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Please find attached a recent article published in Mens Health Magazine by Dr John Cummins

Mens Health How to Live to 100 

What is the incidence of prostate cancer in Australia?

One in nine Australian men will develop prostate cancer and it is a frequent insurance claim. Known risk include having a positive family history, being overweight and a diet of high saturated fat.

What are some of the symptoms men should be aware of?

The prostate is a small gland at the base of your bladder, approximately the size of a small walnut supplying nutrients to your sperm. It surrounds the urethra (see image below), the tube which carries urine from your bladder to the external world. The volume of normal adult prostate averages between 20 - 30mL and it typically increases in size after the age of 50.

If the prostate becomes too large, it can compress the urethra which can decrease urine flow. This  means you can spend a  long time emptying  your bladder or experience incomplete bladder emptying - so that you feel the need to go again within two hours. Furthermore, it is common for men over 50 get up once a night, or at least every other night to empty their bladder.

How can these symptoms be diagnosed?

The prostate can be checked by doctors by feeling the gland through the rectum – this is called a digital rectal examination. Doctors can only access the back of the prostate by this physical examination and are unable to feel the sides or front of the prostate. Further tests can more specifically assess the prostate, including an ultrasound measurement or blood tests that provide an indication of PSA. 

PSA stands for prostate specific antigen, which is a protein produced by normal prostate cells.  As the prostate gland naturally increases in size as you age, it is also normal that your PSA gradually increases.

There are two ways in which prostate cancer is detected. Firstly, men may go to their GP with a concern about urinary flow. So, if your urinary flow has significantly decreased recently and you are getting up two to three times a night, it is recommended you have a check-up.

This ought to be a high priority if you have a family history of prostate cancer.  Your doctor will perform a digital rectal examination and arrange a PSA blood test. Alternatively, if you have no symptoms, a routine blood test may reveal a high PSA.  If your PSA is significantly higher than is normal for men of your age, this may suggest an enlarged prostate or possible prostate cancer.  To verify whether there is a cancer, a prostate biopsy needs to be undertaken.

What are the treatment options available?

If diagnosed with prostate cancer, several treatment options are available. Increasingly, with what appears to be low-grade prostate cancer, there is a clinical trend of active surveillance. This means that no treatment is provided initially.  It is a “wait and see” approach with a repeat biopsy several months later to see if the cancer is becoming more aggressive and careful tracking of PSA to identify rapidly rising PSA both mandate some form of intervention.

The types of intervention offered include complete removal of the prostate, radiotherapy to the prostate gland or brachytherapy, which involves implanting radioactive seeds inside the prostate gland. The PSA should fall to 0 after a prostatectomy and slowly decline to very low levels after either radiotherapy or brachytherapy.

Fortunately, the cure rate for prostate cancer is high if it is detected at an early stage. The most significant side effects of treatment are relative impotence or very occasional problems with urinary leakage.

From your experience how does this impact on the insurance claims process?

Clients who apply for insurance and who present with a higher-than-normal PSA, or a history of a rising PSA, are typically declined until the issue is sorted out. However, clients who have had a normal prostate biopsy often subsequently have normal insurance rates.

About Dr Cummins

Dr John Cummins is a Consultant Physician and the Principle of Executive Medicine. Executive Medicine is Sydney’s Premier assessment site for Insurance Medicals and executive, Corporate and and private health assessments and management.  www.executivemedicine.com.au .