Risky Business: On distinguishing low-risk from high-risk prostate cancer

November 27th, 2013

Written by Dr. Stuart Edmonds, Vice President, Research, Health Promotion and Survivorship


In September, PCC released recommendations with one overarching goal: for more men to get tested for prostate cancer. Currently, the test that is initially used for the early detection of prostate cancer is the Prostate Specific Antigen (PSA) test. It is a simple blood test that detects the levels of a protein released by the prostate when it is under stress. As a test for conditions affecting the prostate, it works fine. As a means to reliably detect prostate cancer, however, it is not perfect, just as mammography is not always reliable in detecting breast cancer. That is why, to confirm accurately a diagnosis of prostate cancer, the PSA blood test must be repeated and backed up with other diagnostic procedures such at the digital rectal exam (DRE), a biopsy and, increasingly more commonly, an MRI.

Early Warning Sign

Despite the shortcomings of the PSA test, physicians do not have many other early detection tests available in their clinics right now to choose instead. While other approaches being developed such as the Prostate Health Index (PHI) or the T2:ERG urine test offer great promise, the PSA test currently remains the only early warning sign available in clinical practice today. Such a red flag, especially when discovered early on, can be the indicator required to allow patients and physicians to explore the issue further and save lives. ‎

Different Forms of Cancer

‎However, we know that prostate cancer comes in multiple forms. A study led by Dr. Alexander Zlotta and funded by Prostate Cancer Canada recently reported that nearly 50% of men over 60 had prostate cancer at their time of death, but died of other causes.‎ This study reinforces the challenge discussed frequently today, which is the difficulty in distinguishing between prostate cancers that are indolent, or low-risk, and those that are aggressive, or high-risk. We often hear indolent cancers being described as those that men die with – in other words, it wasn’t the prostate cancer that was the cause of death, but rather another factor. Such cancers may not ever progress to the point to be life-threatening, and may not even need treatment. There is, however, the other end of the spectrum – those aggressive cancers that men die from. In other words, those aggressive prostate cancers are the ones that cause death and do need treatment. Current therapies can be very effective in saving lives - the death rates in Canada due to prostate cancer have been declining over the past eight years due in part to this. However they can lead to serious side effects such as incontinence and erectile dysfunction so it is especially important that we endeavour to treat only those that need to be treated and monitor those that do not. How can we make progress on this issue?

Taking Action, Searching For A Solution

In developing our research strategic plan, we heard from patients, survivors, researchers and clinicians that the number one issue to tackle with research is determining which men to treat and which to monitor. We listened intently to this feedback and this month launched a new research program funded by Movember that addresses this specific problem. ‎It’s putting resources to answer the question most pressing in the field of prostate cancer diagnosis and treatment, to allow early detection to continue to save lives while at the same time ensuring that we are placing the utmost value on preserving quality of life as well by minimizing unnecessary treatment and potential side effects. We don’t have a fool-proof solution yet, but we are committed to directing resources and research to answering the question and implementing the results.


Dr. Stuart Edmonds joined Prostate Cancer Canada in February 2011. During his time at the organization he has spearheaded the launch of the Research Strategic Plan, providing the direction for research and survivorship activities for 2012-2015. From this plan, PCC has launched numerous new research programs based on the key pillars: Collaboration, Innovation and Talented People. Dr. Edmonds has also instituted a fair and transparent peer review process to steward and safeguard funds raised in support of prostate cancer research and to ensure that only the most promising, high quality research is funded. Prior to joining PCC Dr. Edmonds held leadership roles at the Canadian Cancer Society, the Canadian Partnership Against Cancer, the Canadian Cancer Research Alliance and the National Cancer Institute of Canada. Dr. Edmonds holds a doctorate in pharmacology from Oxford University.
Posted: 2013-11-26 3:38:17 PM
Filed under: Stuart Edmonds, T2:ERG, urine test


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