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Outback curse

Tuesday, 24th June, 2014

By Nick Gibbs

A chronic shortage of health professionals and the stubborn attitude of men in regional Australia are to blame for the disparity between prostate cancer survival rates.

According to a 15-year study involving over 68,000 Australians diagnosed with the disease, those living in rural areas of NSW were 32% more likely to die as a direct result than their metropolitan counterparts.

Despite overall survival rates showing significant improvement over the duration of the investigation, the gap between metro and rural areas has failed to close, according to Cancer Council NSW.

“More men are surviving prostate cancer than ever before but there is still a large gap we need to close, despite the increasing awareness of geographic differences in cancer survival,” Community Engagement Manager Justin Cantelo said.

According to the study, 700 deaths would have been prevented over 15 years if the survival rates of rural and regional areas matched major cities.

The report did not speculate on the reasons behind the difference, but local consultant physician Dr Steve Flecknoe-Brown and Prostate Cancer Support Group president Keith Stubing agreed attitude and service access were major contributing factors.

According to Dr Flecknoe-Brown, middle aged men in regional Australia generally believed they were indestructible.

“They’re bullet proof at that age,” he said.

“That increases the further you get away from a capital city.”

The findings support Far Western NSW reputation as having among the highest rates of cancer in the state.

“It wouldn’t work that way if we could keep our GPs,” Dr Flecknoe-Brown said, highlighting specialists as especially hard to attract.

His sentiment was shared by Mr Stubing who said raising the awareness of men’s health issues in Broken Hill was “like hitting your head against a brick wall”. 

Speaking from personal experience, he advised all men aged in their 40s to have a precautionary blood test to measure levels of PSA, a protein produced by the prostate gland.

In 2004, Mr Stubing’s PSA test gave a reading of four, healthy for a man of his age, before he returned 12 months later to find it had skyrocketed to 36.5 and doctors estimating a life expectancy of five months without further treatment.

“If I hadn’t had that test, I’d be a goner,” he said.

“My recommendation, have it done when your 40.”

His lack of symptoms and healthy lifestyle left him shocked by the news.

“No one has been more active than I’ve been,” he said.

“I had no problems, I was amazed when I was told what it was.”

Dr Flecknoe-Brown agreed that men aged in their forties should have a precautionary PSA test, but said a healthy relationship with a local GP was favourable over yearly testing regardless of circumstance.

“Do it once when a man is between 40 and 45, than as clinically necessary,” he said.

“They should make sure they have a good relationship with their GP and have a check up every one or two years if they’re feeling healthy,” he said, advising more regular consultations with the presence of symptoms.

Dr Flecknoe-Brown believed the influence of organisations concerned with the manufacture and sale of testing kits, and the laboratories that determined results, had led to a growing hazard of “over diagnoses”.

“It’s a very important issue and I don’t want to see it captured by commercial interests,” he said.

According to the local physician, PSA levels could rise from a range of factors including age and with the presence of inflammatory conditions.

“If everybody gets a PSA test every year or two, 10% will have a reading abnormal enough to warrant further investigation,” he said, preferring to advise patients to simply ensure they had a healthy relationship with their doctor.

The advice matches the recommendation of the Urological Society of Australia and New Zealand that directs men to have a single, baseline PSA test in their forties, regardless of family history, to assess their future risk of developing prostate cancer, with more regular testing reserved for men over 50 years of age who have a greater likelihood of developing the disease. 

To find out more about the Broken Hill Prostate Cancer Support Group, phone 8087 4554.

“If more people would come, I could help more,” Mr Stubing said.

“They should come and get advice and find out what they want to know.”

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