'I felt sick to my stomach' Why Australian men need to talk about their prostate
For many Australian men, the health of their prostate is just too uncomfortable to think about.
Thousands of men around the country are growing facial hair this month in the popular "Movember" fundraising drive, but too many of them are still too scared to speak with their doctor about their own prostate health out of fear of the dreaded rectal examination.
Many men associate a prostate check with a doctor putting on a latex glove and poking around their backside.
They don't realise that, these days, a simple blood test is usually the first step to finding out if something is wrong.
The PSA test measures prostate-specific-antigens in the blood, which tells the doctor if there is anything to be concerned about.
If warranted based on those results, the doctor will then do the digital examination and order a biopsy for further examination.
Prostate cancer is the most commonly diagnosed cancer in Australian men and kills about 3500 of them every year.
The cancer forms when abnormal cells develop in the prostate gland, which then multiply and can often spread to other parts of the body, becoming fatal if left untreated.
The Australian Institute of Health and Welfare estimates that over 19,500 new cases of prostate cancer will be diagnosed this year.
A not-so standard trip to the doctor
Sydney man Colin Jeffery had the PSA test done 17 years ago during a routine check-up with his GP.
"I was 45 at the time and while prostate checks were usually for men 50 and over, my doctor suggested I get the PSA test done," Mr Jeffery told 9news.com.au.
"My PSA results came back slightly above the normal range, so I had a second test done a couple of weeks later."
This second blood test showed that Mr Jeffery's PSA levels had increased further, so he then had the digital examination.
The check showed his prostate was enlarged - so a biopsy was done, which came back with the devastating news that he had cancer.
"I felt sick to my stomach. I was very much out of my depth and felt like I had lost control of my life," he said.
Mr Jeffery had gone to his doctor for a standard check-up and now faced having to tell his family he had cancer and might die.
"Telling my parents was the hardest. I cried and couldn't finish talking to them. Jude (Colin's wife) had to take over the call," he said.
"My daughter was seven and my twin boys were five-years-old at the time. Turns out they knew more than we gave them credit for and handled it well."
Mr Jeffery had surgery to remove his prostate - and the cancer, which so far has not returned.
Having the test meant catching the cancer early, something Mr Jeffery credits with saving his life.
He now gets the PSA test done every year to check if the cancer has returned.
"If I hadn't had the initial test done at that routine check-up, I probably wouldn't be here today," he said.
"My advice is, whichever test your doctor recommends, listen to them. I wasn't displaying any symptoms and it saved my life."
New treatment trialled overseas
A new approach to diagnosing prostate cancer was trialled in Britain this year, with researchers saying results could diagnose cancer without the need for biopsies.
The Parsortix Liquid Biopsy is a blood test that detects circulating tumour cells (CTCs) that leave the original tumour and enter the blood stream before the disease spreads.
"Biopsies are invasive and carry a risk of infection with up to four per cent of patients suffering potentially fatal sepsis as a direct result of a biopsy," researchers at the Queen Mary University who conducted the trial said in their report.
They said biopsies only sample a small part of the prostate gland and cancer can be missed in 20 per cent of cases.
The group said the PSA test "is notorious for false positives with about 75 per cent of all PSA positive results ending up with negative biopsies".
The treatment is currently awaiting approval by the US Food and Drug Administration, and there are no plans for it to be brought to Australia.
Can the need for biopsies be eliminated?
The Prostate Cancer Foundation of Australia says significant further research is needed to determine how effective Parsortix is before it is introduced to Australia.
"Australia has a detailed set of evidence-based Clinical Practice Guidelines on PSA Testing which are routinely reviewed to ensure their effectiveness," a PCFA spokesperson told 9news.com.au.
In Australia, as well as PSA, biopsy and digital testing, diagnosis of the disease has been improved with the use of advanced imaging, called multiparametric-MRI, which is now widely accessible through Medicare funding.
"Prostate cancer diagnosis in Australia is among the world's best, and practices are different between countries," PCFA said.
"We must be cautious when seeking to interpret and introduce offshore research findings in the Australian context, where trends and patterns of disease may be different."
They have funded over $5 million in ongoing Australian-based research projects and invested a further $2.5 million in two new projects to help Australian men affected by prostate cancer.
"Awareness is key – we urge men to talk to their doctor about their prostate health and to give generously to Australian-based prostate cancer research."