The Secret Stalker of the Prostate

The Secret Stalker of the Prostate © Copyright Dr Judith O’Malley-Ford, Australia, 2016. MB BS, MPH, JP(Q), FRACGP Morris Publishing Australia i

Introduction Until recently, it was a relatively rare event for a man to bring a problem with the functioning of his uro-genital system to medical attention without prompting by a significant other. For those men who are in the process of taking that difficult step of presenting prostate problems to their doctors, including those unfortunate enough to be facing investigation for prostate cancer, this book is for you. While this book especially addresses the need for information and guidance during the process of coming to terms with prostate cancer, we’ll also be taking a look at other medical conditions which affect the prostate, including benign prostate hypertrophy, prostate infections and prostate pain. The bigger picture relating to prostate cancer also includes the associated risk of breast cancer for women in a family where the men are diagnosed with prostate cancer. There is scientific evidence which shows that the same inherited genetic risk factor applies to breast cancer as applies to prostate cancer. As a GP with substantial clinical experience, I have seen many men during the course of my practicing career. The symptoms of prostate cancer are often similar to those of more benign conditions. Most men will be concerned about cancer when they experience these symptoms. Sometimes such fears contribute to a delay in bringing the symptoms to medical attention. The timeliness of diagnosis is important in relieving troublesome symptoms, and in treating and curing these conditions with minimum adverse effects following treatment. It is also important to provide clear information and reassurance to the patient throughout the entire process of investigation, diagnosis and treatment. Some men are very knowledgeable about health matters, while others feel totally intimidated discussing anything related to their health. That’s not to say that they don’t worry about their health— they do, but for many, the discussion is too intimidating. They may xi

even fear the embarrassment associated with prostate examination more than the spectra of dying from cancer—a situation, which if left unchecked, can result in the patient literally dying from embarrassment. These men tend to be older, they may have experienced few health problems to date and be unaccustomed to discussing intimate health issues, let alone to physical examination and the intrusion into their personal space necessary for diagnosis. This poses specific challenges to men, their partners and to the medical practitioner whose role it is to care, not only for the physical aspects of the condition, but also for mental and psychological wellbeing once a diagnosis has been made. This book represents a very personal account of views and experiences as a medical practitioner and as a member of a family with a history of prostate cancer. The delivery of male gender health services can be a difficult for the man and for the family. Although we would like think that these services are delivered without problems, in reality there are many opportunities for improvement. Certain cases presented in this book, however critical they may appear regarding management, have been presented verbatim from men in my immediate family. I make no apology for presenting this book without fear of favour, mindful of the debate that surrounds some of the opinions expressed. It is not my intention to be destructively critical, quite the contrary. The comments expressed in this book are derived from my professional experience, from research literature, and from my perceived gaps in the provision of services. So, how then does one approach the delicate subject of prostate health? To begin with, men and their observant partners can flag potential prostate problems with the following self-administered questionnaire. Do this quick check and test your risk for possible prostate problems. xii

1. The Prostate Story Begins This is the story of prostate problems including prostate cancer. The most scary of prostate problems is that of prostate cancer. Prostate cancer could be regarded as a true to life crime thriller, with all the components of what we have come to know and regard as the classic \"thriller\". The prostate cancer story teems with danger, uncertainty, sex, romance, violence (surgery), the chase, technology, expert witnesses, the collection of the evidence, and life and death issues. There is a perpetrator or a suspect, either or, depending on your stance in the medico-legal system. There is a body involved, but one that participates in and contributes actively in a resolution of the unfolding scene. There is a weapon, in this case a powerful secret weapon. Finally, as every good editor will tell a decent author, every good story needs a plot. The story of prostate cancer possesses all the ingredients of a nail biting thriller, in slow motion and real time. As part of the research to write this book, I discovered one very important fact about men. It is so obvious, but no one actually states the fact in so many words. It is the elephant in the room. Such a bloody big elephant, I'm not sure why it has not been befriended before now. When you ask the question, \"What motivates men?\" The answer will come back, food, fame, money, and maybe power, but definitely, sex, and not necessarily in that order. Having discovered this fact, the difficult issues about prostate cancer all fall into place. Apart from the fact that food is essential for life itself, sex runs a very close second. Some may even argue this point. 1

Every species is motivated by the instinct to procreate; otherwise, the species would rapidly become extinct. The human race is no different. Sex plays a fundamental role in the whole question of dealing with prostate disease. Sexual identity and sexual performance are essential to the male psyche. Anything that challenges the loss of either creates a great conflict of interest for men, even to the point of life and death itself. Just the thought of or necessity for vasectomy, a minimally invasive surgical procedure (a form of contraception but not related to prostate cancer) can cause major mental trauma for some men. A perceived loss of their masculinity and virulence. Life in the 21st century is quite different to life even 100 years ago. People are living longer, but the flip side is that cancer is playing an increasing role as part of the price for greater longevity. Social media as we now know it now did not exist 15 years ago. It is a common belief that social media makes information infinitely more accessible to a greater number of people and certainly faster than ever before. By the time unfolding current events are presented in traditional hard copy news outlets, it has already been twitted and tweeted, and e-mailed with accompanying pictures to vast numbers of people around the world. In the evolving story of prostate cancer, things have changed too. But maybe not swiftly enough to keep up with the rapidly changing world in which we live. We need to step up the pace when it comes to prostate problems and improving diagnostic technology. If very character in a story needs a good reason for acting the way they do, every man needs a motivator in the quest to reduce the incidence of prostate cancer. There is a secret player in this story— whom you soon meet. Men are currently more than just intimidated by the current way that prostate cancer is managed. After all, men have a lot at stake, and a lot to lose, irrespective of their age or perceived health. In fact, as men age, some of the most important remaining personal attributes may be their male-ness and their sexual identity. Most men need motivation to undergo prostate cancer screening and possible treatment of prostate cancer if detected. Men need 2

reassurance and a greater degree of certainty that they won’t become impotent or incontinent as a result of prostate cancer treatment. Men need someone to motivate them to act early if the risk of prostate cancer is high or if they are experiencing early warning signs. Early intervention and early treatment improve the outcomes of cancers. The current thinking is that some prostate cancers do not need treatment, that watchful waiting, or active surveillance is an alternative. As men, as well as women, are expected to live longer than the current life expectancies of the 21st century, this thinking when it comes to prostate cancer will rapidly become outmoded. Maybe even unethical, or professionally unacceptable, or socially inadequate. Recently an article appeared in social media entitled, \"Cancer Test Market & Forecast, Companies Cancer Test Platform, Pipeline Analysis and Clinical Trials - Global\" by Kristin Wurfel Executive Web Marketing at RnR Market Research. It said in part: “Cancer is the second-leading cause of death and disability in the world, behind only heart disease. More people die from cancer every year around the world than AIDS, Tuberculosis and Malaria combined. Cancer testing has tremendous growth opportunities for the next five years. According to the National Cancer Institute (NCI), 85% of cancer patients are treated in community-based, private practice oncology settings. Accordingly, global expansion of cancer marker technologies may be fueled by an increased marketing of new diagnostic tests to physicians. During the next five years, the worldwide cancer diagnostics market is promising to be an exciting, dynamic, and rapidly expanding field. The anticipated technological breakthroughs will create numerous opportunities for determining genetic predisposition, detecting specific tumors, and monitoring biological response to cancer therapy. The global cancer test market is expected to be more than US$ 14 Billion by 2018.” 3