As well as pathology collection, there was also a multi-header microscope at the event that allowed people to see what pathologists look for when they diagnose prostate cancer. In-depth educational materials were also provided by Lab Tests Online for those attending to learn more about prostate cancer tests.

The PSA testing event was scheduled to coincide with the Big Aussie Barbie, hosted by the Prostate Cancer Foundation of Australia. The Prime Minister Scott Morrison was in attendance, along with other notable Ministers.

“Nineteen thousand men have been diagnosed with prostate cancer just this year,” the Prime Minister said.

The Opposition Leader, Anthony Albanese, also spoke at the barbecue about his personal experience with PSA testing explaining that following a high reading he now gets tested every three months.

The PSA test measures the level of prostate-specific antigen in the blood. The test can be used as a tool to screen for prostate cancer as the PSA level is typically raised when there is a prostate tumour. However, PSA levels can be raised for a number of reasons so in cases of a high PSA result doctors will order further tests to determine the cause.

The Federal Minister for Health, Greg Hunt, attended the PSA testing event to have his blood test and said, “this testing program is immensely important. We’ve been able to support prostate cancer on a variety of fronts”.

The PSA levels of 50 parliamentarians were measured and all participants had their results communicated back to them on the same day.

Warren Entsch, one of the co-chairs for Parliamentary Friends of Prostate Cancer Awareness, said, as part of this event “we may have saved lives”.

As a consequence of the testing event all participants have had the opportunity to learn more about their health status with appropriate guidance from medical professionals.

Events at Parliament House run by the Pathology Awareness Australia team increase the awareness of the role of pathology in healthcare.

Chris Bowen, the Shadow Health Minister, attended the event on behalf of MP Jason Clare who is the other co-chair of the Parliamentary Friends of Prostate Cancer Awareness.

“Warren and I have been down this morning giving blood in the same booth at the same time in a bi-partisan effort to show, Labor or Liberal – we all bleed, and we all need to be checked,” said Chris Bowen MP.

Ahead of testing all men received counselling from a Chemical Pathologist or a General Practitioner on the pros and cons of PSA testing in line with the latest National Health and Medical Research Council guidelines.

The event served as an example of the role of pathology in providing critical information to guide medical decisions that occur hundreds of thousands of times every single day.

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The new liquid biopsy test trialled in the UK is a blood test to detect circulating tumour cells (CTCs) which have split from the original tumour to be found in the bloodstream. Researchers hope this test will indicate if a prostate tumour is likely to spread to other parts of the body (metastasise).

There are several pathology tests currently used to diagnose and monitor prostate cancer. A blood test that looks for Prostate Specific Antigen (PSA) is commonly used as a screening tool, and the results of this test may be the first red flag in the diagnostic chain.

Researchers found that when the CTC tests were combined with the PSA test, they could predict the presence of aggressive prostate cancer in subsequent biopsies with more than 90 per cent accuracy, better than any previously reported biomarkers.

Lead researcher Professor Yong-Jie Lu from Queen Mary University of London said: “Testing for circulating tumour cells is efficient, non-invasive and potentially accurate, and we’ve now demonstrated its potential to improve the current standard of care. By combining the new CTC analysis with the current PSA test, we were able to detect prostate cancer with the highest level of accuracy ever seen in any biomarker test.”

The number and type of CTCs present in the blood could also indicate how aggressive the cancer was, which can help doctors to determine what course of action is best for a patient.

As PSA levels can be raised for reasons other than cancer, PSA test results are used as a screening tool to identify men who may need more regular monitoring or further tests.

Chemical Pathologist, Associate Professor Ken Sikaris said Australia’s current screening practices work well, but new research in the area is welcome:

“It’s encouraging that research is progressing in this area, this study certainly shows potential but more studies are needed. We must be cautious when seeking to apply UK research to the Australian context as pathology practices and guidelines differ between countries. We want to encourage those eligible to discuss the PSA test with their doctor, and not to be fearful. It’s important to note that an abnormal PSA result does not automatically lead straight to another procedure such as a biopsy.”

Pathologists, other specialist doctors and patient organisations have worked together to develop the latest guidelines on PSA testing to maximise the benefits and minimise risk for patients.

High quality standards make Australia’s pathology services among the best in the world, but participation is key. Our fantastic pathology system and the tests we have available can only help Australians who take part in testing.

The guidelines recommend PSA testing every 2 years for men over 50, or if you have a family history of prostate cancer you may start testing from age 40.

Steve Callister, Chairman of the Prostate Cancer Foundation of Australia told Channel 9: “Obviously more needs to be done. 3,500 men are dying and we need to make more men aware of catching it early.”

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Unlike most patients who have been through cancer treatment, Vincent Jenkins has seen inside the laboratory where his diagnosis happened.

At the Melbourne Pathology laboratory that diagnosed his prostate cancer, Vin was able to get a close look at his own prostate biopsy slides and meet with Dr Peter Nguyen, the pathologist whose diagnosis led to life-changing surgery.

Eleven years ago, Vin went to his GP for an annual check-up, and was recommended to have a PSA blood test and have his prostate checked.

Prostate cancer is the most commonly diagnosed cancer in Australian men, and 100% of all cancers are diagnosed in pathology labs.

After surgery to remove his prostate, Vin has been in remission for 11 years. A keen golfer, he now lives an active lifestyle after his most recent brush with cancer.

Inside the lab Vin was able to learn how a biopsy examined by Dr Nguyen saved his life – and to meet Dr Nguyen for the very first time.

“This first test indicated that things were not normal, and I was told to come back in 6 months to see how things had progressed. It was then that we found that the situation had deteriorated.”

“I had never thought about having prostate cancer or even having a test,” said Vin, “that’s the scary thing – I had no symptoms whatsoever. I was asymptomatic, which is why I was so surprised to get back such high PSA test results.”

“After that my urologist suggested I have biopsies to check out my prostate. I was then diagnosed with prostate cancer and I was booked in for surgery about four weeks later,” said Vin, who retired from a career in marketing and advertising some years ago.

Anatomical pathologists like Dr Nguyen are the doctors who examine body tissue samples, such as Vin’s prostate biopsy, to diagnose disease and advise the medical team about treatment, as well as giving the all clear after successful surgery or therapy. Australia’s pathology sector boasts some of the highest quality standards in the world.

“The pathology is interesting to me, because after my prostate was removed, I was concerned that the cancer wasn’t confined to the prostate. However, the pathology tests confirmed that it was, which was a huge relief,” said Vin.

The 5-year survival rate for prostate cancer is 95%, however if cancer spreads to other parts of the body it is harder to treat.

Prostate Cancer Foundation of Australia CEO, Professor Jeff Dunn AO said:

“Regular health check-ups help with early detection, which is crucial in effectively fighting prostate cancer. Men over the age of 50 – or 40 if they have a family history of prostate cancer – need to talk with their GP about prostate health. If you fit the criteria, speak to your GP and remind your loved ones and friends to as well.”

Each year in Australia, approximately 20,000 men are diagnosed with prostate cancer and around 3,500 die of the disease, meaning early diagnosis is crucial to save lives.

“That’s why we need to encourage men over 50 to have regular tests done. If you don’t have symptoms, you can still have cancer. And the most important thing is to catch it early, like I did,” said Vin.

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Ken and David now lead two cancer support groups in Ballina and Byron Bay. David explains;

“Cancer has a major impact on a person’s life. It can affect everything from sleep and appetite to relationships with your family. While many support groups focus on medical issues, we wanted to create a community where people feel comfortable discussing the emotional effects of cancer without judgment.”

Along the way, both Ken and David have discovered the importance of health literacy, to which pathology is integral.

David was diagnosed with Waldenström’s Macroglobulinaemia (WM), a rare, slow growing form of non-Hodgkin lymphoma, a blood cancer affecting the immune system. There is currently no cure.

“After being diagnosed with cancer, my haematologist recommended a watch and wait approach. A combination of blood tests and bone marrow biopsies enabled him to monitor my blood over time and choose a milder form of chemotherapy tailored to my needs. Learning to understand my test results has helped me to keep an eye on my progress ever since.”

David is now participating in an international trial, comparing a new experimental drug, BGB-3111 against Ibrutinib, a drug already used to treat forms of lymphoma including WM, to see if it could be a more effective therapy.

From David’s point of view, education is a crucial tool for battling cancer. “It is critical that patients learn about their illness and treatment options, whether that’s through health care organisations or at their local clinic. Education is so important and those who remain uninformed are missing out on opportunities to improve their health.”

Ken is also a passionate advocate for patient education. Being diagnosed with prostate cancer has motivated him to embrace a holistic approach to health. “The cancer diagnosis was a wake-up call to change my lifestyle. With the help of my doctor, I’ve learnt to harness the benefits of exercise, sleep and nutrition to achieve the healthiest body possible.”

Although Ken has made a full recovery, he still relies on pathology tests to monitor his health. “While pathology tests were instrumental in my diagnosis, they’ve also played an important role in maintaining my health. I still have regular PSA tests as a preventative measure. I’m very fortunate to have been given a second chance and I’m healthier now than ever before.”

Improving your own health literacy

The internet has led to an abundance of easily accessible health information. And whilst this can be great if you’re looking for extra support, it is increasingly difficult to know which sources to trust. A couple of questions you should ask yourself are:

1. What is the source? Government-funded websites, industry bodies and peak national healthcare charities are good places to start. Always read the ‘About Us’ page and be aware of potential biases. Are they a private company pushing a product, for example?
2. Is the information up to date and backed up with scientific evidence? The best websites will reference reputable sources such as scientific journals.

When it comes to pathology, Lab Tests Online (www.labtestsonline.org.au) is one platform where patients can learn more about their illness and the relevant diagnostic tests. Lab Tests Online is run by the Australian Association of Clinical Biochemists, is government funded and provides reliable, accurate information, free from commercial bias. All of the information is written by practising pathologists and scientists and goes through a strict editorial board before being published.

Crucially the information is also Australia focused. When searching the internet it’s easy to end up down a rabbit hole only to discover that the information is not relevant in your location. Best practice guidelines, available tests and treatments can vary between countries, but at labtestsonline.org.au you’ll find information relevant to Australia.

And if you’re ever unsure about where to find the best information or you need additional support, remember your health professionals are there for you. Both Ken and David credit their doctors with supporting them to understand their own health. General Practitioners, nurses, specialists and pharmacists would much rather you asked them than rely on Doctor Google!

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In total 91 men participated in testing including Minister for the Environment and Energy, the Hon Josh Frydenburg MP, Minister for Aged Care and Indigenous Health, the Hon Ken Wyatt AM as well as MP and Shadow Treasurer, the Hon Chris Bowen.

The event was a fantastic opportunity to show parliamentarians first-hand the utility of PSA testing and the benefits of appropriate pathology testing more broadly.

Prostate cancer is the most common cancer in Australian men with 20,000 men diagnosed with the disease each year. In 2017, it is estimated that 3,452 Australian men will die from prostate cancer.

PCFA encourages men between the ages of 50 and 69 to discuss PSA testing with their GP as part of their regular health check-up. For men who decide to undergo testing, the general recommendation is to have a PSA blood test every 2 years, from age 50 to age 69. Men whose risk of prostate cancer is higher than average due to family history can begin testing in their forties, depending on their level of risk.

Associate Professor Anthony Lowe, Chief Executive Officer of PCFA spoke at the event.

“We want men to feel empowered to take control of their own health, learn about their family history and pro-actively ask their GP about their testing options. A check-up is a good opportunity for men to discuss the benefits and harms of testing with their GP before making an informed decision.”

For co-Chairs Hon Jason Clare MP aged 45 and the Hon Warren Entsch MP aged 67 – who are at opposite ends of the age bracket – PSA testing is especially important. Jason Clare MP who lost his grandfather to prostate cancer, commented:

“Unfortunately, a lot of men don’t get checked until it’s too late when all it takes is a simple blood test. Talk to your doctor and get tested. It might just save your life”.

Hon Warren Entsch MP said:

“Prostate cancer is a disease I have become very familiar with in recent times having lost two friends this way. It wasn’t really something I thought about before then but now I know it’s absolutely critical especially as I mature. Take it from me it’s better to be educated by your doctor or PCFA, rather than finding out about prostate cancer like I did through the deaths of close friends.”

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Clinical practice guidelines, released last year by Prostate Cancer Foundation of Australia and Cancer Council Australia with direction from The Royal College of Pathologists of Australasia (RCPA), have sought to establish consensus by providing clear, evidence-based recommendations on the use of PSA blood tests. Guidelines now recommend doctors inform men aged 50-69 of the potential benefits and harms of PSA screening, and the decision should be an individual one.

A/Prof Ken Sikaris, a chemical pathologist and leading expert on PSA testing, commented “For men who decide to be tested, PCFA’s clinical practise guidelines contain comprehensive instructions on matters such as what age to start testing; how frequently to be tested; when to stop testing; the PSA level which should prompt further investigation and family history. These guidelines are intended to resolve confusion and ensure greater consistency in testing practices.”

During Prostate Cancer Awareness month, PCFA encourages GPs to familiarize themselves with the Clinical Practise Guidelines on PSA Testing. According to Associate Professor Anthony Lowe, Chief Executive Officer of PCFA: “The guidelines have been introduced to benefit GPs and enable them to have informed conversations with patients who decide to be tested. We believe that this framework will improve patient outcomes and provide assistance to GPs in explaining to men the role of active surveillance for prostate cancer.”

While some prostate cancers are aggressive, most are not, and appropriate treatment requires careful consideration of the patient’s risk profile. Additional prostate cancer markers through blood, urine and tissue samples help doctors to better identify which patients would likely benefit from treatment and who should forego it.

Recent findings published this month in the Annals of Internal Medicine, have further contributed to the PSA testing debate. Researchers concluded that PSA testing does help save lives from prostate cancer and is linked to as much as a 32% decrease in prostate cancer deaths, compared to men who aren’t tested.^[1]

The findings may give more men and their doctors confidence that PSA testing is a safe and effective way to assess prostate cancer risk, which could potentially prolong their lives.

[1] http://time.com/4927356/psa-test-prostate-cancer/

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Graeme was fit and healthy when he watched the E.J. Whitten AFL match that raises funds for prostate cancer research.

The game inspired him to visit his GP for a health check. A blood test showed his Prostate Specific Antigen (PSA) was slightly raised so his GP decided to continue monitoring. Eighteen months later a sudden spike in Graeme’s PSA led to a biopsy and final diagnosis. Doctors told him that in another six months the cancer could have spread to other organs.

“I didn’t think anything was wrong with me when I went for that first test, I was far too young! Fortunately, it identified the problem early and my doctors kept a close eye on me.”

Graeme is now well following surgery to remove his prostate gland. He has regular blood tests to monitor his health and provide him with peace of mind.

Prostate Cancer Foundation Australia (PCFA) provides support to thousands of Australian men with prostate cancer and their families. CEO A/Prof Anthony Lowe says,

“Prostate cancer diagnosis and management is heavily reliant on pathology services including blood tests and biopsies. PCFA encourages men aged 50 to 69 to have regular, informed discussions with their GPs about their health risks including prostate cancer.”

In a strange twist to the story, Graeme’s partner Erika who is a medical typist at a pathology laboratory where his biopsy samples were examined arrived at work the morning after his biopsy was performed to find his biopsy slides waiting to be reported Erika says:

“It was a confronting moment in my life, but it clarified for me how incredibly important pathology testing is. Without pathology, there is no cancer diagnosis. And at the end of every sample is a human being with family. Everyone is affected by pathology testing.”

Prostate cancer is responsible for around 25% of all cancer cases in Australian men1 and around 20,000 men are diagnosed with it every year.2 Many cases are slow growing and there is a 93% chance of surviving more than 5 years after diagnosis.3 Diagnosis can be challenging as men do not engage with GP services as regularly as women.4.

Australian doctors rely on pathology tests (blood, biopsy) to diagnose every case of cancer in Australia. Effective cancer therapies (radiation, chemotherapy, surgery) often have problematic side effects on the patient. Ongoing pathology tests are integral to select the best treatment, prepare for surgery, adjust dosing and monitor side effects during treatment.

REFERENCES

1. http://prostate-cancer.canceraustralia.gov.au/statistics accessed 8th January 2016
2. Australian Institute of Health and Welfare, 2015 Australian Cancer Incidence and Mortality (ACIM) Book for Prostate Cancer http://www.aihw.gov.au/acim-books/ accessed 12th January 2016
3. http://prostate-cancer.canceraustralia.gov.au/statistics accessed 8th January 2016
4. Australian Bureau of Statistics, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4CD5ABB5FABC202FCA25792E000D5A7E?opendocument accessed 8th January 2016

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The PSA test result came back as high – although the test is not diagnostic, it indicates to doctors that further investigations and monitoring may be necessary.

In Hamish’s case further testing was carried out; and a biopsy confirmed a diagnosis of prostate cancer.

Hamish’s doctor decided at this point to monitor him with regular testing of his PSA level to see if the cancer was progressing.

For a while his PSA level was trending down, but when doctors saw it beginning to rise, they decided that treatment was needed.

Hamish underwent radiation therapy and hormone suppression therapy to treat his cancer, and his last round of radiation treatment was in March 2015. The hormone suppression treatment is set to continue for another twelve months.

As well as being responsible for his diagnosis, pathology is an important part of Hamish’s treatment. It enables the doctors looking after him to determine how well the treatment is working and also to monitor his health overall.

Hamish said: “The very first day with the kidney stones the first thing the doctor did was send me down to pathology.

Each doctor’s visit they’ve relied on the results of pathology tests to plan the next move, without pathology I don’t know where we’d have been.”

In order to look after Hamish’s health overall he saw a whole team of doctors and 2 specialist nurses who often referred him for pathology testing to check on various aspects of his health; this included urine tests, and blood tests for anaemia and vitamin D levels.

Hamish describes pathology as a “critical link in the chain” of his healthcare.

He is now doing well and is thankful for the support he received alongside his medical care. He joined the Geelong Prostate Cancer Support Group and says:

“It was one of the best things I’ve done. It’s really helped because we’re all in the same boat.”

Hamish is a passionate advocate for the group, which supports men with prostate cancer and their partners.

Discovering he had cancer and undergoing lengthy treatment took a great toll on Hamish’s mental health and he is grateful to all those who have helped him through including his medical team, support group and mental health services.

And pathology is still an important part of Hamish’s healthcare, so that he can always know where he stands.

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