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Prostate Cancer in Ontario

Prostate cancer is the most commonly diagnosed cancer in males in Ontario, with 8,414 new cases of prostate cancer diagnosed in 2016. It is also the most commonly diagnosed cancer among First Nations males, with approximately 636 new cases diagnosed from 1991 to 2010. Modifiable risk factors for prostate cancer include overweight and obesity. 

Overall, Ontario’s cancer system is performing well with respect to prostate cancer care compared with other jurisdictions nationally and internationally. Ontario has the second-highest survival rate for prostate cancer among all Canadian provinces. The 5-year relative survival ratio decreased slightly from 95% to 93% between 2002 and 2016. Relative survival is a ratio that compares the survival of people with cancer to the expected survival of people of the same age and sex in the general population.

The following highlights bright spots and opportunities, based on available indicators, to help focus efforts in improving the quality of care delivery for patients with prostate cancer.

Diagnosis and treatment

  • Stage at diagnosis is one of the most important prognostic factors for cancer. Approximately 75% of staged prostate cancers were diagnosed at stage 1 (24%) or stage 2 (51%) in 2017. Most cases of prostate cancer in Ontario were diagnosed at stages 1 and 2 or earlier, compared with only about half the cases in England. However, more patients were diagnosed at stage 1 in England than in Ontario. For detailed comparisons, see Reporting of Cancer Stage at Diagnosis.
  • Typical treatment options for prostate cancer include surgery, radiation, systemic drug therapy (hormonal, chemotherapy) and other novel therapies developed through clinical trials. Treatment often depends on the stage of cancer and patient choice.
  • In Ontario, rates of expectant management (delaying active treatment until the disease progresses) have steadily increased in individuals at low risk for prostate cancer, with 81% of men (ages 35 and older) having no record of treatment in 2016 compared with only 60% in 2012. Ontario is performing well compared with other provinces in Canada, as most low-risk prostate cancer patients did not receive treatment. For detailed provincial comparisons, see Low-Risk Prostate Cancer Patients with no Record of Treatment.
  • The goal of prostate cancer surgery is the complete removal of cancer cells. A “positive margin” means that some cancer cells remain after surgery. In cancer staging, pT2 refers to cancer localized to the prostate, while pT3 means the tumour has grown through the prostate on one or both sides. In 2017, the positive margin rate for pT2 radical prostatectomy was 21%, while the positive margin rate for pT3 radical prostatectomy was 47%. Ontario’s pT2 rates are comparable to rates in Scotland. For details, see Margins in Prostate Cancer Surgery.
  • Twenty-eight percent of patients visited the emergency department or were readmitted to hospital within 30 days after prostate cancer surgery. Reviewing unplanned hospital visits after cancer surgery helps us monitor complications and adverse events associated with the surgery.

Recovery

  • Recovering from cancer is different for each individual. People need access to the necessary healthcare services to help improve their quality of life after cancer treatment has ended.
  • Ongoing symptoms are common after cancer treatment. These may be related to the cancer or side effects of the treatment. Tracking symptoms over time helps clinicians identify changes that may be meaningful to patients and start conversations about symptom management. Electronic symptom screening can result in a greater focus on issues that are most important to the patient. In symptom screens completed by prostate cancer patients in 2018:
    • 67% reported at least 1 symptom in the ‘red’ range (3 or 4 on a 4-point scale, with 4 being the worst)
    • over half reported difficulty with their ability to reach an orgasm
    • 38% noted an overall problem with sexual function

For a visual summary of data on cancer burden and system performance for prostate cancer across the cancer continuum, see Prostate Cancer Overview