A.1: The prostate is an organ of the male reproductive system. It is a spherical gland the size of a walnut, but grows in size as you age. It is located beneath the bladder and in front of the rectum. This gland surrounds the urethra, which is the tube that carries urine from the bladder to the tip of the penis.

The main function of the prostate is to produce a whitish fluid called seminal fluid, one of the constituents of sperm. Because of its location, any change in the prostate can affect the flow of urine. In addition, the prostate produces a protein called prostate-specific antigen (PSA).

A.2: The exact causes of prostate cancer are still unknown. Some research indicates that those at a higher risk for developing it include the following:

• Men over the age of 50, as the risk increases with aging
• Men whose fathers or brothers have had it
• Men of African ancestry (Black men)

Possible risk factors

• Men with inherited or with faulty genes
• Men who consume a diet rich in red meats, animal fats or processed foods
• Men with a vitamin D deficiency or other supplements
• Men who are overweight or obese
• Men exposed to pesticides or chemical/toxic substances

A.3: Testosterone, the determining and influential male hormone, is not by itself a risk factor for prostate cancer. It is known, however, to feed the progression of this type of cancer.

A.4: Men with immediate family members who have been diagnosed with prostate cancer have at least a two to three fold increased risk of developing prostate cancer than those who don’t have this family history.

A.5: They should start their screening at the age of 45 with a yearly digital rectal exam and a PSA blood test. For more information, click here.

A.6: The digital rectal exam is a physical examination of the prostate through the rectum. After inserting a gloved finger into the rectum, the doctor feels the prostate to detect any lumps or abnormalities.

The analysis of prostate-specific antigen is a blood test that measures the concentration of PSA, a substance produced by the prostate. PSA levels vary with age and with the volume of the prostate. Many prostate problems, not just the cancer, can cause an increase in PSA levels. Sometimes men with prostate cancer have PSA levels considered normal. See All about PSA.

The PCA3 test is a urine test using a genetic marker that detects gene “Prostate Cancer Gene 3” (PCA3) involved in the development of prostate cancer. This is not a commonly used test.

The magnetic resonance image (MRI) is a test used in uncertain cases, that is to say when the PSA rate is high and the biopsy results are negative for example.

A.7: If an abnormal result with these tests, other tests will determine if it is cancer or other health problems. Other analyzes are:

• Repeated PSA measurements
• Transrectal ultrasound: imaging device inserted into the rectum that uses sound waves to create an image of the prostate and surrounding organs, through the rectal wall.
• Prostate biopsy: Collection of prostate tissue samples (6 to 24 samples) using 16-18G needles, which are subsequently prepared for microscopic examination for pathological analysis.

A.8: Light bleeding in the stool and urine may be present for several days after the biopsy. The color of semen can be changed for a few weeks after the exam. Prescribed antibiotics before the examination are designed to reduce the risk of infection. Infections after prostate biopsy are rare. The prostate infection is still possible and occurs in 2-4% of patients. Antibiotic treatment may be necessary if there is pain or if onset of fever after the biopsy, and 38.5. You should go to the emergency. Treatment should be initiated quickly. Finally, it is recommended to avoid exercise for 48 hours after the exam.

A.9: In most cases, cancer of the prostate, especially in its early stages, can develop without any signs or symptoms occurring. In some cases, symptoms may occur if the tumor is abnormally increasing the size of the prostate. This then puts pressure on the urethra as does benign prostatic hypertrophy (BPH). Most of the symptoms below are due to BPH. Prostate cancer rarely causes the following signs and symptoms:

• changes in urination
• frequent urination, especially at night
• urgent need to urinate
• difficulty starting to urinate or stop urinating
• inability to urinate
• weak jet or reduced urine
• urine stream that stops
• feeling of not having completely emptied your bladder
• burning or pain during urination
• blood in the urine or semen
• painful ejaculation

A.10: Benign prostatic hypertrophy is a non-cancerous growth of the prostate gland. The increase in the volume of the prostate is a phenomenon that occurs during aging in the majority of men, causing urinary symptoms. Prostatitis is an infection or inflammation of the prostate. Prostatitis can significantly increase PSA levels. Some men, who have urinary problems, suffer acute or chronic prostatitis. Both forms of prostatitis can be treated with antibiotics. For more information, see Prostate diseases.

A.11: It is to completely remove the prostate. This is the surgical removal of the prostate, seminal vesicles, and part of the neck of the bladder. The surgeon usually tries to preserve the nervous and vascular tissues essential for a good erection. He can also remove the pelvic lymph nodes around the prostate if the cancer is at high risk of progression. Prostatectomy can be done by open surgery (with an incision in the lower abdomen) or laparoscopy (with very small incisions to insert instruments only). Laparoscopic or robotic techniques are less invasive than conventional surgeries.

A.12: This is an alternative to open surgery and simple laparoscopy. This procedure uses the laparoscopic approach, but with the addition of a da Vinci® surgical robot system, designed to allow surgeons to perform minimally invasive, complex and delicate procedures.

A.13: As its name suggests, the goal of radiation therapy is to irradiate all the cells of the prostate to kill cancer cells while preserving normal prostate cells. It is often used alone, in associastion with hormone therapy or sometimes, it is given after surgery if there is evidence of residual cancer cells at the surgical site.

A.14: Brachytherapy to treat prostate cancer may be applied either by permanent implantation of radioactive seeds or by placing temporary radiation emitters. The permanent settlement of the grains is suitable for patients who have a localized tumor and good prognosis for recovery. It has been shown that it is a very effective treatment against cancer. The procedure can be performed quickly. Patients are usually able to go home the same day of treatment and return to normal activities within a few days. The permanent seed implantation is often a less invasive treatment option compared to the surgical removal of the prostate.

A.15: The goal of hormonal therapy is to decrease or block the effect of testosterone, the male hormone which is known to feed the progression of prostate cancer. This can be achieved either surgically, by removing testicles responsible for producing the testosterone, or chemically, by the administration of injections and pills. Hormone therapy is indicated more particularly to older men, men with a recurrent cancer and men with advanced prostate cancer with or without metastases. Prostate cancer usually responds well to hormone therapy.

A.16: Chemotherapy is mainly for patients with cancer that no longer responds to hormone therapy or with metastatic cancer.

R17: Fatigue is the most common side effect due to the treatment itself and the daily travelling. Patients may complain they have no energy; this usually starts after the second or third week of treatments. Energy levels gradually reappear after the treatments are finished.

Until then it is best to rest as much as possible during the therapy, prioritize your activities and eat a healthy diet

A bowel disturbance like diarrhea is typical. To alleviate it, avoid high-fibre food, including raw fruits and vegetables, whole grain bread, spicy foods, caffeine and dairy products (yogurt may be better tolerated). Do not take any dietary supplements or vitamins without informing your doctor. Some may be discouraged during treatment. If you have further questions, consult a dietitian or your doctor. Gastrointestinal symptoms are common during treatment. They fade over time, but may be permanent in a small number of patients (5-10%).

Urgent and frequent need to urinate can be another side effect. Some men have difficulty emptying their bladder. Urgent need to urinate and irritative symptoms are quite common in the acute phase. They fade over time, but may be permanent in a small number of patients (5-10%). Finally, another rare side effect, usually only seen in men who had a prior history of difficulty urinating, is the inability to urinate at all. In this case, a visit to the emergency room of the nearest hospital is indicated. Some medications may be prescribed to help with urination problems. Should a complete inability to urinate occurs, a catheter (a tube) may be temporarily inserted into the bladder until the condition is resolved.

Erectile difficulties such as problems obtaining or maintaining an erection can occur. The percentage of risk of erectile dysfunction may vary with each patient. However, unlike other side effects, erection problems appear gradually several months or even years after treatment but do not affect libido or orgasm. The good news is that treatments are available. For more information, see our section on erectile dysfunction. A decrease in the volume of ejaculation can also be observed.

Irritation at the site of the treatment is rare. However, skin problems are another possible side effect and should gradually disappear once the treatments are finished. Your skin may look red, darker, may be sore, dry and may itch. You may want to:

• treat your skin gently using lukewarm water with a mild soap, avoiding washing the marks made by the technician;
• pat dry only, do not rub the area;
• avoid tight clothing;
• avoid applying any cream on the area without consulting a member of the team;
• resist rubbing the area.

Hair loss happens only in the area being radiated and will grow back afterwards.

Each patient responds differently to the treatment, therefore the side effects will vary from one individual to another. One man may experience no side effects, whereas someone else experiences a few. For more information, see Side effects.

A.18: As a general guideline, you should see your radiation-oncologist

• Every three months for the first year;
• Every six months thereafter until the fifth year, and then
• Once a year.

Note that in some treatment centres, your visit with the radiation-oncologist may alternate with visits with your urologist.

A.19: It all depends on your energy level and the amount of physical exertion required in your job. Remember that your daily treatment and travelling will require you to rest. The less demand you put on your body, the faster the recuperation will be. It is always best to check with your radiation-oncologist or nurse.

A.20: Yes you can.

A.21: In general, you cannot, because the radiation that you have received leaves some scarring around your prostate gland. This makes the surgery more difficult and riskier. Nevertheless, in some rare instances, surgery can be performed after radiation therapy.

A.22: The radioactive seeds that are inserted inside your prostate gland are very small and you cannot feel them. They do not cause any discomfort and can safely stay inside your gland for the rest of your life. The seeds will give off radiation for up to a year, with the intensity of the radioactivity decreasing over time. Pregnant women should maintain a distance of three feet from the patient during the first three months after the implant. It is safe for young children to be around patients following the procedure. However, for the first three months, a child under twelve should not sit on the patient’s lap for an extended period of time. For more information, see our Side effects section and our conference on radiotherapy and brachytherapy on our YouTube channel.

A.23: If you are traveling outside of the country, you may want to ask your physician to provide you with a letter explaining the trace radiation.

A.24: Side effects may include any of the following: hot flashes, sweating, decreased sexual desire, which in turn may cause erectile difficulties, enlargement and sensitivity of the breasts, and osteoporosis (the treatment causes a decrease in bone density, which leads to weaker bones and possible fractures). See our Side effects section for tips on managing hormone treatment downsides.

A.25: The close relationship between the prostate and bladder is responsible for the increased rates of incontinence following prostate cancer therapy. Normally urinary continence is maintained by muscles that surround the urethra at its junction with the bladder. The prostate sits at the base of the bladder where it wraps around the urethra, and as such, is in close proximity to the muscles that control urine flow.

With radiation therapy, ionized wave particles are responsible for killing the tumor cells, and unfortunately neighboring cells, such as those involved in urinary control, resulting in the loss of continence. In the case of prostate surgery, a portion of the urethra, which is encircled by the prostate, is removed and the urethra must be reconnected. During the dissection of the urethra, it is possible to damage the muscles responsible for urinary control. However, with improving technology, such as the introduction of robotic assisted laparoscopic prostatectomy, the surgeon is able to better visualize these muscles, resulting in decreased rates of incontinence.

A.26: Certain factors have been implicated in the increased risk of this type of incontinence

• The continence status prior to surgery
• The older the patient the higher the risk
• A history of transurethral prostate surgery before radical prostatectomy
• The stage of cancer evolution. Surgery is more extensive if the cancer is advanced and this can then affect the sphincter muscles
• The surgical technique used by the surgeon

A.27: Urinary incontinence after prostatectomy varies according to the individual. It may last for a few weeks to several months after the surgery. The loss of urine may be abundant for some, but minor for others. Urine leakage often occurs at the end of the day and is often triggered by stress or fatigue. Incontinence can fade over time, but may be permanent in a small number of patients (5-10%).

A.28: Perineal rehabilitation before or after surgery may be effective in reducing urinary incontinence occurring after prostatectomy. After surgery, once the catheter is removed, most patients experience a lack of control of their urine emissions. Muscles get stronger within 1 to 6 months and most of the men regain their continence. You can find in pharmacies products, such as panties or pads, which you can use as a means of protection. They are discreet and comfortable without being too bulky. After surgery, you can also do some pelvic muscle strengthening exercises, called Kegel exercises, to manage incontinence. When incontinence persists, there are other treatments such as medication or exercises with a biofeedback device. For more information, see our Side effects section and our conference on managing incontinence on our YouTube channel.

A.29: Perineal rehabilitation remains the mainstay of treatment. Surgery is a last resort in case of failure of rehabilitation: Sub-urethral sling is indicated for mild to moderate incontinence, while the artificial sphincter is best indicated in cases of severe incontinence after radical prostatectomy.

A.30: Treatment of prostate cancer can cause changes in sexual function in general and especially on erectile function. It is important to keep in mind that the younger you are, the better your chances of having erections after your treatment. Be aware however that if you have a sexual dysfunction before treatment, it will usually be aggravated by your treatment. However, it can often be improved with drugs, therapeutic alternatives (non-drug approach) or surgery. For more information, see our conference on radical surgery and on sexual health on our YouTube channel.