Prostate cancer is the most common cancer in Canadian men, with more than 27,000 Canadians being diagnosed with the disease each year. In many cases, prostate cancer develops slowly and can be successfully removed or managed before it spreads to other parts of the body. However, like most types of cancers, there is a risk of prostate cancer to spread or recur after removal or treatment. Traditionally pathologists and clinicians determine cancer recurrence by manually analyzing different images or biosamples.

Matthew McNeil is a senior PhD student working in senior scientist Dr. Anne Martel’s lab at Sunnybrook Research Institute (SRI) where he is developing tools to support the automatic prediction of cancer recurrence. This fall, Matthew was the winner of the Leopard Challenge, a global AI competition. Specifically, the challenge focused on yielding deep learning solutions to predict the time to biochemical recurrence of prostate cancer from H&E-stained histopathological tissue sections.

Matthew is developing AI models that quickly detect features, like Gleason patterns, on slides that pathologists typically use to determine prognosis. The Gleason classification system is used to grade prostate cancer. The scale looks at how abnormal glands in the prostate look and helps determine how likely the cancer is to grow and spread.

“By having these types of patterns highlighted automatically, pathologists will be able to analyze slides more quickly and effectively,” explains Matthew. “My model also has the potential to provide clinicians and patients with a better understanding of the cancer’s risk.”

The model is capable of quickly generating risk scores for patients with prostate cancer. This has the potential to advance patient care and outcomes by supporting more personalized treatment plans as generating these scores can help both clinicians and patients make more informed care decisions.

Matthew is hoping to apply the model he developed during the Leopard Challenge to other datasets for different types of cancers and see his work expand to clinical settings.

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That could mean finally getting around to making an appointment for that long overdue checkup, finding ways to add light movement into your day, or perhaps reaching for a blood pressure monitor rather than BBQ tongs for a Father’s Day gift.

Dr. Rahul Jain is a family physician with Sunnybrook’s Integrated Community Program and Academic Family Health Team. He shares his thoughts and expertise on men’s health.

It’s often said – and research suggests – that men are more reluctant to go to the doctor than women. Do you find that to be the case and if so, why?

I don’t want to over generalize but men are notorious for sometimes avoiding the doctor or ignoring warning symptoms. But to be honest, in my practice what I see is that it really depends on the person and their preferences rather than a specific gender.

With access to medical information at our fingertips, people have become more health literate over the years, which is great but it doesn’t replace the importance of seeing your healthcare provider for routine checkups.

Some patients might also put off going to the doctor because of time pressures, although the option of virtual as well as in-person care has helped remove that barrier.

Fear of the unknown could be another reason some patients stay away. But I believe in taking a preventative rather than a reactive approach, and the benefit of family medicine is seeing your doctor regularly for checkups and preventing things before they occur.

How often should people go to the doctor for a physical?

I encourage adult males to see their doctor for a routine checkup at least every one to two years although the specific frequency depends on their medical history, risk factors and preferences.

Routine checkups provide an opportunity to focus on preventative screening, immunizations and education.

What types of things do you look for with adult males?

We often start screening for cardiovascular risk factors such as diabetes and high cholesterol at age 40, or sooner if they’re at higher risk.

We recommend colorectal cancer screening at age 50, or sooner if there’s a family history of the disease.

And we often suggest baseline bone mineral density testing, to assess for osteoporosis, at the age of 65 or sooner if there are risk factors.

What about heart health – what preventative steps should patients discuss with their doctor?

There’s good evidence that protecting the heart and brain takes a global approach, which means addressing a number of factors early on which can increase the risk of heart disease and stroke. Risk factors include unhealthy diet, low physical activity, higher body mass index, higher alcohol intake and smoking.

Primary care providers can also screen for modifiable risk factors for heart disease and stroke such as high blood pressure, high cholesterol and diabetes.

High blood pressure is often referred to as a silent killer because it does not always present with symptoms but it is the number one risk factor for stroke and a major risk factor for heart disease. It’s important to see your doctor regularly to screen for risk factors which may or may not even present with symptoms.

What age should screening for testicular and prostate cancer begin?

Testicular cancer can present at any age, although it’s more common in younger males and peaks around age 30. We encourage males to begin regular self-examinations of their testicles in their 20s and 30s. We tell them to watch out for things like a lump or enlargement of either testicle, a dull ache or a feeling of heaviness in the scrotum.

When it comes to prostate cancer screening, this happens after a discussion with the patient about the benefits and risks of screening.

We typically begin screening for prostate cancer when patients are in their 50s, or in their 40s if there is a family history or other risk factors.

Prostate cancer often does not cause symptoms in early stages. But when symptoms occur, they can present similarly to a condition called BPH (benign prostatic hyperplasia). which is a common condition as males age. Some of the symptoms which can overlap are difficulty urinating or having a decreased force and flow of urine.

Symptoms that might be more specific to prostate cancer to watch out for include blood in the urine or semen, painful urination, erectile dysfunction, or unintentional weight loss or bone pain.

Let’s talk about mental health. How important is it for doctors to open up a conversation with their patients about their mental and emotional health and wellbeing?

Anxiety and depression are one of the top reasons patients visit their primary care providers.

Family physicians are uniquely positioned to address mental health concerns given the longitudinal, trusting relationship we have with our patients.

Life is busy but that shouldn’t be an excuse for not prioritizing wellness. Mental health is so important and shouldn’t take a back seat. Addressing wellness means taking a holistic approach to physical, mental and spiritual wellbeing.

As someone with an interest in prevention of cardiovascular disease, I would add that we know there is a bidirectional relationship between depression and heart disease. Depression can worsen heart disease and heart disease can worsen mental health. 

Another important aspect of both physical and mental wellness is staying active. How do you like to stay active?

I’m a big supporter of Canada’s 24-Hour Movement Guidelines, which emphasize the idea of making your whole day matter when it comes to movement behaviours. These guidelines suggest moving more, reducing sedentary time and sleeping well.

We know that regular physical activity at any level has numerous health benefits. If people can do more than what they are doing now, chances are this will lead to improved cardiovascular and mental health.

I often suggest simple ways for patients to become more active in their daily lives. This could involve things like replacing some of their sedentary activities with light physical activity like walking instead of driving to do errands, or standing and stretching while on their screen. Not everyone has to be doing moderate to vigorous exercise – that’s great and we should incorporate it. But even just making a shift from less sedentary behaviours to light physical activity can be beneficial.

Research suggests physicians can be powerful motivators for patients to increase their physical activity, particularly if they are active themselves. When doctors are physically active, their patients often are more active.

I like to think I walk the talk when it comes to physical activity. I try to incorporate a mix of aerobic exercise, strength training, balance training and participating in activities I enjoy such as taking a walk during my lunch break with colleagues or cycling outdoors.

What else would you like to add when it comes to encouraging men to prioritize their health and wellness?

With Father’s Day coming up, why not consider gifting a gym membership, blood pressure monitor or wellness retreat? Or give the men in your life a nudge to visit their primary care physician. Whatever we can do to emphasize the importance of taking care of yourself is encouraged.

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Testicular and prostate cancer

For people with testicles and prostates, it’s important to be aware of possible signs and symptoms of testicular and prostate cancer.

Dr. Jain says testicular cancer can present at any age, although is more common in younger people and peaks around age 30. He says people with testicles should begin regular self-examinations of their testicles in their 20s and 30s, paying attention to any changes.

He says symptoms to speak to your family doctor about would be “a lump or enlargement of either testicle, a dull ache, or a feeling of heaviness in the scrotum that just doesn’t seem right.”

Family doctors will typically begin screening for prostate cancer when patients are in their 50s (40s if there is a family history or other risk factors). Prostate cancer often doesn’t cause symptoms in its early stages, and Dr. Jain says one of the challenges with diagnosis is symptoms, when they occur, can be similar to benign prostatic hyperplasia (BPH), which is a common condition in people with prostates as they age.

Some of those similar symptoms are difficulty urinating or having decreased force and flow, but symptoms that could be more specific to prostate cancer could be “blood in the urine or semen, painful urination, erectile dysfunction or even unintentional weight loss or bone pain in advanced disease,” Dr. Jain says.

Frequency of doctor’s visits

While it used to be common for patients to see their family doctor for an annual physical, Dr. Jain says the recommendations have changed over the past decade.

“We’ve moved toward appointments called periodic health visits,” he says. “And that’s where we really start focusing more on preventative screening, immunizations and education.”

He says since there are several health screenings that are recommended starting at age 40, it’s a good age to start seeing your family doctor more regularly.

“I would say, as in my practice, once someone turns 40, it’s really important to make it more of a regular routine to see your family doctor,” he says. “Every one or two years may be reasonable, although the specific interval should be discussed with your health care provider based on your unique health needs.”

Be proactive 

Dr. Jain says it’s critical to be proactive about your health. Yes, that means going for preventative health screenings and booking those doctor’s appointments, but it’s more than that.

“Watch for concerning symptoms and seek help early. Also, even though it seems simple, it’s paramount to maintain a healthy diet and exercise regularly,” he says.

Another suggestion from Dr. Jain is to monitor your blood pressure periodically, whether at a pharmacy or with an approved home blood pressure device. It can provide useful information in diagnosing hypertension.

“Honestly, having good blood pressure control is probably one of the best things people can do for themselves to prevent heart attacks, strokes and mini strokes (TIAs),” he says. “It’s often under-appreciated, as high blood pressure may not present with symptoms, although it is highly preventable and treatable.”

Whatever it looks like, though, Dr. Jain emphasizes the importance of prioritizing your health and wellness.

“It is important to not neglect taking care of yourself and ensure you continue to connect with your health care provider virtually or in person.”

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Here’s the good news: there are some things we can do to help prevent heart disease and, if heart disease or attack is recognized and treated early, there are some great outcomes for patients.

I spoke with Dr. Mina Madan, cardiologist at Sunnybrook, to answer some FAQs about the heart and how we can keep ours healthy.

Q. A real easy one, to get us started: What is the heart? (Because it’s been awhile since we’ve sat in a Science Class)

The heart is a muscle pump in the left part of the chest that pumps blood carrying oxygen to the rest of the body. It has its own blood supply that delivers oxygen and nutrients to the heart.

Q. What is coronary artery disease?

The heart’s blood supply is kind of like a plumbing system. Coronary artery disease is build up in those pipes. When there’s a blockage – made up of cholesterol plaque – oxygen and nutrients can’t get to the heart, and so it starts starving. The build-up can happen over time or abruptly.

After about 30-40 minutes of a complete (100%) blockage, you may start to feel some or all of the classic symptoms of a heart attack.

Q. What are the symptoms of a heart attack – or what doctors would call a myocardial infarction?

The classic symptoms are: central heaviness in the chest, burning in the chest that radiates up the neck and into the jaw, pain in the back, difficulty breathing, sweating, pain in your left arm, nausea or vomiting. If you experience these symptoms, call 911.

Q. What are some of the not-so-typical symptoms?

There are other atypical symptoms that both men and women may have. Those might be just jaw pain, just back pain, or burning in the stomach area (kind of like acid reflux). This explains why sometimes the diagnosis of heart attack can be missed.

Q. I’ve heard women experience heart attack differently than men and many don’t realize they are having a heart attack at all?

It’s true. Many women have other atypical symptoms or report just feeling breathless, or really fatigued in the days leading up to a heart attack; some women experience the so-called classic symptoms, but less intense. These symptoms could be a sign of trouble in your heart. You should talk to your doctor.

It’s not really known why these differences exist – just differences in how men and women are wired.

Heart attacks are more common in men. Post-menopausal women have heart attacks more often than pre-menopausal women due to the reduced levels of estrogen associated with menopause (estrogen has a protective effect on the heart).

Q. What are heart disease risk factors?

It’s important that people know the risk factors. Diabetes, high blood pressure, high cholesterol, smoking and a family history of heart disease are all risk factors. As you approach middle age it’s important you are aware of your family history. Talk to your doctor about your risk factors and take measures to keep your heart healthy.

Q. What can we all do to stay on the heart-healthy track?

If you smoke, consider quitting.

Get your blood pressure checked – you can actually do it yourself at most pharmacies.

Have an annual appointment with your family doctor.

Maintain a healthy body weight through a healthy diet and by staying active. You should exercise three to five times per week. Obesity itself is not a risk factor – but being overweight often goes hand in hand with high blood pressure, high cholesterol and diabetes.

If you have risk factors, feel out of breath more than usual or have any of the other lead-up symptoms mentioned above, talk to your doctor about taking a stress test. If heart disease is diagnosed, there are treatments and the outcomes are usually very good.

This column was also published in 2017 the Town Crier Group of Newspapers in Toronto, Ont. It has been reviewed and updated for 2021.

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Our long winter means I want to get outside ASAP. I know I’m not the only one who wants to shake off the winter cobwebs with some fresh air!

But before we do, remember these tips from a dermatologist to help us protect our skin from the sun.

A history of sunburns increases the risk of skin cancer, including melanomas. Sun exposure can also cause wrinkles, dry skin and age spots.

Dr. Mary McKenzie, dermatologist in Sunnybrook’s Melanoma Clinic, recommends using a sunscreen 30 SPF or higher if you will be outside. Some make-up and face creams now have SPF between 15 and 30 – that’s OK for your daily use. (For example, if you are just going from your house to car to head to the grocery story and back but not spending time outside, that makeup will provide enough coverage.) If you’ll be outside longer — to take a walk, sit in the backyard or wait in line outside of the hardware store, reach for an SPF 30 or higher. If your skin gets irritated after applying sunscreen, try a mineral formula. If you tend to break out after applying sunscreen, try a formula that is made for acne-prone skin.

While skin cancer is more common in people with light or pale skin, red hair or freckled skin, people with other skin types and tones are not without risk. People of all complexions should also wear sunscreen daily and practice sun safety.

Lips are super sensitive, and should be protected from the sun, particularly when you are near water (which reflects the sun). Try a chapstick with 30 SPF or more. And reapply often. Some colour lipsticks also offer SPF protection.

Don’t forget to apply sunscreen to the commonly missed places — your ears, tops of your feet and hands. Wear a hat to protect the top of your scalp (in particular if your hair is thin, fair or if you are bald) or apply sunscreen on the top of your head. Dr. McKenzie says the top of the head is a common trouble spot when it comes to skin cancers.

Cover up or find shade

There are ways to cover up besides sunscreen. Wear light, long-sleeve clothing to protect your skin. Linens are nice and airy. Or there’s sun-protective clothing available too. Wear a hat. Avoid the outdoors mid-afternoon when the sun is at its peak. Seek shade. Carry an umbrella.

And wear shades

Dr. McKenzie doesn’t recommend putting sunscreen on your eyelids – sweat can make the sunscreen run into the eyes and sting. Sunglasses do double duty – they protect the eyeballs and the eyelids. So don’t forget them!

If you find your eyes do sting (often from sunscreen mixed with forehead sweat) try a mineral sunscreen.

Rub it in

Be sure to put a thick coating of sunscreen on your skin (about a shot glass worth) and rub it in. If you are using a spray sunscreen, keep the bottle close to the skin when you spray. “With the spray bottles, it’s a little harder to tell if you’ve missed a spot,” Dr. McKenzie says. “Be sure to still rub it in and use enough sunscreen.” Don’t spray it in the wind – you want to make sure it’s getting onto your body.

After sun

Is there anything we can do to feel better or minimize a sunburn’s effects? Dr. McKenzie says try a mild cortisone cream, available over-the-counter, to reduce the inflammation. But, most importantly, try to avoid the burn by using sunscreen and following the other tips above.

(This post was reviewed and updated April 28, 2023)

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“When DeRozan said he hoped that some people might look at him and see a person who has struggled with depression and who nevertheless lives a meaningful and successful life, to me it was even more exciting than a Game 7 buzzer beater,” Dr. Sinyor explains in the op-ed.

It was 2018 when DeRozan, then a Toronto Raptor, tweeted “This depression get the best of me.”

Dr. Sinyor explains that by DeRozan opening up about his struggle with depression, it inspired conversation to help address stigma around mental health, in particular, among men who are still facing stereotypes that seeking help is ‘weak.’

Dr. Sinyor says DeRozan’s game-changing tweet and openness “gave this city and its fans a gift beyond basketball.”

Read the full op-ed.

Learn why it is important to talk about men’s mental health.

If you need help in an emergency, please call 911 or visit your local emergency department. If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available 24/7 through community resources:
Phone: toll-free at 1-833-456-4566
Text: 45645 (4 p.m. – 12 a.m. EST)
Chat: crisisservicescanada.ca

The post How former Toronto Raptors player DeMar DeRozan helped change the conversation about mental health appeared first on Your Health Matters.

Cannabinoid hyperemesis is a condition that leads to nausea and frequent vomiting and is brought about by long-term cannabis use. This condition isn’t well understood, but it is known that THC affects the digestive tract (because there are molecules in it that bind to the THC). This syndrome doesn’t affect all users but it is a possible adverse effect that people who use cannabis should know about.

Here, oncology pharmacist Carlo DeAngelis answers some common questions about this condition.

What is cannabinoid hyperemesis?

This is a condition that presents as recurrent/cyclical nausea, vomiting and abdominal cramping due to long-term cannabis use. The symptoms are also often associated with a compulsive desire to take a hot bath or shower, which provides temporary relief of symptoms. Combined with a history of cannabis use, this behaviour is considered somewhat diagnostic.

How common is it?

We really do not know. There have been several studies looking at this question from different perspectives. In a survey of heavy users (smoking cannabis for a least 20 days in a month) about 33 per cent of those surveyed had symptoms suggestive of hyperemesis syndrome. In a study of emergency room visits following legalization of cannabis in Colorado, emergency room visits for cyclic vomiting doubled. In another study looking at emergency room visits for vomiting about 6% of the visits were Cannabis Hyperemesis Syndrome.  Another study that looked at patients who were diagnosed with hyperemesis syndrome: 48% were daily users, 24% were greater than daily cannabis users, 19% were weekly users and 2% were less than weekly users.

Do you need medical attention if you have vomiting after cannabis use?

This will depend on you and the severity of your vomiting and nausea and so I cannot offer medical advice to you. In early stages of cannabinoid hyperemesis, patients typically experience morning nausea with an urge/need to vomit (however they typically do not vomit) and abdominal discomfort. At this stage they may even increase cannabis use thinking that it will help their nausea. The most appropriate thing to do is stop the cannabis. We do hear of people who present to the emergency department when they are having uncontrolled vomiting. If you are having uncontrolled vomiting you should seek medical attention.

Is there anything that can treat cannabinoid hyperemesis?

Stop cannabis use and take supportive measures (hydration).  Rubbing capsaicin on the belly has been reported to help with symptoms as does hot showers. There are some medications that can help with symptoms. Speak to your healthcare provider.

If you have more questions or concerns, speak to your healthcare provider.

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Hon and his urology laboratory have developed and fine-tuned a blood test, also known as a “liquid biopsy”.

“When a tumour dies or grows, fragments are constantly being shed into the blood stream like a cat or dog shedding its hair all over a living room. We developed technology to count these fragments in the blood,” he says. “Looking for cancer cell fragments is a better method than looking for travelling cancer cells, which are very difficult to catch or find. Their job is to find a place to form a new cancer as fast as possible and their presence in the blood is only temporary.”

By counting the fragments from a simple blood sample, the researchers are able to determine who has prostate cancer and even whose cancer is aggressive and whose is low-risk.

At Sunnybrook, Hon is teaming up with imaging researchers to come up with an even more accurate way of determining whose cancer is high-risk and requires treatment.

“I call it ‘two-step authentication’,” he says. “The blood test and an MRI of the prostate work together to determine who is most at-risk and needs a biopsy. There would be no delay in this process. The patient gets both tests and there is minimal anxiety felt by the patient. There’s no waiting game and that’s the part patients hate.”

Currently, men who have a rising PSA or a suspicious finding on a digital rectal exam are typically referred straight to biopsy but there is often a delay of days to weeks.

“And what we know is that very often, those biopsies are negative for cancer,” he says. “We’d like to reduce the number of unnecessary biopsies, which are costly, painful and have long-term side effects. It ends up being a regretful and negative experience for many men; we want to prevent that.”

Some men receive a prostate MRI, and the findings are given a score from 1-5. Those who score 3 or higher are typically referred for a biopsy. More than half of those who score 3 are found not to have cancer.

“By pairing the MRI together with the liquid biopsy, the urologist could say, ‘I see this man scores a 3 on MRI, but his liquid biopsy shows very few fragments. So I won’t refer him for biopsy at this time’,” Hon says. “The patient gets spared the burden of biopsy and is just watched carefully by their family doctor.”

Clinical trials for this approach are underway in collaboration with imaging scientists, radiologists, and other experts at Sunnybrook and the Ontario Institute for Cancer Research (OICR).

Dr. Leong is also looking to find an easier and accurate way to determine who is at risk of prostate cancer at all by working on developing an at-home test. In the SMART biopsy method, men whose at-home test show signs of prostate cancer would then be referred to their family doctor to initiate the next step – the two-way authentication test, which would be the “liquid biopsy” blood test and an MRI.

“The moonshot of this program is that within several years, the current screening methods for prostate cancer will be obsolete in favour of this new SMART biopsy method,” Dr. Leong says. “This could help more men avoid prostate surgery and instead undergo active surveillance if they know the cancer is low risk.”

More importantly, he says, it will hopefully change the perception that prostate cancer is a rocky journey.

“We want it to be as smooth and fast as possible. Taking advantage of various strengths already here and combining them towards this single goal will give this moonshot a smooth landing.”

The post Behind the research: looking to transform prostate cancer detection appeared first on Your Health Matters.

To answer this question, we spoke with Dr. Brittany Waller, community dermatologist and former Sunnybrook clinical fellow.

Here’s her reply:

Before we can discuss topical products, we need to understand the physiological differences between male and female skin. In general, males tend to have 25 per cent thicker skin than females. In males, the outer layer of the skin’s epidermis, known as the stratum corneum, tends to be quite dense, which can lead to uneven texture. Male skin is also firmer with a higher concentration of collagen, the main protein that provides skin’s structure. With higher concentrations of androgens, aka male hormones, men tend to have oilier complexions.

Men have more dark, coarse facial hair, which can lead to significant irritation with shaving. Using a hydrating shave cream to protect the skin while allowing the blade to glide smoothly is very important. Given the increased oil production, men tend to be more acne-prone and need lighter moisturizers. Heavy creams, which may be needed by women with drier skin, can lead to breakouts in men.

Trans patients taking gender-affirming hormones may experience changes that align with more masculine skin if taking testosterone and more feminine skin if on estrogen and androgen-blocking medications. Please speak with your primary care provider and/or dermatologist if you are taking these hormones and have any questions or concerns.

The number one most important skin care product for everyone is sunscreen. In addition to preventing sunburn, sunscreens prevent repetitive UV damage, something directly linked to skin cancer development. Sunscreens also protect against pigmentation changes/uneven tone and fine lines/wrinkles, so they have both health and cosmetic benefits. Look for a broad-spectrum sunscreen to protect against both UVA/UVB rays. An SPF of minimum 30 or higher is also important too.

So to answer your question, using your wife’s face cream won’t likely do much harm, but consider picking up a product that’s right for your own personal skin care needs.

Keep it simple for both of you and look for non-scented, gentle products free of perfumes and fragrances. The Canada Dermatology Association has some great recommendations listed on their website. Check it out, and protect the skin you’re in.

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