John is 69 years old. He was working for BHP from 1994 to 1998 as a technical expert on road and rail transport, and based in Melbourne. After leaving BHP John set up his own consultancy business, specializing in the areas of road, agricultural and industrial safety. This can involve up to 70 hours of work a week.
John has always been pro-active in looking after his health; from age 50 he was having annual PSA blood checks and rectal examinations. With a history of bowel cancer in the family, he was also having a regular colonoscopy.
Whilst at BHP, the management encouraged staff to have a thorough in-house annual medical examination. John took advantage of this opportunity, but notes that 40% of the male staff at the time would not accept a DRE (digital rectal examination of the prostate).
Since first being tested to the present day, John’s PSA has always been within the range of 1.3 – 1.9.
In May 2009 John attended his medical clinic in Melbourne, and saw his regular doctor. A rectal examination detected an abnormality of the prostate. He was referred to an urologist who, after another DRE, expressed concern. In August of the same year John had a biopsy. Fourteen core samples were taken and the result showed a Gleason Score of 5.
Following discussion with the urologist John commenced a program of Active Surveillance with a blood check every three months and a biopsy every 12 months. Whilst his PSA remained virtually unchanged, by late 2010 another biopsy showed a Gleason Score of 6.
Active Surveillance continued into 2013, and a biopsy in that year showed the Gleason Score having increased to 7 – as with earlier biopsies less than 1mm out of 168mm of the core sample showed any cancer.
It was about this time that John joined the Geelong Prostate Support Group. He had seen a brochure which promoted the existence of a national network of support groups, and made contact with the Geelong PSG. He has attended most meetings since then.
John’s urologist suggested that it was time to consider surgery, though John was not convinced – “There is bugger-all cancer, a PSA that isn’t rising …. So why do I need surgery?”
He was advised to have a bone and a CT scan to determine whether the cancer had spread beyond the prostate. This was done and showed the cancer was still contained. He also discovered that he had Paget’s disease of the bone – not linked to the prostate cancer.
Still not convinced of the need for surgery and wanting more definitive information, John agreed to have an MRI of the prostate; at the Royal Melbourne Hospital in June 2014. The results detected no evidence of prostate cancer though a PIRADS 3 lesion was evident in that part of the prostate not tested in a normal rectal biopsy.
John’s urologist advised that he now have a transperineal biopsy. This would be yet another very costly out-of-pocket expense, and he was anticipating that the advice would remain the same – to proceed with surgery.
John felt that it was time now for a second opinion.
He made an appointment to see an urologist in Geelong in January 2014. A rectal examination revealed nothing unusual.
After a thorough examination of his case history, John asked the urologist “….given all the information I have presented, if you were the patient, would you go ahead with surgery?”
The urologist responded, “No” and in a later consultation suggested that arguably John should not have been sent down the route of biopsies etc in the first place.
John now sees the urologist for a six-monthly PSA check and rectal examination. John also sees a doctor who supports integrative medicine. In particular he is taking dietary supplements which he has been advised could minimise the chances of the prostate cancer spreading. Some of these include turmeric, pomegranate juice, vitamin D, linseed meal and green tea.
As well as running his consultancy business, John is heavily involved in personal campaigns in three areas he is passionate about – removing speed cameras, quad bike safety, and dramatically reducing police pursuits. Living on 37 acres, John is kept busy with weed and rabbit control, garden maintenance and agistment of sheep and goats. When not working on his own land, John enjoys spending time with his friend Lyn working on her Gold Coast property. John also enjoys travel, and last year was away in Europe and the UK for six weeks.