Men's killer disease can hit with little or no warning

By Roy Burke

Waikato Hospital oncologist Cristian Hartopeanu (right) oversaw Roy's radiation therapy using one of the hospital's $5m radiation therapy machines. Photo / Stephen Barker
Waikato Hospital oncologist Cristian Hartopeanu (right) oversaw Roy's radiation therapy using one of the hospital's $5m radiation therapy machines. Photo / Stephen Barker

If you're a bloke, read this - it could save your life. Prostate cancer killed 564 New Zealanders last year, and Roy Burke nearly made it 565

Cancer hit me without warning, like an out-of-control truck crossing the centreline. There were no symptoms. I felt as well as any 79-year-old, and I didn't welcome the instruction from my friendly doctor, Ed Barrio, to drop my drawers for a finger-up-the-bottom examination. It took mere seconds. His gloved and lubricated forefinger discovered lumps that shouldn't be in my prostate - and the story begins.

Cancer: it's a word to turn strong men (and women) pale. Probably, I was ahead of the game here; for almost a decade the health round was my responsibility on my newspaper. I wrote every day about health and sickness. I won a row of national awards in this field. I was chosen for a research scholarship that took me around the world. I wrote about cancer and have much better than an average lay understanding of this disease.

But when biopsies confirmed I too had cancer, my world went strangely quiet.

Cancer in its various forms is New Zealand's number one killer. I've had two wives. I've got adult children and grandchildren, and four great-grandchildren. I'm not ready for The Grim Reaper and here he was tapping my shoulder!

Ed helped. He explained (what I already knew) that eight out of 10 men my age have prostate problems. Most die with prostate problems but relatively few die of prostate cancer. In most cases, prostate cancer is a slow-moving disease and doctors monitor its progress (they call it "active surveillance") and don't intervene unless they must.

When a patient is young, say in his 40s or 50s, his longer life expectancy increases his chance of becoming one of the 564 who die each year of the disease. Early detection helps move him off the list.

Yet this was me, with cancer. I know of nobody in my family who has had cancer. I write a weekly obituary for The Waikato Times. I know what these people died of. Lots died of cancer. Some my age got bowled by prostate cancer. Was I worried? Take a guess.

Ed ordered a prostate specific antigen (PSA) blood test. It gives more information on the possibility of cancer. He checked the result and referred me to Waikato Hospital specialists. A registrar (trainee urologist) confirmed his finger too had found a prostate tumour. A second PSA test showed another elevated result - not good news.

What is this troublesome gland? The prostate is common to all male mammals but seems to give problems only to dogs and humans. It's walnut-size, sits under the bladder, and its main function is to provide nutrition for sperm. The bladder's drain (urethra) passes through the prostate.

A prostate biopsy was next in line for me, a painless bit of medical magic that literally gets to the root of the problem. In a slightly darkened room a finger-slim probe was inserted up my backside. Perhaps it was a female probe, for it handled complex multi-tasking far beyond the average male. With ultrasound pictures it measured my prostate and relayed data through a cable feed to a monitor screen. It anaesthetised my prostate. It fired a precisely aimed biopsy needle through the rectum wall into the prostate about 12 times, recovering core samples 20mm long and 1mm wide for the lab. They looked like worms.

The laboratory identified an active prostate tumour on the left side and a scattering of cancer on the right. A magnetic resonance image scan (MRI) was ordered to give more data. Urologist Dr Patrick Bary told me a team of gurus, including radiologists, would recommend how and whether to treat - but the informed decision would be over to me.

Romanian-born Dr Cristian Hartopeanu, my guru of oncology gurus, explained the 36 radiotherapy treatments spread over seven weeks. Of course I said "yes".

Tattoos by radiation therapists were part of the service - not daggers or anchors, just three almost invisible dots, one on each hip and one over the pelvic bone. They enabled me to be measured into precise position on the multi-million-dollar radiation therapy machine every day.

The aim is accurate to within one millimetre. Lining up the prostate and delivering four therapy "zaps" takes about 20 minutes. Some people have side-effects; I had none apart from a slightly stirred up bowel.

Radiation therapy shrinks tumours and aims to kill cancers, though this is not always possible.

Cristian told me my cancer was unlikely to be killed, but it would be smacked around so soundly it was unlikely to rear its head again in my lifetime. "Something else will get you ... "

Waikato Hospital has three of these therapy machines and treats an average of 100 people a day for a variety of conditions. They come from a vast area of the central North Island and include some special cases from Auckland.

My therapy sessions were completed on Wednesday, August 22, the day I baked a cream sponge as a "thank you" to the therapy staff (flowers were delivered later).

Now I have to wait three months for another PSA blood test to see what's happening to the antigen count.

"By then the fire will have gone out and most of the smoke cleared," says Cristian. The real proof will come a further three months later with a second PSA blood test.

I'm waiting, fingers crossed.

Get tested for family's sake: Brendon Pongia

This month is Blue September, raising awareness of prostate cancer. Former Tall Black and broadcaster Brendon Pongia became a Blue September ambassador after the death of a family member.

"My father-in-law passed away just on four years ago because the cancer had spread from his prostate out through his body. That's the reason I became involved in the Blue September campaign and why I'm so passionate about raising awareness.

"Blue September is about encouraging the men of New Zealand and their loved ones to face up to prostate cancer. The reality is that one in 10 Kiwi men will get it - over 500 of our men die of it here each year - and that's just too many.

"The Prostate Cancer Foundation encourages men to get tested from 40 onwards. However, it isn't pushing for a screening programme at this stage.

"The thing about prostate cancer is that, if caught early enough, it's entirely treatable. As men we have to start taking responsibility for our health and making sure we go to the doctor once a year, regardless of whether we're sick or not.

"It's recommended that men should undergo an annual prostate specific antigen (PSA) blood test or a digital rectal exam (DRE) from the age of 40. I know a lot of men get hung up on the DRE thing but if it saves your life then it's worth it.

"Maori and Pacific Island men have the worst death rate from prostate cancer of any indigenous population. Us Maori men, we're staunch. We have a hard exterior and we don't go to the doctor. But it's time to start making sure we're around to look after our families, to see our mokopuna grow up and enjoy a long, healthy life."

More men asking same question: Dr Ian Milne

As a general practitioner for 35 years, Ian Milne has been hearing one question with increasing frequency: Could regular checks of my prostate gland save my life, doctor?

"Well, maybe, but it is highly unlikely. The odds are against it making any difference to what you eventually die of.

The best available evidence to date comes from the European Randomised Study of Screening for Prostate Cancer (ERSPC).

This study enrolled 162,000 men aged 55 to 69 and followed them for an average of 11 years. They demonstrated a small benefit from screening (one less prostate cancer death per 1000 men regularly screened).

However, there was a cost involved in screening: It detected 37 more cancers per 1000 men than in the control group (the men who were not being screened). Thus for every one cancer death prevented, 37 men experienced the distress of receiving a diagnosis of cancer.

Many of these would have undergone surgery or radiotherapy, with attendant complications and side-effects (potentially including impotence, a leaky bladder or an upset bowel). Some would ultimately have died from the cancer - despite the screening.

What's more, there were no fewer deaths overall in the screened group than in the 'control' group. So it seems that if the Grim Reaper does not get you one way, he'll get you in another.

The ERSPC findings apply to men aged 55 to 69 at the time of commencing screening.

There has never been good evidence for screening older men. In fact, most experts advise against it. And there is minimal evidence either way for screening younger men.

Everything I have said refers to screening: that is, having a blood test, with or without a 'finger' examination, when you do not have any symptoms of disease.

If you are suffering from symptoms in the bladder department you should consult your GP regardless."

Further reading:

- Herald on Sunday

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