News and Events

Dr. Neil Fleshner on Prostate Cancer (Benefits Canada)

Unequal funding and treatment for cancer costs employers

Moira Potter | May 4, 2015

Cancer is an equal opportunity disease. But the way it’s treated is not—and we’re all paying the price. In February, Benefits Canada’s 2015 Employers Cancer Care Summit brought physicians, employers, insurers, pharmacists and healthcare advocates together in Toronto to hear why there are huge nationwide disparities in the quality of available cancer care and access to new medications, as well as in provincial policies toward funding existing tests and emerging treatments.

The PSA Controversy

Prostate cancer is the most common male malignancy, but governments—and men themselves—seem to be ignoring it.

Dr. Neil Fleshner, University of Toronto and University Health Network
Dr. Neil Fleshner, University of Toronto and University Health Network

“Getting prostate cancer is like getting grey hair and wrinkles,” said Dr. Neil Fleshner, chair of urology at the University of Toronto and chief of urology for the University Health Network. “Eighty percent of men will develop some degree of prostate cancer as they age, and one in four will die from it.”

A simple blood test—the prostate-specific antigen (PSA) test—can dramatically reduce, through early detection, a man’s chance of dying from the disease. Since the test’s introduction in the early ’90s, there has been a 40% decline in mortality for Canadian men battling the disease.

So why, then, did the Canadian Task Force on Preventative Health recently say PSA testing isn’t necessary for men of any age? “I think this is an abomination,” said Fleshner. “These guidelines even recommend against the digital rectum exam—even when a man has symptoms such as difficulty urinating. So [the Task Force] is essentially saying we should let any man destined to die of prostate cancer do so.”

Rocco Rossi, president and CEO of Prostate Cancer Canada, agreed. “This is the same organization that, a couple of years ago, suggested mammograms weren’t necessary for women under the age of 50. Guess what happened? Provincial legislators across the country received visits from our colleagues in the breast cancer movement who told them, in no uncertain terms, that if they defunded mammograms, they did so at their peril.” The pressure worked. Governments across Canada continue to fund mammograms for all women.

So why aren’t men mobilizing in the same way? Why aren’t they outraged that the Ontario and British Columbia governments refuse to fund the PSA test for men without symptoms?

“Because men are their own worst enemies,” said Rossi. “We ignore our health. And if it concerns anything below the waist, if we’re not bragging, we’re not talking about it!”

Both Fleshner and Rossi agreed men are being sent the message that the PSA test is optional. “And when men don’t have to take a test, they won’t,” Rossi said. “Because of that, they are dying and suffering unnecessarily.”

The solution is to raise awareness. While the Movember campaign has been hugely successful in doing that, Rossi wants women and workplaces to be more involved. “Women will ask the tough questions and push their men to take this seriously,” he said. “And employers can help by promoting PSA testing and including it in their workplace health plans.”

Moira Potter is a freelance writer based in Toronto.


Division of Urology 2015 Awards


John Honey has been selected as this year’s winner of the James Waddell Mentoring Award in recognition of his excellent mentoring of junior Faculty in the Division of Urology at St. Michael’s Hospital.

Michael Jewett is the recipient of an award from the Canadian Institutes of Health Research (CIHR) for his project “Determining the Research Priorities of Canadian Kidney Cancer Patients, Caregivers and Clinicians: A Priority Setting Partnership for Kidney Cancer”. This award was ranked #1 in the entire competition.

Laurence Klotz received the Order of Canada, one of our country’s highest civilian honours, recognizing outstanding achievement, dedication to the community and service to the nation. He received this honour for his contributions to the treatment of prostate cancer, notably for leading the adoption of active surveillance as a standard aspect of patient care.

Laurence Klotz also received the Canadian Cancer Sociery O. Harold Warwick Prize which is given annually to honour distinguished investigators who have undertaken studies in Canada that have led to significant advances in cancer control.

Girish Kulkarni received the 2015 Bernard Langer Surgeon Scientist Award, which is awarded to an outstanding graduate of the Surgeon Scientist Program in the Department of Surgery, who shows the greatest promise for a career in academic surgery.

Ken Pace was awarded the 2015 St. Michael’s Hospital Complete Physician Award at the annual hospital Educational Achievement Day.


Hanmu Yan (PGY 4) received the 2015 D.R. Wilson Award for Teaching. This award is given to the surgical resident who is rated by undergraduate students as being an outstanding teacher. The resident will demonstrate both a positive attitude toward teaching and will be considered a good surgical role model for undergraduate medical students

Dr. Dean Elterman on Men’s Health (The Globe and Mail)


For me, improving men’s health is personal. I am a man in my mid-thirties and the statistics for living a life free of disease and health complications are not in my favour, unless I take action now. I know this because I am urologist. Every day I see male patients and colleagues who have put off taking care of their health because we live in a society where masculinity forces us to focus on our careers, abuse our bodies and neglect our health-care needs. Across all age groups globally, men die earlier and live more years in poorer health compared to women. Men are at increased risk of premature death related to heart disease, stroke, workplace accidents, suicide and risky behaviour such as drunk driving.

In some respects I’m about to make sweeping generalizations that don’t apply to all men. But bear with me.

Is there a faulty or self-destruct gene on the Y-chromosome or does being “manly” lead men to engage in riskier physical activities and socially-influenced neglect of their own health? Historically, men’s health seemed to fall off a cliff once they reached their late teens. After the days of routine pediatrician visits, boys are noticeably absent from doctors’ waiting rooms.

We become men. And men don’t see doctors. Men are fearless and strong. Men avoid asking for help or acknowledging vulnerability or weakness. We get caught up in life, starting careers and families. And society doesn’t make it easy for us. When’s the last time you ordered a kale salad and carrot juice at the hockey game? Exactly.

Men eat poorly, drink and smoke too much, don’t get enough sleep or exercise, and don’t see doctors regularly. They vanish only to show up at my office door 30 years later with a urologic complaint or in the emergency department with something much more serious.

These generalizations, I’m pleased to say, appear to be on the wane.

More young men are being inspired by campaigns like Movember to know their health risks and make changes earlier in life. Boomers are turning back the clock and men of all ages are taking a more open and proactive approach to their health.

Men never used to talk about their erections or the way they urinated. Now I have men coming in to my office, who after seeing their family doctor for the first time in decades, are asking about their testosterone or ways to improve their urinary/sexual health after hearing about it from friends. As a urologist, working in collaboration with my primary care colleagues, I am in a unique position to talk to men for perhaps the first time in many years about their cardiovascular health, lifestyle habits as well as urologic concerns.

Urologists used to see men for a single system complaint, such as an enlarged prostate, cancers or infertility. Problems were isolated and treated in a targeted fashion with little consideration for the interrelatedness of bodily systems. We now recognize the association between metabolic dysfunction, such as diabetes, and urologic disorders like lower urinary tract symptoms, low testosterone and erectile dysfunction. We also know that these urologic complaints can be the early warning signs for more serious, life-threatening conditions just a few years down the road. When a middle aged man comes into my office with a new complaint of erectile dysfunction, the first thing I think of his is heart, cholesterol, blood sugar and blood pressure, not which little erection pill I can prescribe him.

We are making great strides in both health policy and technology in the domain of men’s health. Australia and Ireland, as well as British Columbia have national/provincial men’s health initiatives that approach the issues facing men through a uniquely gendered lens, just as had been done for women’s and children’s health in the late 20th century. New minimally invasive technologies, like the laser surgery that I perform for benign prostate enlargement, are making the prospect of medical treatment and recovery that much easier for men to palate.

Men’s health is a personal issue for me. But it should be a personal issue for everyone. Men’s health affects spouses, families and communities. The health of men impacts our economy, culture and social fabric. Having healthy men is a women’s health and children’s health issue. It’s time to think about your health or the health of the men in your life. It’s never too late to make a change.

Dr. Dean Elterman is a urologic surgeon at the Toronto Western Hospital/University Health Network with a special interest in men’s health. He is the Medical Director of the Prostate Cancer Rehabilitation Clinic at Princess Margaret Hospital Cancer Centre. Dr. Elterman specializes in voiding dysfunction, sexual dysfunction and pelvic reconstruction in both men and women.

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