‘Tracking my own PSA levels saved my life’
26 April 2023
Dr Oliver Sutherland’s (ONZM) account of the early detection and treatment of his prostate cancer
Dr Oliver Sutherland believes his experience of early detection and survival of prostate cancer is different from that of many other patients, but he doesn’t think it has to be.
The 79 year old retired entomologist, who lives in Nelson, credits his own vigilance and determination in annually monitoring and tracking his own PSA levels with saving his life.
“I initiated the diagnosis of my cancer before it spread beyond the prostate with no particular encouragement from my GP – if I hadn’t been advocating for myself and insisting on annual PSA tests it might not have been picked up early enough to save my life,” Sutherland says.
Five years ago, Sutherland noticed a PSA level which was trending upwards (it reached 6). His GP conducted a digital rectal exam (DRE), an MRI scan, and a biopsy so the diagnosis of prostate cancer was confirmed. A prompt prostatectomy left him ‘cured’ and his PSA levels have been ‘unrecordable’ for the five years since.
What is unique about Dr Sutherland’s story is that he had requested and maintained a programme of regular PSA tests for the previous 18 years.
“Because I had a family of history of prostate cancer I’d been intent on screening for it since my 50s.”
Dr Sutherland, who is involved in the Nelson Prostate Cancer Support Group says as there is no national screening programme for prostate cancer, many men are not aware of the benefits of PSA testing.
“I encourage all GPs to urge their male patients over the age of 50, and over the age of 40 if there is a family history of prostate cancer, to have a regular PSA test.”
“I have lost several people very close to me because their prostate cancer was not diagnosed until it was too late and I hear stories at our support group all the time about cancers that have metastasized by the time they are detected.”
“Those men have shared with me their desolation and disappointment at the thought they might have lived if they’d caught it sooner, and that the treatment options that were available to me were not available to them.”
Doctor Sutherland eloquently describes how he took control and managed his own risk of prostate cancer. His experience identifies at least two important points.
Firstly, we need to hear and understand the personal feelings and concerns of our patients. These are the stories that make us realise that screening for disease involves not just populations but individuals who have great insight into the health risks that they face, or indeed want to face.
Secondly, Doctor Sutherland’s story encourages us to think about the importance of screening and the pitfalls and constraints associated with these activities. Many screening guidelines require primary care input and prostate cancer is a good example. Our now president, Samantha Murton was a member of the Ministry of Health initiated Prostate Cancer Management and Referral Guidance (2015). There are in addition other prostate guidelines which have significant primary care input.
The College has also recognised the important prostate cancer research going on in Waikato with the Waikato Bay of Plenty Prostate Cancer Register. The College gave an Honorary Fellowship to Dr Ross Lawrenson for his exemplary work on this project and helping to raise the issues faced by men with prostate cancer in the Waikato region. This information is then able to inform our services across the country. Dr Jo Scott Jones, one of our Specialist General Practitioners (Fellows), is also involved in this mahi, and is one of the speakers at the National Conference 2023 new horizons in prostate cancer care.
Prostate cancer screening, particularly with the use of PSA testing has a long and changing history. For many years there was intense debate about whether PSA testing should be carried on a case finding basis only as it did not fulfil all the “rules” of screening. There were concerns about the reliability and validity of PSA testing along with the worry that treating a “false positive” case could result in real harm. Along with this was the question as to whether early detection of prostate cancer really improved both the quantity and the quality of life.
The answers to these questions are now becoming clearer particularly due to improved MRI and PSMA imaging which allows for better staging and individualised treatment, but the National Guidelines wisely stress that the pros and cons of testing should be carefully discussed with the patient and again when a positive PSA is found.
We need to be aware that this is still an evolving area with changes in investigations like MRI along with newer treatment options. We should be alert to changes in guidance as they occur.
Finally, all the guidelines refer to “men” with prostates rather “people” with prostates or “people” who have a risk of prostate cancer. Is it time for change?