Prostate cancer no longer secret men's business

Up to 30 per cent of men over the age of 50 have prostate cancer. Even so, most of these men will not die of prostate cancer, but rather will die with it. Partly because of this fact, just screening for the disease itself can be controversial. Why cause angst about something that may not actually kill you in the end? Having said that, men who have been screened and have found a slow-growing, early-stage cancer then have the option of monitoring their cancer and only acting with invasive treatment when deemed advisable.

The first set of Australian national guidelines for PSA testing are due out before the end of the year, a collaboration between the Foundation, the Urological Society of Australia and New Zealand and other major groups. At the moment, the Foundation recommends men 50-plus -- or 40-plus, for those with a family history of prostate cancer -- talk to their doctor about using the PSA test and rectal examination as part of their annual health check.

If cancer is detected as a result of the biopsy then surgery isnot a forgone conclusion. Doctors can recommend different approaches to treatment; some will suggest surgery or radiotherapy, of course, but others may talk about watchful waiting, or active surveillance, depending on age, the general state of health and the aggressiveness of the cancer.

Urological Society vice president Professor Mark Frydenberg says most groups would suggest a man diagnosed with a low volume, low risk cancer "should be managed expectantly with close surveillance, and not with immediate treatments that may affect quality of life."

"Similarly, all screening studies have shown that unless a man has a 10 year life expectancy he will not benefit from the early detection and treatment of a prostate cancer due to the slow growth rate of many such cancers," he says.

But there are no excuses for not getting tested when appropriate, or for ignoring those bothersome signs and symptoms. Three men in my family can attest to that.

On that bright Queensland spring day in 2011 as I sat next to Dad the mood in the room was sombre. Outside, flamboyant birds quarrelled over the birdbath in the garden. Vivid green foliage wafted in the breeze. Dad convulsed and gasped, grabbing sharply for breath. He strained to sit up, looking beseechingly into Mum's eyes, panicked, knowing the inevitable. His eyes spoke the words he couldn't articulate. "I'm done. I love you." He slumped back. Finally, his pain was over. Momentarily, the birds outside his window fell silent. The breeze quietly died.