Prostate - Like it or Lump it

Us blokes are generally rubbish when it comes to our health. Our approach can be best described as ‘ignore it and it will go away’. The absurdity of this, of course, is that this totally kiboshes the truism of disease which is ‘get it early- increase your chances’. In men this is nowhere more obvious than issues to do with prostate health. Too often the issue is left until too late resulting in advanced cancer. If ‘lucky’ only invasive and serious surgical or radiation options on the table.

Women are so much smarter in this department and props to them for that. They have breast cancer pretty sorted. That’s not to say this scourge has been beaten, but it’s now not the death sentence it once was and the support available (just think McGrath Foundation Breast Nurses). Coupled with this is a large focus on research which has meant that there are now clear clinical protocols and less invasive options available – think lumpectomy rather than the total mastectomy of yesteryear for many patients. Caught early and with good margins, a woman can have a lumpectomy followed by radiation that will do little to disrupt normal life. If support is needed there are a plethora of options available and during and after surgery the breast care team will ‘wrap their arms around you’ literally. I’ve seen it up close – it’s impressive.

Put simply prostate cancer is for men what breast cancer is for women. Well strictly speaking not quite true because rates of diagnosis for men per week are higher for men’s prostate cancer than women’s breast cancer. At a more granular level the observation was that men on average are diagnosed later in life than their breast cancer counterparts. Recent research challenges this presumption somewhat. For the sake of argument let’s just say they are ‘same-same’.

The point I wish to convey is that for ‘same-same’ conditions there is a glaring gender-based disparity between the two. A gap that in my opinion amounts to a ‘human rights issue.’ How can this be you might ask and how come we’ve never heard of it? You are referred to my opening paragraph…

When confronted with the news that you have prostate cancer a few things happen. You are stunned while your brain processes the full implications of the ‘C’ word. Furthermore, your mind quickly leaps ahead and you are confronted by the two big dreads following surgery – ED (erectile dysfunction) and incontinence. Our knowledge level hits a step trajectory because let’s face it we know stuff all about this tiny organ located somewhere down in out nether regions.  I reckon a good 50% of men refer to the organ in question as the ‘prostrate’. We do however strangely know, through some form of secret men’s business, that you’ll ‘never get it up again’ and you’ll be wearing adult nappies.  Oh and at the same time, with a twinge of regret due to your inertia, some penny may be dropping as to why you were getting up so many times in the night to pee and why the majesty of your stream from your youth has gone from Manneken pis to little tinkle.

Once prostate cancer is diagnosed it’s straight to the ‘mastectomy option if ‘watch and wait’ (surveillance) is no longer an option. Where breast cancer has protocols (e.g. if this is the situation you do A, if this other situation exists you do B) prostate cancer just starts to get all fuzzy. Admittedly not helpful at a time when you are still taking in all of the ramifications of being diagnosed with cancer. Nothing is straightforward and the range of options including all with different outcomes on the ED and nappy front quickly become overwhelming. This is where a ‘McGrathesque’ prostate nurse might shine. But alas, as readers will know from the opening paragraph, as we haven’t taken care of our own health we are unlikely to have advocated for prostate nurses. Or gone on fun runs for raising research funds. Or insisted on the opening men’s cricket test each year to be the prostate cancer test. Or to have a prostate cancer round in the AFL and NRL. Imagine the impact if the Las Vegas NRL season opener was played in blue (the prostate cancer’s designated colour) to raise awareness. We have a women in AFL and NRL round each year so why are we so pathetic that we can’t raise awareness for our own disease that will take 10 lives per week in Australia during both footy and big bash seasons.

To circle back, all this lack of awareness or advocacy by men masks a very sad fact. A fact that I think is a clear breach of male human rights - men with prostate cancer DO have a lumpectomy option. If this option is available the ED and nappy issues reduce to around 10%. And yet so few know about it and so few are offered it.

How come I know so much? Well recently I opted for this treatment which is a form of Focal Therapy and now I’m a passionate advocate for this being on the table. My Focal Therapy was a form of ablation called Nano Knife. Sound hi-tech – sure is. Sound expensive – you betcha. And here’s the rub. Despite being day surgery with low post surgery complication rates it’s a totally non-reimbursed procedure anywhere in Australia. To choose this option, your trousers will be $25,000 lighter without a cent back. The reason given for not qualifying for any reimbursement is because this is considered ‘an experimental and new treatment’. My arse it is (pun intended!). It’s been around for over 10 years with lots of peer-reviewed studies showing its efficacy. The litmus test here is the UK where it’s even available for free on the conservative and cash-strapped NHS!

Our situation must change. Men must be offered this option where it is suitable and not be forced by price point and affordability to opt for more radical invasive approaches with poorer outcomes. ‘Male privilege’ loses some of its sting when we throw our prostates in the mix. My heart goes out to those blokes, who by dint of economic status have had to ensure ED and nappies because our much vaunted ‘world’s-best’ health system can’t see its way clear to offering men a lumpectomy analogue.

Do I blame insurers and the Government? Of course I do. However, I lay blame mostly at the feet of us bokes. For too long we have maintained a silence closely resembling stupidity. We need to start owning our prostates and getting to know our bodies. We need to explode the myths surrounding the digital rectal exam (DRE). NO GP needs to do this.  All you need is a simple blood test to check your PSA and take things from there. Starting at 40 unless you have a family history is not a bad way to get the ball rolling. Remember ‘get in early- increase your chances’. Put simply we need to get our big boys pants on before we are forced into the big boys nappies.