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The Healthy Male
Issue 22 – Autumn 2007
Andrology Australia is supported by a grant
from The Australian Government Department of
Health and Ageing.
Contents
2
Community education
Men Behaving Positively
2
Coming Events
Andrology Australia
Advisory Forum
Australian Prostate Cancer
Collaboration AGM
3
Focus on
PSA test
5
Professional education
Prostate cancer education
available
5
Research roundup
Sexual functioning after
treatment for localised
prostate cancer
6
In brief
6
Latest news
Newsletter of Andrology Australia – Australian Centre of Excellence in Male Reproductive Health
A united front in the ﬁght against prostate cancer
Andrology Australia and the Australian
Prostate Cancer Collaboration (APCC) are
combining expertise to improve prostate
cancer research and education in Australia.
“By combining the strengths of the two
organisations, health outcomes will greatly
improve for men diagnosed with prostate
cancer, and their families,” he said.
Andrology Australia is well established
as Australia’s peak body in promotion
and education of male reproductive
health. The APCC is the National
research and education body in prostate
cancer. The two organisations working
closely together cements their position
as a national force in prostate cancer
research and education in Australia.
“Consultation with a wider network of
individuals and organisations working
in prostate cancer will lead to better
decisions being made about priorities
and strategies in this area.”
The combined strength of clinical
and scientiﬁc expertise will ensure
that quality research and evidencebased education is made available to
the wider Australian community.
Professor Rob McLachlan, Director of
Andrology Australia, said this collaboration
will have great beneﬁts for the community.
“The APCC leads the way in education
and research into prostate cancer
and Andrology Australia has
excellent outreach and information
networks,” Prof. McLachlan said.
Andrology Australia will manage the
secretariat for the APCC for two years
to enhance collaboration and minimise
duplication of effort in prostate cancer
research and education. Professor Villis
Marshall, Chair of the APCC, said this
collaboration may also lead to increased
ﬁnancial support to further prostate cancer
research and education in Australia.
“Improved understanding of prostate
cancer in the community is fundamental
to increasing the level of ﬁnancial and
in-kind support,” Prof. Marshall said.
To ﬁnd out more about becoming a
member of the APCC, contact Andrology
Australia on 1300 303 878 or email
info@andrologyaustralia.org
From the Director
Prostate cancer is the most common cancer
in Australian men, aside from some forms
of skin cancer. The disease is diagnosed in
about 12,000 men in Australia every year.
As prostate cancer often has no symptoms,
it is important to educate men about the
disease and who is at risk, so they can
make informed decisions about whether
or not to get tested for prostate cancer.
There is much debate about the role of the
PSA test in diagnosing prostate cancer, as
it doesn’t tell you deﬁnitely that you have
cancer. It tells you that there is something
awry with the prostate. Further tests are
needed to conﬁrm a diagnosis of cancer.
Being tested for prostate cancer can save
a man’s life, but a false positive test result
from a PSA test can lead to unnecessary
further testing and medical treatments
often with unpleasant side-effects.
This issue of the Healthy Male focuses
on the PSA test. If you are a man over
the age of 50, or have a family history of
prostate cancer, talk to your doctor about the
beneﬁts and risks associated with testing.
Professor Rob McLachlan
Community education
Men Behaving Positively
A series of annual ‘Men Behaving Positively’ public
health forums, spearheaded by Peninsula Health and
Rotary with support from Andrology Australia, have
succeeded in educating men about social, mental
and physical health issues over several years.
The next forum, ‘Men, work and family relationships
- navigating the road map and staying sane’ will
be held at the Frankston Arts Centre Auditorium on
Wednesday June 13th 2007, from 7.30pm to 9.30pm.
This forum aims to raise awareness about the link between
general and reproductive health, and that making
lifestyle changes to improve physical and mental health
can also beneﬁt quality of life and relationships.
Guest speakers include:
• Merv Hughes – Ambassador for Andrology Australia
• Les Twentyman – Youth worker, Open Family
Foundation, Victorian of the Year 2006
• Wayne Schwass – Champion AFL footballer,
CEO Sunrise Foundation
• Tom Bentley – former Director DEMOS (UK),
Director Policy and Cabinet Victoria
• A/Prof. Neil Cole – award winning playwright,
mental health consumer and advocate
For further details about the forum contact Greg Holding at
Peninsula Health on 0419 007 638 or Gholding@phcn.vic.gov.au
Coming events
Andrology Australia advisory forum
Have a say in our future direction!
Plenary speakers include:
Andrology Australia is holding an advisory forum on men’s health
in Adelaide, 26 – 27 May 2007, and we want you to be involved.
• International speaker Prof. John McKinlay, Chief
Investigator, Massachusetts Male Ageing Study, USA
Over the past seven years, Andrology Australia has built a strong
foundation for educating the community and health professionals on
men’s health. Prostate disease (including prostate cancer), testicular
cancer, male infertility, androgen deﬁciency and erectile dysfunction
affect large numbers of Australian males, and in all of these
conditions, there are many aspects that are still poorly understood.
• Dr Mark Wenitong, President, Australian
Indigenous Doctors’ Association
The Andrology Australia advisory forum aims to provide
an opportunity to all interested health professional
and community members to discuss and contribute
to the future direction of Andrology Australia.
The forum will showcase a number of community, professional
and research projects, and general and specialist workshops
will increase attendees’ knowledge on all aspects of male
reproductive health. It is hoped the forum will also provide an
opportunity for research and education collaborations to evolve.
• A/Prof. Michael Baigent, Clinical Advisor, Beyond Blue
• Governor Prof. David de Kretser AC,
Former Director Andrology Australia
Plus a special guest appearance by Merv Hughes,
Ambassador for Andrology Australia.
Registration is $220 (includes conference dinner)
RACGP QA&CPD 20 Category 2 points. ACRRM 13.5 PDP points
For more details about the forum, please visit
www.asnevents.net.au/andrology/
Places are limited so register your interest today!
The forum is
sponsored by:
Australian Prostate Cancer Collaboration AGM
Australian Prostate Cancer Collaboration (APCC) is holding
their 9th Annual Scientiﬁc Meeting and Annual General
Meeting in Melbourne, 11 – 12 October, 2007.
Keynote speakers include:
The meeting, ‘Challenges for the Future Scientist, Clinician and
Patient: From Bench to Bedside to Bedroom’ will focus on:
• A/Prof. David M. Latini, Scott Department of
Urology and Dan L. Duncan Cancer Center, Baylor
College of Medicine, Houston, Texas, USA
• Stem cell research and stem cells in prostate disease
• Community education for men with prostate cancer with
particular focus on population subgroups (men with low
health literacy, gay men with localised prostate cancer)
• Clinical trials for prostate cancer
• Sexual dysfunction in prostate cancer
• A/Prof. Ian Davis, Ludwig Institute Oncology
Unit and University of Melbourne, Victoria
• Prof. Norm Maitland, York Cancer Research
Unit, University of York, UK
APCC welcomes your attendance at this year’s Annual
Scientiﬁc Meeting and in the process conﬁrm your
commitment and vision to better health for men with
prostate cancer and their families in Australia.
For more details, please visit www.asnevents.net.au/apcc
Focus on: PSA test
What is a PSA test?
A PSA test measures the level of Prostate Speciﬁc Antigen (PSA)
in the blood. It is a blood test that can help diagnose prostate
disease. Prostate Speciﬁc Antigen is a protein made mainly in the
prostate gland and low levels of PSA are normally present in the
blood stream. As a man ages, the prostate grows and the level of
PSA also increases.
PSA levels for different age groups of Western men
Age (years)
Serum PSA (ng/ml)
– average
Serum PSA (ng/ml)
– upper limit of normal
40-49
0.65
2.0
50-59
0.85
3.0
60-69
1.39
4.0
70-79
1.64
5.5
A high PSA in the blood almost always means that something is
wrong with the prostate, but not necessarily prostate cancer. The
causes of a high PSA include the benign (non-cancerous) growth
that accompanies ageing (benign prostatic hyperplasia, BPH),
inﬂammation or infection of the prostate (prostatitis), and, least
commonly, prostate cancer.
Is a PSA test worthwhile if there are no symptoms
of prostate cancer?
Although there are still many questions about the value of using
PSA to test for prostate cancer because there are too many false
positive and negative results, it is the best test that is available.
A false positive result occurs when PSA levels are high but there is
no prostate cancer. A false negative result occurs when PSA levels
are low or within the normal range, but prostate cancer is present.
In the early stages, prostate cancers usually do not show any
symptoms. Cancer can grow in the prostate and not affect
urine ﬂow until it is late stage prostate cancer. A PSA test will
give an indication of problems in the prostate before symptoms
have developed.
How well does the PSA test work for ﬁnding
prostate cancer?
About one in three men with a PSA between 4 and 10 ng/ml
could have prostate cancer, although this proportion varies with
the population tested.
Of 100 unscreened men in each age group tested for the ﬁrst time1-4:
Age
Men who will have a
PSA over 4.0
Of these, men who
could have cancer
50s
5 out of 100
1-2 men
60s
15 out of 100
3-5 men
70s
27 out of 100
9 men
Recent studies have shown that there is still a small risk of
prostate cancer, even if blood PSA levels are normal for age.
Therefore even a normal blood PSA level does not mean that there
is deﬁnitely no prostate cancer present.
The only deﬁnite way to conﬁrm whether prostate cancer is
present or not is by prostate biopsies (taking small samples of
tissue). Transrectal ultrasound (TRUS) biopsies are almost always
performed using an ultrasound probe which is placed in the back
passage (rectum) to visualise the prostate. A small needle is then
inserted into the prostate gland through the rectal wall to remove
samples from different parts of the prostate gland.
Biopsies are not a minor medical procedure and can be
accompanied by short term side-effects such as blood in the
urine, faeces and/or ejaculate. After biopsies, patients may have
temporary difﬁculty passing urine. Importantly, there is a low
(less than 1%) risk of serious infection as a result of this procedure
but it is rarely life-threatening.
How do I make a decision about whether or not to
have a PSA test?
Having a PSA test may require further decisions after the test
results are back, especially if the blood PSA level is raised.
There are several things to consider before having a PSA test
for prostate cancer:
•
Your level of concern about having prostate cancer
•
Your risk of having prostate cancer e.g. is there a family history
of the disease
•
The risk and beneﬁts of early detection. The beneﬁt being that
a PSA test may detect prostate cancer when it is small and
curable. The risks being those associated with unnecessary and
possibly harmful treatment from surgery or radiotherapy (with
or without male hormone suppression) with complications
such as erectile problems (difﬁculty having erections,
impotence) and urinary incontinence (inability to hold urine,
urine leakage, having to wear urine pads).
Unlike many other cancers, the majority of prostate cancers tend
to progress slowly with most men dying from other diseases such
as a cardiovascular episode (heart attack, stroke) rather than
prostate cancer. Therefore a man’s age and his personal choices
must be considered before deciding to have a blood PSA test and/
or deciding what to do if raised PSA levels are found.
For example, an increased PSA level due to a prostate cancer in
an older man aged 75-80 may not be a major health threat when
other factors are considered such as life expectancy and general
health. On the other hand, in an otherwise healthy younger man
aged 50-55, an increased PSA level is more likely to affect his
life (due to the effect of prostate cancer or the complications of
treatment) and further investigation should be considered.
The risk of death from prostate cancer depends on the man’s life
expectancy and the aggressiveness of the cancer. As a rule, men
with high blood PSA levels with a life expectancy of 10 years
or more (or a family history of prostate cancer) should consider
further testing to make the diagnosis of prostate cancer.
With more aggressive cancers, local treatments do not always cure
cancers as microscopic spread may have happened that cannot be
detected with scans and X-ray imaging. These patients need to be
followed so that other treatments can be undertaken as indicated.
Will a PSA test tell me if I have prostate cancer?
A single PSA test is not a reliable indication of prostate cancer,
unless it is extremely high. Men with a blood PSA level over
10 ng/ml have a 50 per cent risk of having prostate cancer.
An increased PSA level may cause concern and anxiety in some
men. It is important to remember that not everyone with
increased levels of PSA has prostate cancer. Other prostatic
conditions, such as BPH or prostatitis can also cause increased
PSA levels.
Results of a PSA test need to be interpreted with caution. Prostatic
biopsies are needed to conﬁrm prostate cancer is present and to
give an idea of how aggressive the prostate cancer is.
New research suggests that the rate or how quickly PSA levels rise
over time is important (this is called PSA velocity). Regular tests,
every one to two years, are necessary to check if the level of PSA
changes with time. If the PSA level doubles in 12 months, this
is of concern as it may be due to the presence of a fast growing
cancer or infection in the prostate (prostatitis). So, if PSA level is
increasing, further action should be taken and a specialist Urologist
consulted for more detailed monitoring.
What if I choose to get tested?
If a man makes an informed decision
to be tested for prostate cancer,
it is important that a digital rectal
examination (DRE) is also performed.
A combination of a PSA test and DRE is
better than either one alone.
If a PSA test is performed, it is
important to return to your GP for
follow-up testing every 12 months. And
if a PSA level is high for your age, the
test should be repeated. For men with
PSA values less than 1ng/ml with no
risk factors, further testing may not be
needed for several years.
What other tests can check for prostate cancer?
There are currently no tests better than PSA for testing for prostate
cancer. Throughout the world, investigators are trying to develop
more accurate and reliable tests for prostate cancer.
There are some reﬁnements of the PSA test that some doctors
believe may add more value to the test. For example, the free
to total PSA ratio is another blood test that can help determine
whether or not an elevated PSA level may be a result of
prostate cancer.
A proportion of the PSA circulating in the blood is free. Non-free
PSA is bound to proteins. Men with prostate cancer will usually
have lower levels of free PSA as a proportion of their total PSA
measurement, than men with prostate enlargement (BPH).
This ratio (or percentage) is most useful for PSA values between
4 and 10 ng/ml.
What are the beneﬁts and risks of testing for
prostate cancer?
This information can help the patient and doctor make a decision
regarding the options for further investigation and management.
An important beneﬁt of testing for prostate cancer is that early
detection of prostate cancer when it is smaller and curable gives
better chance for more effective treatment and cure.
The decision to be tested for prostate cancer is entirely a personal
one in consultation with your doctor to help you make the best
informed choice for your situation. This information is provided to
help men and their families understand the PSA test, and to make
discussion with a doctor easier. Andrology Australia recommends
readers speak to a local doctor about PSA testing and any other
health concerns.
Risks of testing for prostate cancer include:
•
If the PSA level is raised, it does not always indicate prostate
cancer. Biopsies will be needed to determine if cancer is present.
•
Prostate biopsies and treatments for prostate cancer have sideeffects that may affect the quality of life.
•
If prostate cancer is slow-growing, a decision may be made
not to undergo any active treatment (watchful waiting/active
surveillance with further biopsies at a later date) but to have
careful monitoring. In some men this approach can cause
considerable anxiety.
Andrology Australia wishes to acknowledge and thank
all those who contributed to and reviewed this information.
1-4 Oesterling JE et al. 1995; Fang et al. 2001; Gann et al. 1995;
Carter et al. 1992
Professional education
Prostate cancer education available
The online module will include
presentations by specialists, clinical
case studies and other resources to
show how different GPs approach
discussion of prostate cancer testing
with patients. As part of this
online program, a decision-aid is
available to underpin the informed
choice discussion which is currently
available to download from the
Andrology Australia website.
As community awareness about
prostate cancer is increasing, GPs may
ﬁnd more patients wanting to discuss
prostate cancer and the possibility of
being tested. A number of education
activities on prostate cancer and PSA
testing are available through Andrology
Australia for GPs and other health
professionals, to assist in decisionmaking and discussion with patients.
An audio interview on PSA testing
is available to download from
the Health Professional section of
the Andrology Australia website
(www.andrologyaustralia.org).
Consultant urologist A/Prof. Mark
Frydenberg discusses PSA testing
and the latest developments in the
use of the test for the diagnosis of
prostate cancer. This interview was
recorded for Edition 3 of the RACGP
General Practice Essentials CD.
An online Active Learning Module
(RACGP/ACRRM accredited) on
prostate cancer testing is currently
being developed with support
from Andrology Australia and
will be available mid 2007.
The module is being developed by
the Queensland Cancer Fund through
the ThinkGP online training facility
in collaboration with the Australian
Prostate Cancer Collaboration
education group, with input from
the Queensland Faculty of the RACGP
and the Northern Section of the
Urological Society of Australasia.
Research round-up
Sexual functioning after treatment for localised prostate cancer
Men who have had prostate cancer
treatment often experience longterm sexual dysfunction, which can
be very distressing and affect quality
of life. The term sexual dysfunction
covers not only erectile dysfunction
but also orgasmic function, sexual
desire, and ejaculatory function.
A study is being conducted to
better understand the types of
issues associated with the sexual
dysfunction that men experience,
in particular those men going
through radical prostatectomy
or permanent brachytherapy.
The chief investigator Dr Sue Burney
and lead researcher Dr Fiona Newton
said that to date, the study has found
some differences in sexual function
between men who underwent
radical prostatectomy and permanent
brachytherapy. For example,
preliminary results suggest that
men who underwent prostatectomy
had signiﬁcantly lower levels of
erectile and orgasmic function nine
months after treatment compared
with brachytherapy patients.
However, Dr Newton stated that
“sexual desire after treatment was
similar between the two groups.”
Qualitative data obtained from patient
telephone interviews suggested that
some men with sexual dysfunction
also experienced changes in their
wellbeing. For instance, some
men reported changes in how
they perceived themselves as men
while others noted changes in
their emotional affect (mood). Dr
Newton stated that “emotions such
as bereavement and disappointment
were not uncommon”. However, the
research team (including A/Prof. Mark
Frydenberg and A/Prof. Jeremy Millar)
stress that not all patients experienced
negative changes in these areas.
Interpersonal relationships played
an essential role in the way in
which prostate cancer patients
coped with sexual dysfunction.
“Many patients emphasised the
importance of being able to talk with
partners, friends, fellow prostate cancer
patients, and medical personnel who
understand the issues,” said Dr Newton.
“The preliminary results would tend
to suggest that communication
and compassion may well be
important in helping men adjust
after prostate cancer treatment.”
The ﬁndings from this study emphasise
the importance of managing
expectations of prostate cancer patients
and their partners, and providing
psychological support during the
post-treatment recovery phase.
Andrology Australia supported
this study conducted by the
School of Psychology, Psychiatry,
and Psychological Medicine,
Monash University.
In brief
Latest news
Prostate cancer booklet
available
Diet and vitamins reduce
prostate cancer risk
Queensland Cancer Fund produces
quality health information on a
range of cancers, including prostate
cancer. A booklet ‘Sex after
treatment – Prostate Cancer’ is
available at no cost. It is now also
available to download from the
Andrology Australia website, visit
www.andrologyaustralia.org
Following reports in the mid 1990’s
that men who took selenium had
a lower risk of prostate cancer, a
number of scientiﬁc studies have
examined the role of selenium in
protecting against prostate cancer.
Professor awarded for
prostate research
Professor Gail Risbridger,
management group member of
Andrology Australia and Director of
the Centre for Urological Research
at the Monash Institute of Medical
Research, has received one of the
world's top endocrinology awards.
Gail was awarded the Asia
and Oceania Medal from the
British Endocrinology Society in
recognition of her contribution
to endocrinology, especially
her research into the effects of
hormones on the prostate gland.
Congratulations Gail!
Online education for GPs
The second of four online case
studies on the reproductive
health of younger males is now
available (www.andrologyaustralia.
org). The case study, Dylan,
focuses on the management of
testicular lumps in young men.
Fully accredited for ACRRM/RACGP
points, the four case studies
together comprise an Active
Learning Module which attracts
30 Category 1 RACGP points.
The ALM is a key initiative for
Andrology Australia and developed
in conjunction with the Department
of General Practice, Monash
University and by ThinkGP.
International Men’s
Health Week 2007
Show your support for men’s
health and hold an event or display
during International Men’s Health
Week 2007 (11-19 June). Visit
the Andrology Australia website
(www.andrologyaustralia.org) to
order resources and to enter our
competition to meet Merv Hughes!
Selenium is an essential mineral
in the human body that acts as an
antioxidant. Antioxidants can help
prevent damage to cells with the potential
that they may reduce cancer risk.
Plant foods are a major dietary source of
selenium, but it is also found in meats
and seafood. Most often selenium
can be found naturally in foods such
as Brazil nuts, ﬁsh, red meat, beef
and chicken liver, grains and eggs.
A recent study has found that a diet
high in selenium may reduce the risk
of prostate cancer in selected men1,
but this only applied to men who also
had a high intake of vitamin E or men
who were taking multivitamins.
The study used data from the Prostate,
Lung, Colorectal, and Ovarian Cancer
(PLCO) Trial conducted in the USA, and
looked at 724 men with prostate cancer
and a control group of 879 men without
prostate cancer. Men in this study had
blood samples taken over a number of
years with the aim of identifying factors
present in men who went on to develop
a variety of cancers. As this was a longterm study, blood samples from the men
who went on to develop prostate cancer
were available from time points before
the diagnosis was made. A survey of
their dietary habits was also done.
The researchers found that there was
no link between selenium levels in the
blood and the risk of prostate cancer
except in those men with a high intake
of vitamin E and multivitamins. They
concluded that there was no evidence to
support the role of selenium supplements
in the general male population.
Selenium deﬁciency is unusual in
Australia, but men need to be careful
if taking selenium supplements as
excess amounts can lead to toxicity. The
National Health and Medical Research
Council recommend a dietary intake
of 65μg a day for men, which should
be provided by a balanced diet.
1 Peters U, Foster CB, Chatterjee N, Schatzkin A,
Reding D, Andriole GL, Crawford ED, Sturup S,
Chanock SJ, Hayes RB. Serum selenium and risk
of prostate cancer – a nested case-control study.
Am J Clin Nutri 2007; 85: 209-17
Newsletter of Andrology Australia
Australian Centre of Excellence in Male Reproductive Health
Editor: Cassy Bezeruk
Andrology Australia
C/O - Monash Institute of
Medical Research
Postal Address:
Monash Medical Centre
246 Clayton Road,
Clayton Victoria 3168
Street Address:
27-31 Wright Street,
Clayton Victoria 3168
Telephone:
1300 303 878
Facsimile:
+ 61 3 9594 7111
Internet:
www.andrologyaustralia.org
Email:
info@andrologyaustralia.org
Andrology Australia is administered by
Monash Institute of Medical Research
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DISCLAIMER
This newsletter is provided as
an information service.
Information contained in this newsletter
is based on current medical evidence
but should not take the place of
proper medical advice from a qualiﬁed
health professional. The services
of a qualiﬁed medical practitioner
should be sought before applying the
information to particular circumstances.