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As many Australian men die of prostate cancer each year as women do of breast cancer.
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The thought of a prostate exam may be daunting for men, but early detection is vital. As one doctor said, “I’ve never seen a patient too early, but I’ve seen plenty too late.”
A national survey conducted by the Prostate Cancer Foundation of Australia in 2002, however, shows only half of all men feel well informed about the condition, as opposed to almost 80 per cent of women feeling well informed about breast cancer.
Every day, over 30 men on average will be told they have prostate cancer, and sadly, one will die every three hours.
Yet the subject of prostate cancer affects a person’s manhood, and so it is largely taboo in comparison to other cancers.
So when a man agrees to discuss the condition, it is all the more important his story is heard.
“It is often said that men are not conscious of their health,” says Jack*, of Kadina. “This is not entirely true, most of my friends know which doctor they are staying away from.
“It’s a bloke thing, a ‘gung ho, she’ll be right’ attitude that works on the premise men only visit the doctor when they are standing at death’s door. And so it was with me.”
Jack was diagnosed with prostate cancer last year, after a relative’s passing caused him to start taking PSA tests on a regular basis.
His doctor told him recently if he hadn’t taken the tests, the two would not have been speaking in 12 months.
“I considered I was fit and healthy, had never been in hospital, was not taking any medication, I hadn’t increased my weight for 40 years and played sport twice a week,” said Jack, who often bragged he had taken only three sick days off of work in 35 years.
“But then a close relative on my wife’s side died of prostate cancer after a relatively short time, and my wife exhorted me to have the blood test, to check the possibility of prostate cancer.”
Testing
“Reluctantly, I visited my doctor, who thought it was a good idea at my age, and after a digital rectal examination, I had a blood test to measure my levels of PSA.”
PSA (Prostate-Specific Antigen) is a protein produced by the prostate, low levels of which can be found in the bloodstream. However, when the normal structure of the prostate tissue is disrupted, most notably by cancer, higher levels can be detected, making it the leading test for prostate cancer.
“The results of my test showed no cause for alarm,” said Jack.
“However, I agreed to have a PSA test done on a regular basis, and did so over a period of three years with none of them sinister, so it was disconcerting to receive a call from my doctor following the latest test, requesting me to see him.”
Jack’s doctor explained his PSA levels had risen from their formerly level plateau, so much so he referred Jack to an urologist specialising in prostate disorders.
“After undergoing several tests with the urologist, I was not unduly concerned when he prescribed a month-long course of medication, which he thought would do the job.
“After all, I was feeling well, having no trouble passing urine and only requiring the toilet once a night.”
Unfortunately, after two months of treatment, Jack’s next blood test showed his PSA levels had more than doubled.
“For the first time I began to realise the fallacy of my perceived invincibility,” he said.
Following the unexpected result, Jack’s urologist arranged for a Prostate Ultrasound Biopsy procedure, which entailed an ultrasound probe being inserted into the rectum, guiding an instrument that snips out 12 sections of tissue from the prostate gland.
Diagnosis
The results became available less than a fortnight later, at which point Jack was diagnosed with cancer.
“The results were not a complete surprise,” he said.
“After the failure of the first treatment, the possibility of cancer loomed even larger, so I was half expecting the verdict, but in truth, my first reaction was surprisingly one of relief.
“Relief, to the extent it had happened to me at this stage of my life, I am in my 70s, my children have grown up and are successful in their chosen careers, and no longer dependent on me. I also have the knowledge my wife will be financially secure in future years, no matter what happens.”
If he had been diagnosed 30 years earlier, the news would have been devastating.
Jack informed his wife, knowing the condition can often put strain on a relationship, though he believes the couple have only grown closer since.
He decided not to tell his children until he knew more about the condition, including the big question — had the cancer spread?
“My urologist explained the next step would be to ascertain if the cancer has spread outside the prostate gland, and so doctors took a radionuclide bone scan involving radioactive material being injected into my bloodstream.”
The test showed Jack’s cancer had not spread outside the prostate gland, at which point he informed his children, something he says he could not imagine having to do at an age his children were still dependent on him.
Treatment
Jack’s urologist referred him onto a number of specialists, who had a combined meeting to discuss how to treat his cancer, in regard to how it was defined.
Prostate cancers are defined on a Tumor/Nodes/Metastases (TNM) scale of one to four, one being the least aggressive stage, or using a Gleason Scale, which ranks the cancer from two to 10 based on abnormalities.
Jack’s TNM score was two, raising his chances of surgery being successful.
The panel of specialists discussed which treatment option would be the most viable, from a Radical Prostatectomy (physical surgery), to external beam radiation therapy or Brachytherapy, a procedure in which small radioactive seeds are implanted directly into the prostate.
“The next meeting the panel advised me I had met the criteria for Brachytherapy, and suggested this be done as soon as possible,” said Jack.
Surgery
“The urologist on the panel decided because of my latest urine test flow, a procedure known as Cystoscopy and Bladder Neck Incision be done before the implant, to allow for a greater amount of waste and blood to be passed following the operation.”
A Cystoscopy is an Endoscopy of the urinary bladder, in which the doctor uses a cystoscope to see inside the urethra and bladder to detect any problems.
A Bladder Neck Incision was then done, essentially cutting the bladder neck, allowing for easier passage of waste and blood after the Brachytherapy.
“This operation was done five days later, but even though I was only hospitalised for two days, it set the seed implant back weeks, to allow the bladder to heal,” said Jack.
“The seed implant operation began at 8am. The radioactive seeds, each the size of a grain of rice, had arrived from the Canberra Lucas Heights depository overnight, and in my case, 78 seeds were implanted directly into the prostate gland.”
The seeds required vary from person to person, and are placed into the prostate through hollow needles. The radioactivity within each seed lasts 12 months.
Recovery
“I awoke from the operation at 4pm, and after the doctor removed the catheter, a cat scan showed all the seeds were in place,” he said.
“I experienced no pain, and the bleeding stopped after a few days, at which point I was back to my morning walks.
“For the first four days, I was required to filter my urine through a sieved funnel in case any seeds were passed, as they had to be placed in a lead lined container and returned to the hospital due to their radioactivity, but I passed none.
“I was also issued a Radiation Exposure Card, which I have to present at airports as the seeds can activate security alarms.”
As Jack now looks to the future, neither he nor the panel know the prognosis.
Regular blood tests must be maintained, with PSA levels projected to rise and fall, in what is known as “the bounce”.
After two years a trend of either up or down will become apparent, and until that time, Jack simply plans to live his life to the fullest.
“What I have learned from all of this, is that without exception, all the doctors to whom I’ve spoken agree on one thing — early intervention is the key to successful treatment,” he said.
“One of the urologists on my team remarked, ‘I’ve never seen a patient too early, but I’ve seen plenty too late’.”
* Name changed upon request to protect identity.
The chances you have of being diagnosed with prostate cancer:
A man in his 40s - one in 1,000
A man in his 50s - 12 in 1,000
A man in his 60s - 45 in 1,000
A man in his 70s - 81 in 1,000
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