At the forefront of prostate cancer

Dr. Armen Aprikian, MUHC urologist-in-chief and one of five MUHC surgeons specializing in complex urological cancers. (Photo: Pierre Dubois)

According to Dr. Armen Aprikian, MUHC urologistin- chief, prostate cancer and non-melanoma skin cancer are the number one cancers that strike men, affecting roughly the same number of men as breast cancer affects women.

With a team of five surgeons specializing in complex urological cancers and three high-tech operating rooms, the MUHC is at the frontlines of this disease. Today, approximately 80 to 90 per cent of all radical prostatectomies are performed using minimally invasive laparoscopy - introduced in Quebec at the MUHC about five years ago. The MUHC was the first healthcare institution in the province to develop a dedicated program to this minimally invasive approach to prostatectomies. The program, initiated by Drs. Maurice Anidjar and Simon Tanguay, has expanded to include Dr. Aprikian.

Minimally invasive radical prostatectomy involves the use of a laparoscope that transmits images to the surgical team and requires only a small incision in the patient. The surgeon, using other small incisions, operates without having to open a larger abdominal incision. Despite the fact that the abdomen is not opened, the surgical field is seen with greater detail and definition. According to Aprikian, patients who undergo this type of surgery lose much less blood, recover quicker-and therefore get back to work quicker and they experience less discomfort or pain compared to traditional surgery.

Not all men who suffer from prostate cancer require surgery. "There are many prostate cancers that don't need treatment," says Aprikian. Depending on the severity and individual circumstances, some patients require only watchful waiting. "All other patients require treatment."

For the patients that need treatment, the prostate gland and the cancer can also be treated by radiation. Surgery and radiation have similarly excellent outcomes when the cancer is detected early. "Deciding what path to take is a very personal choice," says Aprikian. "Some patients don't like surgery."

Patients who elect to go with the surgical option can also choose the traditional method, as opposed to the minimally invasive route. "Both have the same objectives - remove the prostate cleanly, it's the method that's different between the two. In the end both methods appear to have the same cancer-control rates."

Aprikian and the team of urologic oncologists at the MUHC are working on improving overall outcomes through minimally invasive surgery. "Since the surgery is more precise, the goal, as yet unproven, is that we'll have better outcomes, like less erectile dysfunction and less urinary difficulties compared to traditional surgery."

"But technology and surgeons can only do so much," says Aprikian. "Men need to speak up and out about this cancer because it is detectable with a blood test and physical exam, and if caught early enough it is treatable."

What is "The Prostate?"

The prostate is a male sex gland that produces a white fluid, which forms the majority of semen. It is located below the urinary bladder, in front of the rectum and it surrounds the upper part of the urethra-the tube that empties urine from the bladder. The prostate gland relies on the hormone androgen to grow and maintain its function. This hormone, however, doesn't significantly kick in until puberty, after which the gland continues to grow very slowly up to about the age of 40, and then more rapidly. In its normal state it's about the size of a small prune. When someone has prostate cancer it's because there is first a growth of cancerous cells within the prostate gland and then outside the gland (metastasis). It's rare to find this in men under 50 but the risk of getting it increases considerably with advancing age.

If you're over 50, get tested!

"There are no telltale signs that a man has prostate cancer," says Dr. Armen Aprikian, MUHC Urologistin- Chief. "If men have no symptoms, yet they're in their 50's or 60's, this does not mean that they don't have prostate cancer. And vice versa - men in their 60's can experience trouble urinating... but this doesn't mean they have prostate cancer. There is actually no relation between urinary symptoms and this cancer. That's why it's so important that men get checked with a PSA blood test that detects a substance produced only by the prostate and a rectal exam, even if they're feeling fine." Aprikian recommends that men have an annual test that detects prostate cancer once they reach 50, earlier if they have a close relative diagnosed with the disease. Quick detection of the problem allows for better treatment options. "Fortunately, we have a test," says Aprikian. "There're a lot of cancers that we don't have a test for."