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Posts Tagged ‘NZ’

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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My newspaper column this week (Taranaki Daily News, Saturday March 18, 2017) urges men recently diagnosed with prostate cancer to make more use of support groups.

In New Zealand, most provinces have them. They’re run in conjunction with the Prostate Cancer Foundation of NZ, the NZ Cancer Society and local area health boards.

I went to the New Plymouth one in Taranaki province recently for the first time and was surprised at the low attendance.

I also got a shock to hear one guy talk about discovering he’d had recurrence after 12 years. Twelve years!

I’d always hung on to advice that once you passed a decade of no further signs of cancer you were in the clear. Cured, in effect – although that’s not a word the medical profession ever uses.

I’m into my ninth year of showing no signs of anything untoward, so I thought I was getting close to the magic decade. Not so, it seems.

Anyway, the main message is make use of the support groups, or the dear old government might stop supporting them.

The contact for the New Plymouth one is: Peter Hickey (021-162-1334); newplymouth@prostate.org.nz. Or go to the Prostate Cancer Foundation website to find out how to reach the group in your region: https://prostate.org.nz/support-groups/

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PROSTABLOG NZ: The final report from a two-year NZ Parliamentary investigation into prostate cancer detection and treatment has been released by the Health Select Committee. READ MORE>

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PROSTABLOG NZ: Rates of prostate cancer detected in NZ are expected to rise about 23% in the decade leading up to 2016, moving from 91 cases per 100,000 to 112.

That’s the finding of a Ministry of Health cancer projection report released late last month, but only just picked up by news media (none of whom looked in detail at prostate cancer).

Something the report calls the “burden of new cases” is expected to increase by 71% over the 2006-2016 period. This term is not explained (for the uninitiated).

Interpreting the report is something of a challenge.

The Ministry’s researchers have chosen to single out prostate cancer projections as the only ones that “could not be updated  (although they have been extended), as these are based only on data up to 1984-88”.

The reason given is something they dub the “PSA effect”.

It’s hard to be sure, but this apparently means that because of a sudden upsurge of PSA testing in the late 1980s and early 1990s – leading to perhaps half of the Kiwi aged male population getting tested – there has been a massive blip in the detection statistics.

A half generation of men who would otherwise have not been detected until symptoms showed at an older age have been diagnosed “early”.

This has distorted trends to such an extent, it seems, the projection models can’t cope.

Graphs from the report, reproduced here, show the “bulge” effect. In the bottom one, the solid lines showing rates up to 2006 are extrapolated out (dotted lines) from 1986, ignoring what really happened because of PSA testing:

The Ministry says until rates return to what would have been expected “pre-PSA”, it cannot provide reliable predictions.

Despite that constraint, it has a go anyway: it concludes the rate of prostate cancer will continue to rise (presumably because of the baby boomer bulge moving through).

Confused? Join the club.

Why is prostate cancer being dealt with differently from other cancers that have been the subject of widespread screening and marketing campaigns, such as breast and cervical?

Is it because those screening campaigns were Ministry-approved, while PSA is frowned on by the Ministry because it leads to a problem – once prostate cancer is found there is no reliable way to know if it needs treatment, leading to possible over-treatment, and with it, unnecessary cost on the health system.

It would be useful to hear from epidemiologists on this, despite their inherent bias against PSA testing casting doubt on their views.

Still, they might help unravel the technicalities of the Ministry’s convoluted explanation.

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