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Rob Harry Jim Xmas 2018 cropped

My brother (left), his grandson, and me last Christmas.

MAY 18, 2019: The inconsistency of PSA testing has hit close to home – my brother has just been diagnosed with advanced and aggressive prostate cancer, but his PSA showed little signs of change.

Prostate cancer was confirmed a couple of weeks ago, but he’s obviously had it for years. It’s out of the capsule and he has secondary lesions on his spine, pelvis and upper arm.

So far, no symptoms are showing with any of his internal organs (other than his prostate, obviously). He is peeing fine and there’s no bleeding anywhere.

However, the spinal tumour was large and extremely painful, the trouble first showing up last June (2018). His GP found nothing with digital examinations, so gave him painkillers and suggested he see a physiotherapist.

Physio gave temporary relief only, so he went to a chiropracter. No help. Back to the GP, who referred him to New Plymouth’s main hospital to be screened for a specilaist appointment.

After a delay of several months – because the hospital is chronically short-staffed and suffering from NZ-wide strikes by young doctors – the doctor who finally saw him in late March suspected bone cancer and had him admitted urgently for tests.

When I told one of the hospital specialists I’m a prostate cancer survivor (more than a decade now) and our father also had it diagnosed in his 80s, the place scrambled and my brother was soon told he had terminal bone or prostate cancer.

He was immediately transported by plane to Palmerston North (a three-hour road trip away) whose hospital has the major radiation treatment centre for the lower half of the North Island. After treatment with radiation and steroids, the tumour shrank and his doses of morphine for the pain were greatly reduced.

Back in New Plymouth a week later, he was given a digital examination by a hospital doctor, who found signs of cancer; that was confirmed by a biopsy. His Gleasons was reported as a low 3/4, but the secondary tumours are considered aggressive.

He is now on initial treatment with a combination of hormonal therapy plus docetaxel-based chemotherapy, just as my old friend Mike Scott predicted when I asked his advice last month. Mike runs that fabulous website The ‘New’ Prostate Cancer Infolink, in my view the best source of prostate cancer news and information in the world.

My brother went through the usual stages of shock, despair and denial, but moved quickly to the positive stages. Despite a stiffened arm, he has returned to work as one of New Zealand’s top freelance photographers, works the dog 4km each day and is generally positive about getting on with his life.

I would say his prognosis for years of useful life are good, despite the spread of the cancer. He can be sure of support from me (we have worked together for years anyway).

The screening of prostate cancer continues to be a worry. After I was first diagnosed in 2008, my brother has had regular digital and PSA tests every year since. My PSA never changed and my cancer was discovered by a GP with long fingers. Goes to show, doesn’t it.

BELOW: A couple of my brother’s photos that are about to be published in his 35th book. They show Mt Taranaki.

Screen Shot 2019-05-08 at 7.52.36 AM

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NEW PROSTATE CANCER INFOLINK: A recent article in Cancer seems to further support Stamey’s contention (published in 2004) that — at least in the USA — the PSA test has a great deal less value as a screening test for prostate cancer today than it had when it was initially introduced in the 1980s and 1990s. READ MORE>

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JULY 28: EUREKALERT: Men with early stages of prostate cancer who delay radical treatment in favor of an approach of “expectant management” do not have high levels of anxiety and distress, according to a new study published in Cancer, a peer-reviewed journal of the American Cancer Society. READ MORE>

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Part 1 of My PC Adventure: a Kiwi male’s brush with prostate cancer

NZ TV current affairs host Paul Holmes said it on his show during one his monologues: “Got trouble with the wee-wees – get it checked out.”

It was the 1990s, I seem to recall, and he was taking us through his experience of prostate cancer: discovery, treatment, aftermath, and advice on how up-tight Kiwi blokes should have regular medical checkups to catch the devil early. He said it all in a dramatic sweat, the perspiration running off him under bright lights and the effects of whatever chemo/radiation treatment he was getting at the time.

It resonated, but only slightly, in that “yeah-better-get-checked-but-not-because-I’m-a-hypochondriac” way men have.

I’d had a gradual slowing of piddle flow from about 1994, and eventually mentioned it when I was talking to my GP on Waiheke Island where we lived at the time. I asked the doctor – an old school colleague called Barnett Bond – whether I needed a blood test (I’d heard about it, vaguely) and his response surprised me: “I’m not giving you the test.” 

In his opinion, the PSA test was as yet inexact: it could pick up five different enzymes (I think that was the term he used), only one of which was a cancer indicator. A positive test had a good chance of being a false alarm, needlessly putting the patient through further testing that was not very pleasant.

Meantime, he said, a digital exploration would do. My first, it revealed nothing untoward.

Ah, I hear you say: the old “finger-up-the-arse”, the dread of every red-blooded Kiwi male, a wellspring of homophobic fear and tasteless “jokes” along the lines of “I’m bloody glad I’m not gay”, etc.

Actually, it’s no big deal. The doc gets you to lie on your side, underpants down and knees drawn up. He puts on a rubber glove (in my experience, without any snapping sounds) and before you can blink inserts a finger (I’ve never seen which one) deftly up the back passage and has a quick feel of the prostate gland, a walnut-sized organ attached to the bottom of the bladder, and through which the urethra (the tube taking piss from the bladder) passes on its way to the penis.

The prostate can be easily felt up through the wall of the colon. My only advice is, have a leak before the examination, because prodding against a full bladder is uncomfortable.

By 1998, I’d moved to New Plymouth, where my new GP, Hiran Fernando (who later ended up in jail for offences against some of his female patients), did both the digital exam and a PSA blood test, about which he had no qualms. Both showed a benign result, so at the age of 56, I seemed in good shape to avoid the prostate cancer discovered in my father at the age of 83.

Or so I thought. I now know that most men develop it or at least an enlarged prostate as they head into old age (I’ll put that at 80), and the chances you’ll get it if your father did are probably enhanced.

Meantime, what was causing the gradual loss of flow? Why was it becoming something of a joke to stand in a public urinal taking several minutes to leak a weak stream, while two or more young men could come in, let fly with what sounded to my increasingly sensitive ear like a horse slash and leave well before I was finished?

Odd thing is, I didn’t ask my New Plymouth GP. I was happy with the negative test results for prostate cancer, so thought it was just age creeping up gradually. Turned out, I was right, but more on that later.

There was another reason not to push it. In my adolescent years and up until I was about 30, I suffered a “condition” sensitively dubbed by a mate I confided in as being “piss proud”. Basically, I couldn’t go in public. Even one other bloke standing at another urinal at the far end of a line of 20 was enough to stop anything happening.

This led to some fairly stressful experiences, the most memorable at the age of about 12 when trying to go during halftime at a Ranfurly Shield match at New Plymouth’s Rugby Park. Finding myself at the head of a 1000-man queue for what seemed like the sole male lavatory and being told in no uncertain terms it was “three-at-a-time”, I froze.

Full bladder notwithstanding, all I could do was aim a maddenly dry dick – shrunk by fright to the size of a peanut – at the filthy white bowl for what seemed like hours, ever mindful of a howl of impatience and derision rising behind me. My comrades in micturition changed constantly, until, at a point when two new ones stepped up at the same time, I feigned shaking the drops off and stepped away. The capacity of a full bladder to stay that way for a long time was cruelly demonstrated that day.

Eventually, I found a way to overcome the problem – by counting the tiles in the loo. I would start at the roof of the wall before me and count the tiles (or screws, or individual letters in the graffiti, whatever) and freeze my mind with distraction until a tentative piddle began. By 30, this ridiculous affliction simply vanished and now I can piss it out with the best of them.

Except, of course, I was past my wall-conquering best. That hydrant flow of the 18-year-old had matured into a respectable stream that was able to be directed clear of the shoes, but which never again approached the cataract qualities of the stallion. Not that I gave a bugger, given that just to be able to piss on demand was triumph enough.

Then, in the late-40s, the arcing stream, though still intact as a single body of water, began ever-so-slowly to weaken. I put it down to nothing more than the psychological aftermath of my youthful brush with piss pride and apart from my half-hearted alert to Barnett (his response escapes me now) said nothing during annual medical checkups, which I’d started getting after an accidental discovery of raised cholesterol in 1991 (that’s a whole different story).

So, that’s the rundown on some of my internal plumbing, the bits relevant to this tale. Read my next blog to see where it all began to add up.

For information about prostate cancer,  go to the Prostate Cancer Foundation of NZ

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