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Breaking a taboo |
Prostate cancer is the most commonly diagnosed cancer in Australian men and the second leading cause of cancer deaths.
Once a taboo topic, recent media attention has done much to bring the disease to the fore. Yet despite this attention, the medical community is still divided on whether men should be universally screened for prostate cancer. And just the thought of a prostate check is enough to make most men cringe.
The prostate is the small male reproductive gland that is responsible for producing the fluid that protects and enriches sperm. It is walnut shaped and sits below the bladder.
Cancer of the prostate is the only life threatening condition of the prostate. There are often no symptoms in the early stages of prostate cancer, making early detection difficult.
However there are some common prostate problems that men should be aware of.
Most will be unrelated to prostate cancer and some common symptoms can include:
- Frequent urination
- Difficulty controlling the flow of urination
- Discomfort when urinating
- Blood in the urine or semen
- Painful ejaculation
- Decrease in libido
- Difficulty in obtaining an erection
The good news is that if caught early enough, while the cancer is confined to the prostate, it is often curable. If the cancer spreads to other organs, it can be treated, but cure is less likely.
Some prostate cancers are slow growing and not life threatening, while others are fast growing with the potential to cause death. Unfortunately, our screening programs are not currently sophisticated enough to be able to distinguish between the different types of cancer.
How is it diagnosed?
At present, there are two prostate cancer tests – the Prostate Specific Antigen (PSA) test and the Digital Rectal Examination (DRE).
PSA is a protein produced by the cells of the prostate gland. When the prostate enlarges, the PSA levels in the blood tend to rise. The PSA test checks the amount of PSA in the blood. Large quantities can indicate prostate cancer or other prostate conditions. The Prostate Cancer Foundation of Australia estimates that one third of men with an elevated PSA level will have prostate cancer.
The DRE is a manual examination of the prostate gland. It involves a GP or urologist inserting a gloved finger into the rectum to check for any abnormality in size, shape or texture in the prostate.
Dr Jacinta Halloran says that if either the PSA test or a DRE reveals any abnormalities, your doctor may suggest you see a urologist to decide whether a prostate biopsy is needed.
Jacinta says a biopsy of the prostate gland is the only reliable way of diagnosing prostate cancer.
"Both the PSA and the DRE are screening tests only. They pick up abnormalities that require further investigation. A prostate biopsy is
the only way of being 100 percent sure of what you're dealing with."
To screen or not to screen
This is a complex question, says Jacinta.
The complexity comes from several issues, including the slow-growing nature of prostate cancers, the problems with PSA testing and the side effects most treatments cause.
The Urological Society of Australia and New Zealand (USANZ) strongly advocate that all men should have the opportunity of making an informed personal decision about PSA testing.
They believe men should be given as much information as possible about the tests, the treatments available and the side-effects they may encounter and then leave the decision up to them.
The Cancer Council Australia is also not sold on the benefits of population screening because there is as yet no evidence that supports the premise that population screening reduces deaths.
"The Cancer Council's position on PSA testing is that PSA levels do not give us enough information to differentiate between benign prostate conditions and cancer," says Professor Ian Olver, Chief Executive Officer of The Cancer Council Australia.
"The PSA test doesn't allow us to differentiate between cancers that would never cause harm, and those with the potential to cause death.
"The test is also limited in that a low PSA result does not necessarily mean you're cancer free in that same way
that PSA elevations does not always mean you've got cancer."
Like the USANZ, the Cancer Council supports giving individuals the information they need to make an informed decision about prostate cancer testing and treatment.
So what should you do?
"My advice to any man who is tossing up whether to be tested or not is this," says Jacinta, "speak to your GP and make sure you discuss any risk factors that may increase your chance of developing prostate cancer.
"Then, once you have all the relevant information, you'll be able to make an informed decision about what is best for you, your health and your family."
The Risks
At present, doctors don't know what causes prostate cancer but they have been able to identify two risk factors –
age and family history. Jacinta says that increasing age is the most significant prostate cancer risk factor.
"The disease generally affects older men with 85 percent of new cases and more than 96 percent of deaths occurring in men over 60 years. If younger men – those under 45 years – are not diagnosed early enough however, they are more likely to die prematurely from the disease as there is more time for the cancer to progress."
Although not as significant as age, a family history of prostate cancer can also increase your risk. Research from the Cancer Council suggests that men with a family history of prostate cancer in a first-degree relative (father, son or brother) have two to three times the average lifetime risk of developing prostate cancer.
"It's important for these men to discuss the risks and benefits of prostate cancer screening with their doctors," says Jacinta. "Some men, after discussion with their GP or urologist, might elect to have a yearly PSA and DRE test from the age of 40, while other men might decide they don't want to be tested."
Medical researchers also believe environmental and lifestyle factors may also increase the risk but more research needs to be done in this area.
Men's health is all about women
A recent Newspoll survey has found that women need to be educated about men's health issues as they play the leading role in men's healthcare.
The survey found that a remarkable 78 percent of men only visited a doctor after being encouraged by
a female while a further 61 percent only had a prostate check after the female in their life hassled them.
Andrew Giles, Chief Executive of the Prostate Cancer Foundation says the findings show what a crucial role women play in men's health.
He believes it's important to continue to educate women about prostate cancer as well as encouraging men to be more aware and active when it comes to men's health issues.
Jim's Story
I had visited my doctor in March 2002 seeking some travel inoculations, as I was attending the 2002 Anzac Day Service in Gallipoli, Turkey.
My GP recommended I have a routine PSA and cholesterol blood test. Despite having no symptoms, my PSA was elevated at four. I was not concerned as I virtually knew nothing about prostate cancer and my GP recommended a further test in three months time.
Like most men I delayed having the test for a further six months until I visited my GP on an unrelated matter. The second test revealed a further elevation of my PSA to six and I was referred to a urologist in September 2002.
My urologist recommended a biopsy, and whilst I was warned that this was uncomfortable, nothing really prepared me for the reality. I can't say it was painful but I can only describe it as a builder's rivet gun being discharged inside your backside. I had nine
samples taken on the 9th of October and I counted each one of them!
The next two weeks were an anxious time, waiting for the results, but I always felt positive that the results would be negative. After all I was 48 years old, relatively fit and feeling very healthy. I couldn't possibly have cancer.
But I did. The biopsy was positive. I guess my mind went blank – this couldn't possibly happen to me. I still have the hand-written diagram that my urologist sketched for us, trying to assist in explaining the diagnosis.
Like all prostate cancer patients I had to decide between the following options:
- Do nothing (not a realistic option)
- Surgery (a very scary idea)
- Radiation (an even scarier idea for me)
I researched as much as I could about prostate cancer (only confusing me further) and finally chose the surgery option on the basis of the following fact – I was 48 years old, reasonably fit, the cancer was detected early, and there was a reasonable chance of a complete cure.
Eight months after the surgery my PSA levels reduced to less than .01 and my life returned completely to normal. I am fitter now than I was before the operation and looking forward to continuing a long and active lifestyle, something that would not have been the case without a routine PSA test and early detection.
* Provided courtesy of The Prostate Cancer Foundation.
Like to know more?
For further information about prostate and other cancers, visit the Cancer Council's website www.cancer.org.au
or call the Cancer Council Helpline on 13 11 20. You can also visit the Prostate Cancer Foundation's website
www.prostate.org.au or call 1800 22 00 99.
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