Perhaps the worst thing about prostate cancer – other than the fact it is a big killer of New Zealand men – is that detecting it can be unreliable.
It's also a tricky cancer – some men may have a slow-growing variety, so slow they live for many years and die of other causes. Other men have no symptoms – right up until the day they are diagnosed with an aggressive prostate cancer which has or will spread to other organs.
That's where Professor Cather Simpson and her research team at the University of Auckland come in – they are developing a non-invasive, ultra-fast laser diagnostic tool to increase greatly the accuracy of prostate cancer detection.
"That's our goal," says Simpson, the founder of the university's Photon Factory from the University's Department of Physics and the Department of Chemistry. "We want to make prostate biopsies much, much more effective and much less necessary."
To understand what she and her team are trying to do, it is first necessary to understand the current problems with prostate cancer diagnostics.
There are two early tests: a digital rectal exam and a PSA (prostate specific antigen) blood test. The finger test is unreliable and many feel the PSA test is too. That's because neither test rules out other causes of symptoms like infection or benign prostate enlargements.
For a reliable test, you need a biopsy and/or an MRI. But they're expensive, too costly to use as a screening programme.
But if a man's PSA level is up (meaning a greater risk of prostate cancer), he can opt for a biopsy and/or an MRI.
But here's where the tricky bit comes in – if that man has an MRI revealing cancer is present in his prostate gland, he faces a big grey area and a tough decision.
Surgery and radiotherapy are options but there can be pain, a weakened immune system, it risks incontinence and could kill off the man's sex life. Hormone therapy is another option, but that can affect your personality and have the same effect as surgery on sex life.
Another option is to do nothing – just living a healthy life and monitoring it. In 80-90 per cent of men with untreated prostate cancer, the disease doesn't spread within the first five years after diagnosis. For many it's way longer than that. If it does start to spread, then you sign up for treatment.
The problem is, prostate cancer is much easier to treat and cure before it spreads and, as previously mentioned, some men present with no symptoms at all before reporting something like pain when urinating – only to discover it is too late.
Once again, that is where Professor Simpson's team comes in. Her lead researcher, Dr Claude Aguergaray, had the idea of a laser device to be used as part of a biopsy.
"If you need to have a biopsy, the current prostate probe uses ultra-sound," says Simpson. "But the resolution is not very high. Typically the biopsy will involve 12-15 snippets of tissue which they then send to the lab to find out if they are cancerous or not.
"We will couple that approach with laser-based scanners which give much better perception and resolution – and it will give a much higher degree of accuracy when it comes to biopsy results.
"That's important because, under the current system, even if the biopsied tissue comes back all healthy, you still have to go back to the doctor in a year because they might have missed some cancerous tissue."
The laser device being developed works on a combination of high-speed light and sound pulses but also uses time as a measurement: "That means we end up with a lot of data – it becomes a big data problem; we will use algorithms to extract wisdom from that data."
The science of photonics that Simpson and her team are using in this project is a formidably high-tech branch of science – but their forays into this complex realm have already produced two spin-off companies commercialising their findings.
One is Engender Technologies Ltd which uses photonic techniques, among others, to improve the sorting of sperm by sex in the dairy industry (effectively managing the sex of calves) and Orbis Diagnostics Ltd which analyses the composition of milk in the milking shed so nutritional and other information – including picking up potential problems like the onset of bovine mastitis.
In New Zealand, prostate cancer is the most commonly diagnosed in men (though it isn't the biggest killer, behind lung and bowel cancer). While it is still most commonly reported in men over 55, some studies say the incidence is increasing in younger men (when the cancer can often be at its most aggressive).
So if the laser project comes up with an effective diagnostic tool for prostate cancer, the effects could be felt here and around the world.