In honour of Movember, UBC Prof. Martin Gleave talks about prostate cancer
Men across the world will be growing moustaches in honour of Movember, a month-long campaign that has men cultivate their facial hair to raise money and increase awareness around prostate cancer. Martin Gleave, distinguished professor in the Department of Urologic Sciences and Director of the Vancouver Prostate Centre, discusses a deadly but often overlooked form of cancer.
What’s the most important thing men need to know about prostate cancer?
Prostate and breast cancer are sibling tumours with very similar incidence and mortality rates across Canada. For example, prostate cancer accounts for 25 per cent of 96,000 male cancers and 10 per cent of 39,000 deaths in men. In comparison, breast cancer accounts for 26 per cent of 91,000 female cancers and 14 per cent of 36,000 deaths in women.
In both cancers, early detection and early treatment are critical to improve survival rates. For breast cancer, it is a breast self-examination and mammography; and for prostate cancer it is the use of the serum PSA, a blood test that helps stratify and guide the need for prostate biopsy. We recommend a PSA in men beginning in their 40s. Men should discuss the pros and cons of early detection with their family doctor or urologist.
What role does personalized medicine play in prostate cancer treatment?
The treatment recommendations for men with prostate cancer are individualized. For example, in men diagnosed with localized prostate cancer the disease are stratified into low, intermediate, and high-risk categories; low-risk tumours are most often treated with active surveillance rather than treatment because of the indolent natural history of the disease. In contrast men with high-risk localized prostate cancer are often treated with multimodal combination therapies including surgery, postoperative radiotherapy and hormone therapy to improve outcomes in localized, but potentially lethal cancer. In people who recur after definitive therapy, subsequent treatments like radiation or hormone therapy may be appropriate.
In the future personalized or precision medicine will be further guided by integrating molecular-based biomarkers or gene signatures into these treatment algorithms. While this is not ready for primetime, we anticipate that the use of gene signatures enabled by the next generation of gene sequencing technologies will help guide treatment decisions within the next five to 10 years.