The day before Barry Shiffman was to fly from Toronto to Russia to begin serving on the Violin Jury of the International Tchaikovsky Competition, the 44-year-old learned he had prostate cancer.
"I was floored by the diagnosis. I sat for in the lobby of Sunnybrook for two-and-a-half hours thinking, 'What is happening?'" recalls Barry, who is the associate dean of the Glenn Gould School at the Royal Conservatory of Music, and father of two. "But once you get over the insanity, the realization, that you have cancer, then you think, 'I am so lucky. It could have easily been missed'," he says.
When Barry moved with his family to Toronto from Banff, Alberta in 2010, he thought he had his health under control. He had been previously diagnosed with a benign enlarged prostate, the harmless growth of the prostate often associated with aging. As a precaution, Barry had his PSA levels checked routinely, to rule out the possibility of prostate cancer.
The adult prostate gland makes a protein called prostate specific antigen (PSA). A healthy prostate releases small amounts of the protein into the blood, but prostate cancer will often increase its production. Men with PSA levels greater than 4 nanograms per millilitre of blood may be offered a needle biopsy to check the prostate for cancer.
In December, Barry's PSA test came back higher than normal. His physician consulted with Sunnybrook's Dr. Robert Nam, a urologic oncologist at the Odette Cancer Centre, and researcher behind a new online tool that provides a better assessment of prostate cancer risk. It helps patients avoid unnecessary prostate biopsies, but it can also detect prostate cancer at an earlier, more curable stage, and identify high-risk patients.
Dr. Nam developed the risk calculator when he realized that the PSA blood tests doctors use to screen for prostate cancer were no longer reliable. "When it was introduced 20 years ago it was a fabulous test. It caught all the cancers out there. But it couldn't detect the low volume prostate cancers-the new cases that were just starting out and didn't have enough cancer cells to crank up that PSA. But then we realized that we knew a lot about the established risk factors for prostate cancer," Dr. Nam says.
Unlike the standard approach, the new calculator (also called a nomogram) considers age, ethnicity, family history of prostate cancer and urinary symptoms when calculating a man's prostate cancer risk. Dr. Nam and his colleagues developed and checked the risk calculator with over 3,100 Canadian men, including 408 men with normal PSA levels. It worked better than conventional screening methods. Nearly a quarter of the men with a normal PSA were diagnosed with prostate cancer.
"The calculator empowers the patient. They still control what they want to do, but it gives them more information to make their decision," says Dr. Nam. "That's the bottom line."
"I haven't cancelled my plans for the summer," says Barry. "My treatment plan doesn't include chemo or radiation, but I will have surgery in April. Hopefully I'll be back to life as I know it soon."
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RAPID DIAGNOSIS: A CANADIAN FIRST
Sunnybrook's Odette Cancer Centre recently launched a new clinic for rapid results on prostate biopsies. Now offering results in 72 hours versus the standard two to three weeks, this is a Canadian first with results that are more accurate than conventional testing. Men will know sooner and more accurately. This is particularly critical if they are diagnosed with an aggressive form of the cancer. Once results are back in 72 hours, if positive, treatment plans are immediately evaluated.