KERRY O’BRIEN: Every year, about 2,700 Australian men die from prostate cancer, roughly similar to the number of women killed by breast cancer. Yet, contrary to popular belief, prostate cancer isn’t just a disease of the aged. The Prostate Cancer Foundation recommends men with no family history be checked at 50, and those with a family history should be tested from 40. But, for all the advice and growing awareness, there is no clear path for men to follow for testing and treatment. While there is a blood test that can track changes in the prostate, medical opinion is divided about its effectiveness and whether ultimately it does help save lives. Scott Bevan reports.
RON BENDER: I guess your head swims a little and I guess you sort of say, “Well, okay, what does that actually mean?” The first thing that comes into your mind is, “Well, how long am I going to survive?”
SCOTT BEVAN: While many men flinch at the thought of a blood test, Ron Bender has no qualms about an appointment with the needle. The retired police commander believes it was this kind of test, to read his levels of a substance called prostate-specific antigen, or PSA, that led to an early diagnosis of cancer two and a half years ago.
RON BENDER: Had I not had a PSA test, I would probably be looking down the barrel of within the next couple of years, I would be having all sorts of unfortunate symptoms, and it would then be discovered that I had advanced prostate cancer.
SCOTT BEVAN: After further tests revealed about 40 per cent of his prostate was cancer-affected, Ron Bender had the gland removed. Ongoing check-ups, he says, indicate that he is cancer free.
CHERYLE BENDER: We were always positive. It meant that we were going to catch this thing in time. I was so glad that Ron had been having regular PSA tests.
PROFESSOR JIM DENHAM, NEWCASTLE MATER HOSPITAL: I can’t help feeling, when I see men coming up with these locally advanced cancers, for Goodness’ sake, why couldn’t they have been diagnosed 10 or 15 years earlier?
SCOTT BEVAN: Professor Jim Denham knows all too well that in many cases prostate cancer is not being caught in time. He’s a radiation oncologist in Newcastle. Professor Denham is an advocate of PSA testing, particularly for men with a family history of prostate cancer, to pick up early signs of trouble, but the battle is not against just cancer, but ignorance.
JIM DENHAM: The prostate, in fact, is sitting right here underneath the bladder.
SCOTT BEVAN: He says many men aren’t even sure where the prostate is, let alone know there is a test available to check its health.
SCOTT BEVAN: What symptoms would you notice if you do have prostate cancer?
JIM DENHAM: Well, for the first 20 years, none whatsoever.
SCOTT BEVAN: Is that part of the problem?
JIM DENHAM: That is completely the problem. It is silent.
CONFERENCE SPEAKER: What are we going to do about it?
SCOTT BEVAN: In the Hunter region, survivors, health professionals and business supporters have started a prostate cancer awareness campaign. And they recently gathered to launch a book, written by a survivor’s wife, Gail Tingle, and a retired professor of nursing, Irena Madjar. It’s aimed at enlisting women in the fight against this men’s disease.
PROFESSOR IRENA MADJAR, AUTHOR: In our small way, we want to change community attitudes to prostate cancer and get more men to be tested for it.
SCOTT BEVAN: The Prostate Cancer Foundation of Australia has been trying to encourage men to think and act, through its promotional campaign. But once awareness is raised, what then? For talking to the doctor won’t necessarily lead to a PSA test.
GAIL TINGLE, AUTHOR: A lot of men, particularly in country areas, have found that they’ve been to GPs and GPs have said, “No, it is not necessary”, and they won’t even give them a referral for a PSA test.
PROFESSOR MARK HARRIS, ROYAL AUSTRALIAN COLLEGE OF GPS: There is a lot of PSA testing going on at the moment and, as far as we can tell, it’s had no effect on cancer mortality. We really do need a better test, and we need better evidence.
SCOTT BEVAN: Professor Mark Harris not only has a GP, he is one himself. He has doubts about the reliability of PSA tests, and the possible side effects of treatment, concerns echoed in the Royal Australian College of General Practitioners’ guidelines. The college doesn’t recommend routine screening for prostate cancer with PSA tests. Instead, it advises that patients should make their own decision after talking to their doctor about the benefits and risks of testing.
JIM DENHAM: I would say over half of all general practitioners actually regularly advise men to have PSA tests. The problem is, as I suspect, that they advise them a little bit too late.
PROFESSOR IAN OLIVER, CANCER COUNCIL: It is important to realise that the PSA test doesn’t tell you necessarily that you have cancer. It tells you that there is something going on in the prostate.
SCOTT BEVAN: Professor Ian Olver is the head of the Cancer Council of Australia. He says that the PSA test may help in some cases in detecting an aggressive cancer early, but in others, it’s far from definitive, and that can create a host of new problems.
IAN OLIVER: Because we don’t know what to do; some men are being over treated. They are being frightened by a diagnosis of a disease that, for them, isn’t going to be a problem. So, it’s not that this test is harmless.
RON BENDER: You could use the same argument with breast screening. A lot of women find benign lumps, benign tumours, and they have them removed and they are happy at the end of the exercise to find that they don’t have cancer. I think men would be equally happy to find that they didn’t have prostate cancer. But what about the large percentage of those men that will have cancer?
SCOTT BEVAN: For Professor Jim Denham, the doubts swirling around PSA testing have an air of history repeating. 25 years ago, he recalls, breast cancer screening was also questioned. Now, there is no question; it’s helped save many women’s lives. PSA testing, he believes, can do the same for men.
JIM DENHAM: It is reckoned to be about as reliable as mammographic screening. One in four men with an elevated level are likely to have prostate cancer.
SCOTT BEVAN: Well, if mammograms have about the same accuracy as PSA testing and mammography is now widely accepted, why aren’t PSA tests?
JIM DENHAM: Well, I think the reason for that is because prostate cancer treatment and research is that much behind breast cancer research, about 20 to 30 years, in fact.
SCOTT BEVAN: And it is what comes after the test results, according to the College of GPs’ Professor Mark Harris, that is different.
MARK HARRIS: It is much simpler to do a biopsy on the breast in the majority of cases and we’ve got some interventions that we can offer that make a really big difference, in the vast majority of women.
SCOTT BEVAN: Australian medical organisations, governments, doctors and patients are waiting to see the results of two major trials into prostate screening being held overseas. Now, those results are expected next year, but the hope here is that they will provide clearer answers as to whether a nationwide screening program would be beneficial. Until then, it seems, the mixed messages about PSA testing will continue.
IAN OLIVER: We would like there to be an effective screening test, but we need to know that first.
JIM DENHAM: I think evidence has come from the screening trials already that, despite its imperfections, the PSA test will identity early cases of prostate cancer in large numbers.
RON BENDER: I think PSA should get the same level that breast cancer screening is. I think it should get there quickly. We are worth it. We are not just statistics. We’re not just these numbers on paper that don’t matter. We are real human beings who want to live happy and productive lives in our old age.
KERRY O’BRIEN: That report from Scott Bevan.