time of initial diagnosis onwards.

This is a Canadian non-profit entity dedicated to the fight against prostate cancer through resources, research, awareness, information, and support services. 

They include a toll free support line as well for men: 1-855-899-2873

The Canadian Urological Association is a website that has resources for both patients and doctors. Patient resources include information videos, pamphlets and guidelines.