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BUILDING CONNECTION
SUMMER 2016
MY THOUGHTS ANDWHAT I DO
Overall, I am happy that there is at least a framework for
GPs and patients to work on rather than a blanket yes or no.
But I have a few misgivings. Prostate cancer unfortunately
does occur before 50 and the consequences can be tragic.
I believe that PSA screening for those with a family history
should commence at 40. Trying to work out who and how
many in the family have had or even been checked for
prostate cancer can be very difficult and unreliable.
My father may have had prostate cancer but was never
checked and I wouldn’t have a clue if my other brothers
have been checked. In the instance of my late brother Peter
Crimmins, he died at 28 years of age, and so I don’t know if
he may have developed prostate cancer if he lived a full life.
What if you were adopted? I think keep it simple. GP land
needs to be simple. Start at 40 when there is a family history
or you don’t know your
family history. I also
think that yearly
is preferable over
biannually. The latter
probably saves a few
health dollars but I
think young male
lives are more
important.
If there is no
family history of
prostate cancer
then I am happy
for it to start at
50 but I also like to
have a baseline reading
or two from the 40s as a
comparison. This may also pick up
the isolated cancers that crop out of the
blue. Yearly or two yearly testing? At 50 the normal range
of PSA is less than three. If the patient’s level is normal but
between 2-3 then I like to keep a closer eye on them and
recommend yearly tests. Every two years is OK if their level
is under one and 1 to 2 is a grey zone for me. I reckon I lean
more to yearly testing.
Seventy is the new 60 so I don’t think that surveillance
should stop then. But what to do about prostate cancer
after 70 years of age needs a lot of looking into with your GP,
urologist and oncologist. With respect to the PSA velocity
testing, I must say that I am a big fan and have found it very
useful along with the Free to Total PSA level. The latter is a
bit like the good versus the bad cholesterol test.
BOWEL CANCER SCREENING
Bowel cancer screening has been around since 2007 when
a kit was sent out to all Australians who had turned 55 or 65
years of age. There are around 15,000 new cases of bowel
cancer diagnosed in Australia every year and the numbers
seem to be increasing. Of that 15,000, about 8500 are
males so there is a higher incidence in us. Over 2000 blokes
die of the disease every year but if found early, it is certainly
curable.
Family history is an important risk factor as well as
lifestyle prevention with measures such as an increased
dietary fibre intake and smoking cessation. Bowel cancers
generally arise from stalks of tissue inside your bowel called
polyps which protrude into the lumen of the bowel. It is
important to know if you have any of these inside your bowel
as they may be pre-cancerous. The best way is to directly
look inside your bowel with a long tube and camera on the
end in a procedure called a colonoscopy. If there is a family
history of bowel cancer then a colonoscopy should be done
sometime soon after 40 as a baseline and then based
on what is found the person doing
the colonoscopy will generally
organise a recall.
Some with a very
strong family history
may even need
it earlier as
it should be
done about
10 years back
from when the
close relative
developed
it. It would be
impractical and
costly to do this
test on the whole
population so a very
good screening test has
been devised. If there is
no family history then there is the National Bowel Cancer
Screening Program or ‘poo test’ which has been expanded
and now commences when you turn 50 and will continue
until you are 74. Between these ages it will be further
expanded over the next 4 years so that by 2020 you will get
a kit every 2 years.
The test picks up microscopic traces of blood which may
come from a number of sources. About 1 in 14 tests are
positive but it doesn’t automatically mean that you have
bowel cancer. Yes, the bleeding may have come from a
bowel cancer but it also may have come from a polyp. As the
poo brushes past these bits of tissue they may bleed. Or the
bleeding may come from a completely different source such
as haemorrhoids, an anal tear or inflammation in the bowel.
A positive test warrants further investigation and a
colonoscopy is generally the test of choice. If polyps
MEN’S HEALTH
DR BERNIE CRIMMINS