The Urine Test

In a recent edition of the Otago Daily Times, there was a reprint of an essay Chris Harris wrote on the need to find a better method of detecting prostate cancer.

At present one of the prime methods used is a biopsy in which a needle is pushed up into the man's anus, and then through the wall dividing the bowel and the prostate. Tiny pieces of his prostate are chipped off and then sent to the lab for examination. This is the examination I had back in late 2008. There were complications as a result of this biopsy which I describe in some detail in my ebook, Diary of a Prostate Wimp. [This ebook is currently available at half-price at Smashwords to support Movember, the prostate cancer month.]

The problem with this biopsy - the transrectal method - is that infection can easily occur. In fact, men are routinely given antibiotics after the biopsy because it's assumed there will be infections. It's hardly surprising that there are, because the wall between two parts of the body - one of them intended to deal with faecal matter - is pierced and broken open. It's a bit like sticking your hand in a toilet, then using your hand straightaway to put food in your mouth. If you don't get infected, it'll be surprising.

Chris Harris wrote about a new option that's being looked at to avoid this biopsy. Currently several PSA blood tests are done before a biopsy is considered, in tandem with the unpleasant finger up the bum approach that shows whether the prostate is unduly enlarged or not. Chris says the PSA test was never designed to do what it's being used for now, and writes: 'We aim to take a more direct approach by analysing small amounts of prostate cells exfoliated in urine. There is evidence that very small amounts of prostate cancer cells, between one and a few dozen, are shed normally into the urine at an early stage of the disease. Our aim is to pick out these cancer cells and extract molecular information from them to predict if a tumour is going to become a malignant monster or a benign wimp.'

It's normal for men's prostates to enlarge as they get older. Most of the time this isn't anything to do with cancer; it's a common problem many men will have to deal with - as I did. Surgery is performed to decrease the size of the prostate, thus allowing the urinary tract to function properly. (The urinary tract gets blocked by the prostate rather like a large stone in a small river bed.)

There is hope that the urine test will be readily available soon - possibly within months. In the UK, trial tests of the urine samples were accurate in about 70% of cases. However Chris warns that there is still work to be done to ensure thorough accuracy. And of course, as always, funding is a problem.

What my second ebook (Prostate Wimp) is about

I haven't mentioned my second ebook, Diary of a Prostate Wimp, on this blog as much as I should have. Other things have kept getting in the way - like the writing of the sequel to Grimhilda! which thankfully, is in its last draft (of what feels like the last of several hundred).

Anyway, Prostate Wimp came out at the end of April this year, and I've been considering some of the things that I should point out about it to readers, to give it a better opportunity in the world.

Here are some of the things the book addresses:

If you have any concerns about matters to do with your prostate (here's a list of symptoms from the New Zealand Prostate Cancer Society) talk to your doctor and don't let them put you off. Some doctors can be a bit off-hand about men's issues, and others aren't good at answering questions in sufficient detail. Thankfully I had a very good doctor.

The book focuses on what happened after I'd had a prostate biopsy. The biopsy is done initially to check whether you have any sign of cancer. The current method of biopsy is the transrectal method: through the anus, through the protective skin between the bowel and the prostate, and then chipping off tiny bits of the prostate for inspection. There is increasing concern that this is not a healthy method. Regrettably, in New Zealand at present, this is the main method. There are two articles noted in my book by an Australian journalist, Jason Gale. These are worth reading, even though they're now one and three years old respectively.
Prostate exam [biopsy] deaths from 'superbugs' spur inquiry into cancer tests
and
Prostate cancer test causing sepsis [infections] spurs biopsy concerns.
Gale is not alone in writing about this issue. I have a number of other similar articles on file, which I'll detail in future blog posts.

In the book, a medical friend of mine expresses considerable concern about the use of a blood test, generally known by the name, PSA. This gives an indication of the degree of enlargement of the prostate - something that is normal in men as they grow older. What it doesn't do is tell the medical people whether you have cancer. When my prostate was shown to be enlarged according to the test (and it was accurate on that point) I was informed by a urologist at the hospital that I could well have cancer, and I needed to have a biopsy. In fact I didn't have cancer, and the biopsy caused problems I could have done without. I detail in the book the case of another friend of mine who had considerably worse experiences than me, as a result of the biopsy and subsequent investigations.

An enlarged prostate is not necessarily a cancerous prostate. An enlarged prostate is a nuisance, and will probably require an operation (the TURP) to remove some of the enlargement. An enlarged prostate causes problems with peeing: it can make it hard to pee, on one hand, and on the other, cause you to go far more often than normal. This still doesn't indicate cancer.

However, it is still necessary to take prostate issues seriously. I'll talk more about this in a later post.