“It’s a hell of a shock to anyone when they get told they have cancer,” says Mike Maurer, who was diagnosed with prostate cancer in his 60s.
“My mum and dad died of cancer and it was a bit ‘Oh my god, here we go again’. I knew things had changed since they’d passed away, but I wanted to find out, what does cancer mean now, what has changed and what can I look for?”
Mike is just one of thousands of Aussie men diagnosed with prostate cancer each year. In fact, by the time an Australian man reaches the age of 85, he has a one in five chance of developing the disease.
It’s a worrying statistic, but one we need to pay more attention to.
Prostate cancer is one of the biggest killers for men over 60, with more than 21,000 Aussie blokes expected to be diagnosed this year alone.
The majority of those diagnosed with the potentially deadly disease don’t show any physical symptoms, which is why it’s so important to have an informed discussion with your GP regarding testing for prostate cancer.
Icon oncologist Dr Eve Tiong says that while some men may develop symptoms before a formal diagnosis, it is ultimately specific testing that will detect and confirm the presence of cancer.
“The majority of prostate cancers these days are diagnosed because they’ve had a blood test that was ordered by their GP, namely the prostate specific antigen (PSA) test,” she explains.
Typically, the blood level of PSA is elevated in men with prostate cancer.
“From there, [patients have] a biopsy that would then confirm the prostate cancer.”
In addition to a PSA screening, some health professionals perform a digital rectal exam. This test is designed to feel for nodules that could be cancerous and can prompt further examinations including imaging, biopsies and referrals to a urologist.
For Mike, it was a PSA test that first indicated he might have cancer.
“I was shocked initially because I had no symptoms or indication that something was wrong,” he said. “Until that day, I hadn’t heard of PSA markers and had no idea what they meant.”
While many cancers require annual or bi-annual screening measures, screening for prostate cancer is controversial. The Cancer Council, with other organisations, has developed guidelines regarding the need for PSA testing, but it’s imperative that people talk to their GP about the correct approach for them.
As with many patients living with prostate cancer, Mike was given two treatment options: radiation or surgery. Not wanting to make an uninformed choice, he set out researching both treatments to determine which would be best for him.
After spending hours combing through all corners of the internet, he met a group of men who were willing to share stories of their own experiences with prostate cancer, stories which ultimately guided him towards his own treatment decision.
“After much soul searching, I chose radiation treatment,” he said. “There was some concern that the cancer may have started to progress to the immediate area around the prostate, [so] I felt radiation treatment could perhaps deal with this aspect better. As there was an Icon radiation oncology clinic at the local hospital, which was only 20 minutes from home, the final decision was easy.”
For patients, choosing a treatment path is dependent on a number of factors. Preference can be based on information provided about the potential long-term side effects and impact on quality of life with radiation and surgery. The particular aggressiveness of prostate cancer can also play a factor in treatment methods. Surgery for prostate cancer is known as radical prostatectomy. This can be performed in three ways: open surgery, laparoscopic and robotic, with the latter two options having shorter hospital stays and quicker recovery times.
There has also been a shift for patients showing high risk features to have multiple treatments; that being surgery, as well as radiation therapy, and in some cases other medications, commonly known as hormone therapy. There is a third treatment available for patients with low risk prostate cancer: active surveillance.
Prostate cancer isn’t typically as aggressive as other cancers in the early stages, so active surveillance can be a way of managing the disease without treatment. This is usually done through strict PSA monitoring, MRIs and frequent biopsies to ensure that any cells or tumours don’t progress to dangerous levels.
Dr Tiong says it’s important for all patients to do their research and choose the option that’s right for them.
“Surgery and radiotherapy are very different treatments, and they have very different logistics. The current surgery and radiotherapy options both show fairly similar survival rates, with the main difference being logistics, and potential side effects and impact on quality of life,” she explained.
With cancer survival rates increasing, and allowing more people to live well into old age, Dr Tiong says it’s also important to understand the possible side effects of all treatments.
“I think this is important because as people live longer with cancer they will be living longer with the consequences of their treatment so they really need, both them and their partner, to understand what decision they’ve made. Men often find it harder to access peers who can impart their experience when it comes to different treatment options, particularly radiation therapy. I encourage them to speak to their family doctor or ring their local radiation oncology centre to seek professional advice and ask if some of the men being treated are willing to share their experience. It is also important to note that prostate cancer can relapse, so ensuring you maintain long term follow-up care and regular tests is key.”
Although it wasn’t an easy road for Mike, he says he wouldn’t change a thing.
“No treatment, whichever pathway you go down, is going to be exempt from discomfort,” he says. “But my gosh the alternative… This is pretty mild to what the alternative might have been.”
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