Dr. Tony Finelli, (L), Head of Division of Urology at UHN, and Dr. Robert Hamilton, urologic oncologist at Princess Margaret Cancer Centre. (Photos: UHN)

Male cancers can be difficult for men both physically and psychologically.

In Canada, one in eight men will be diagnosed with prostate cancer in their lifetime, and testicular cancer continues to be the most diagnosed cancer in young men.

Thanks to efforts around patient education and social media campaigns, there is growing awareness around men's health and a willingness to engage in conversations around prostate cancer, testicular cancer, and mental health.

UHN News talked with Dr. Tony Finelli, Head of the Division of Urology at UHN, a urologic oncologist and surgeon within the Sprott Department of Surgery, and Dr. Robert Hamilton, a urologic oncologist at the Princess Margaret Cancer Centre and a surgeon-investigator about the reasons for optimism, including longer survival rates and minimally invasive surgery.

Q: How prevalent are prostate and testicular cancer, and what makes them particularly impactful on men's health? How have survival rates improved?

Prostate cancer is the most common cancer among males overall and testis cancer is the most common cancer for men aged 15 to 35. They are particularly difficult on men's health for a couple reasons. They affect organs that are part of a man's private life (genital/sexual organs). Men don't like to talk about issues "down there" in general and often it's only the support of partners who encourage them to raise these issues with their doctors. Moreover, the treatments for these cancer can have an impact on sexual performance and fertility. Finally, men, and in particular young men, can have a sense of invincibility. Learning about a cancer diagnosis can cause a major psychological trauma that may be hard to overcome without the proper supports and guidance.

Fortunately, survival rates have improved for both cancers. For prostate cancer, about one in 18 diagnosed will die of the disease. For testis cancer, more than 95 per cent will survive.

Q: What kind of mental health challenges do survivors have?

Survivors of both cancer types can have significant mental health challenges across a spectrum of domains – anxiety, depression, loneliness, body image issues, depersonalization, difficulty forming and maintaining relationships, to name a few.

Q: How important is early diagnosis and screening for prostate and testicular cancer, respectively?

All cancers benefit from early diagnosis and treatment. Some cancers more than others. Some cancers are not easy to diagnose early – in particular those where the organs are not possible to view by the patients themselves.

In the case of prostate cancer, we rely on blood tests and physical exams by health professionals. Evidence suggests that regular testing with the PSA blood test and rectal examinations of the prostate lead to early detection and treatment which translates into improved survival. This fact is clearly established with trials conducted across the globe.

In the case of testis cancer, the situation is slightly different. While the testicles are "external" and thus easier to examine by the patients themselves, we often see delays in presentation of cancerous masses. Such delays stem from patient embarrassment, lack of knowledge or failure to exam. This has improved over the past decade, particularly through education delivered via social media – platforms much more accessible to young men at risk for testis cancer.

Unlike prostate cancer, there are no studies that have looked at the role of early detection and treatment for testicular cancer. So while we intrinsically feel it is important to find the cancer early, there is no evidence that this actually improves survival.

Q: What about the age of most men with testicular cancer; do they need certain kinds of survivorship supports?

Most commonly, men get testicular cancer at the age of 15 years to 35 years. Psychological support to address some of the issues is so important. After treatment, we often see symptoms akin to post-traumatic stress disorder as these young men have had to face potential mortality. And then they survived. So support is key. Family can often help tremendously in this domain.

Q: Tell us about minimally-invasive surgery and the benefits for patients.

The term minimally-invasive surgery implies an approach to doing a surgery on the inside, but achieving it without making a large cut in the body. For prostate and testis cancers, this is achieved through robotic surgery. The surgeon controls robotic arms that enter the abdomen and execute the surgery on the inside, leaving only a series of small (less than one centimetre) incisions on the outside. Data thus far suggests the outcomes are just as good as the traditional "open" surgery, while the side effects are notably less: shorter hospital stay, less blood less, less pain, faster return to work and better cosmetic appearance.

Q: What is the WATChmAN study, which provides patient-centred care for testicular cancer patients via virtual surveillance clinic using a mobile app?

WATChmAN stands for Web-based Testiclar Cancer Clinic. We innovated this in 2017 (long before COVID) when we realized that a lot of the routine survivorship care we provide for men we have treated for testis cancer can be accomplished without them having to take a day off work, drive for hours, pay $30 to park and wait three hours in a clinic.

We designed and built this "in-house" at the Princess Margaret. The virtual clinic allows patients to receive notification of when their CAT scans or blood marker tests are due. They are reminded to complete these on time. Once completed, the medical team reviews the results and feeds back the news to them. We launched and did a trial where patients were randomized to either the virtual clinic or regular clinic. The results were overwhelmingly positive. Patients loved the virtual clinic. It was just as safe and patients actually followed our follow-up protocols even more closely. We have now designed version 2.0 of our clinic and are about to launch in January.

Q: Any other message you'd like to share?

I think the future is very bright for both cancers. The pace of discovery and advancement is rapid. "Movember" has invested huge sums of money both in Canada, and globally in these two cancers. They have been instrumental in pushing forward research in this field. In particular, Movember has included survivorship research – an often forgotten area of research. While this area of research is not as sexy as discovering a new drug or innovating a new surgery, it is of marquis importance for patients who have completed their cancer treatment. 

So many of the breakthroughs at the Princess Margaret have been made possible thanks to our generous donors, event participants and The Princess Margaret Cancer Foundation.

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