Information and page credit to Prostate Cancer Foundation NZ

SEPTEMBER - MENS HEALTH MONTH

OUR FOCUS FOR SEPTEMBER IS ALL ABOUT MEN. this includes encouraging them to have their prostate checked, LOOKING AT LIFESTYLE CHANGES FOR A HEALTHIER FUTURE as well as DISCUSSING ANY other HEALTH CONCERNS WITH their GP, such as SExual health queries, mental health, skin, diabetes and so much more.

But, let’s deal with the elephant in the room first…

What’s the problem guys? So many men are on the wrong side of most health statistics and still they don’t seem to want to get along to visit a doctor on a regular basis. Like they really should.

So, this month we need to nudge our tangata (man) on!

Whether it’s our husband, partner, father, grandfather, brother, friend or any other special and important male figure in our lives. We need to encourage them to get their health in shape.

The reluctance some men feel when it comes to visiting the doctor is like a stubborn stain on a white shirt—it’s there, and it’s not going away without some serious attention. So, let’s roll up our sleeves (metaphorically, of course) and explore why this happens.

1. The Masculinity Conundrum: Men and doctors—it’s like they’re playing a game of hide-and-seek, but the stakes are way higher. You see, it’s not just about avoiding the waiting room magazines or the sterile smell of antiseptic. Nope. It’s about a whole bunch of stereotypes and societal expectations. Picture this: a guy thinks, “If I admit pain or ask for help, someone’s going to snatch my ‘man card’ away.”

So, they soldier on, even when their body is whispering, “Hey, buddy, maybe you should get that checked out.” The whole “take it like a man,” “boys don’t cry,” and “walk it off” narrative? Yeah, some men internalize that with the rigidity of a steel girder. But here’s the twist: not all men think this way. Some are more evolved, like those Pokémon that finally evolved into something cooler.

2. Trust Issues: Men and trust—it’s like a complicated relationship status on Facebook. They tend to have higher levels of mistrust in the medical system. Maybe it’s because they’ve heard too many horror stories about needles or had a bad experience with a grumpy receptionist. Or perhaps they’re convinced that doctors secretly moonlight as car mechanics.

And let’s not forget the historic baggage. The infamous Tuskegee Syphilis Study left a scar on trust, especially among Black men. But even without time-traveling back to the 1930s, constant, subtle racism chips away at trust. It’s like death by a thousand paper cuts, but with more paperwork.

3. The Convenience Factor: Imagine if doctors had drive-thru windows. “Welcome to Doc’s Diner! May I take your symptoms, sir?” Convenience matters. If seeing the doc was as easy as ordering a burger, more men would show up. Virtual visits, after-hours appointments, and health screenings at the local pub (okay, maybe not the last one) could make a difference.

4. Fear Factor: Fear—the ultimate villain in this saga. Men worry about bad diagnoses or outcomes. It’s like they’re starring in their own medical thriller: “The Case of the Mysterious Ailment.” But hey, spoiler alert: early detection often saves the day. So, gentlemen, let’s rewrite the script.

5. The Wife vs. Doctor Showdown: In one corner, we have the doctor. In the other, the wife. And the husband? Caught in the middle, like a deer in headlights. A survey revealed that 77% of married or partnered men would rather go shopping with their significant other than visit the doc. Maybe they secretly hope the doctor’s office has a clearance sale section.

6. Honesty Dilemma: Ah, honesty—the elusive unicorn. About 20% of men admit they haven’t been completely truthful with their doctors. Why? Embarrassment, fear of dietary scolding, or the classic “I’d rather not know if I have health issues.” Ignorance is bliss, right?

So, dear menfolk, let’s break the cycle. Next time you feel like avoiding the GP, remember: real strength lies in taking care of yourself. And hey, if you need directions to the doctor’s office, just ask. No shame in that game!

Now, spill the beans: when was your last check-up? And did you secretly hope for a BOGO deal on vaccinations?

THE PROSTATE & PROSTATE CANCER

Credit to Prostate Cancer Foundation NZ

Know your prostate – the anatomy

The prostate is a male sex gland located just below the bladder and in front of the rectum. Along with the testicles and seminal vesicles, are part of the male reproductive system as shown in the diagram below. It surrounds the urethra, the tube that carries urine and semen out of the body through the penis.

The prostate produces some of the fluid that makes up semen, which enriches and protects sperm when men ejaculate. The male hormone testosterone, which is made by the testicles, enables the prostate gland to grow and develop during puberty. In an adult, the prostate gland is usually about the size of a walnut and it is normal for it to grow larger as men age. Sometimes this can cause problems, such as difficulty with passing urine, and may develop into a benign condition called Benign Prostatic Hyperplasia (BPH). Tumours can also develop in the prostate, these are known as prostate cancer.

Prostate Cancer

To get checked for prostate cancer please consult with your GP.
The human body is made up of billions of tiny building blocks called cells. Sometimes, cells reproduce in an uncontrolled way and grow into a lump, or tumour. There are two kinds of tumours: noncancerous (benign) and cancerous (malignant). Benign tumours do not spread to other parts of the body and are not life threatening (except in very rare situations).
Prostate cancer occurs when abnormal cells develop in the prostate. These cells have the potential to continue to multiply, and possibly spread beyond the prostate. Doctors do not know what causes prostate cancer. What they do know however, is that the growth of cancer cells in the prostate is stimulated by male hormones, especially testosterone. Most prostate cancer growth is influenced by testosterone but the speed at which prostate cancer grows varies from man to man. In some men the cancer grows very slowly (called indolent), in others growth is more rapid (aggressive).
Men are more likely to develop prostate cancer as they get older. It is also more common in men who have a father or brother with prostate cancer, and in families who carry certain genes such as the BRCA1 or BRCA2 genes.
Anyone with a prostate can get prostate cancer – including transgender women, male-assigned non-binary people or intersex people.
It is our most commonly diagnosed cancer (apart from skin cancers) in New Zealand. Every year more than 4000* are diagnosed with the disease and over 700* die - the second highest cause of cancer death in men behind lung cancer. For all sexes it sits third behind lung and bowel cancers.
Māori men have a slightly lower incidence of prostate cancer but have a higher death rate than other New Zealand men. The reasons for this may be a later diagnosis or treatment choices offered to them.
Overall, the number of men diagnosed in New Zealand is increasing, largely due to increased rates of testing and the death rate is slowly dropping, largely due to better outcomes from early diagnosis and improved treatments available.
Men are more likely to develop prostate cancer as they get older. It is also more common in men who have a father or brother with prostate cancer, and in families who carry certain genes such as the BRCA1 or BRCA2 genes.
Source: The New Zealand Cancer Registry
Prostate cancer is described according to where it is located in the body. Most grow very slowly and about 95% of men survive at least 5 years after diagnosis, particularly if diagnosed with localised prostate cancer, and about 90% will survive 10 years beyond diagnosis.
Localised – prostate cancer that is confined to the prostate gland.
Locally advanced – prostate cancer that extends into the surrounding tissues near the prostate or into the pelvic lymph nodes.
Advanced or metastatic – prostate cancer that has spread to other parts of the body including other organs, lymph nodes (outside the pelvis) and bones.
Benign prostate conditions - Prostate problems are often not the result of prostate cancer. Two common benign conditions with similar symptoms are:
Benign Prostate Hyperplasia (BPH) – enlarged prostate

From about the age of 40, a man’s prostate begins to enlarge and create a condition called Benign Prostate Hyperplasia (BPH). Benign means it is not cancer, and hyperplasia means ‘too much tissue’. The likelihood of developing BPH increases with age and eventually 80% of men have enlarged prostates, but many will never have symptoms.
The enlarged prostate puts pressure on the urethra and causes problems urinating. Medicines or surgery are used to treat BPH but only when symptoms become troublesome. Remember, BPH is not prostate cancer even though most of the symptoms are the same when passing urine.
Prostatitis

Is an infection of the prostate which can cause pain, fever, swelling of the prostate and, blood and pus in the urine. It may have symptoms similar to BPH but is usually treated with antibiotics. Infection of the bladder usually occurs at the same time. See your doctor if blood appears in the urine (Haematuria).
Symptoms of prostate cancer

Getting Tested

Men should be proactive in taking responsibility for their health & wellbeing, and getting tested regularly. More options are available if prostate cancer is detected before it causes symptoms (not common in the early stages). Not all doctors are proactive in promoting prostate cancer testing so men should be willing to take the initiative and request testing if they have any concerns, and wish to be tested.
The New Zealand Prostate Management and Referral Guidelines recommend that men aged 50 and over discuss prostate testing with their doctor (usually GP). For men with a known family history of prostate cancer this discussion should begin at 40 years of age, as they may be at higher risk.
Men over 50 (and those over 40 with known family history) should be tested at least every one to two years using both the PSA and DRE tests, under a programme of testing appropriate to them. The initial test will find a baseline level and subsequent tests can be recorded to note any significant change that may warrant further investigation. Regular testing should continue until mid-70s or later, depending on the risk profile that has been recorded.
Beware of misinformation. There is an old adage that ‘men will more likely die with prostate cancer than from prostate cancer’. While it is true that many cancers, particularly in older men, are slow growing and don’t need treatment or other intervention, prostate cancer remains a significant killer.
There is no easy way of diagnosing prostate cancer. Doctors will usually do a series of tests that may include the following:
The PSA is a simple blood test that looks for raised levels of a protein in the blood called prostate specific antigen (PSA), which is made by prostate cells. A PSA level that is above the limits for your age indicated that there could be a problem with the prostate and further tests might be necessary. This test is used as an initial screening test, usually ordered by a GP, and can be done in conjunction with other routine blood tests. The PSA test is only an indicator of the possibility of prostate cancer and a higher level doesn’t necessarily mean there is prostate cancer.
A high PSA can be caused by other conditions such as Benign Prostatic Hyperplasia (BPH) or enlarged prostate (a common condition that occurs when the prostate grows larger with age); or Prostatitis which is an infection or imflammation of the prostate, where the prostate becomes inflammed and sore.
Other things that can influence the PSA level include:
- Age – the older men are, the higher the PSA level is likely to be
- Size of the prostate – levels will be higher with an enlarged prostate
- Ethnicity
- Medications being taken
- A urinary infection
- Certain types of exercise such as cycling or vigorous exercise
- How recently a man has had sex or ejaculated
- Anal sex or prostate stimulation
The DRE is a test where the doctor inserts a gloved, lubricated finger into the rectum to feel the prostate and check the size, shape and for any abnormalities. Occasionally a cancer can be felt this way, but not always. A normal DRE exam does not rule out prostate cancer.
If there are possible indications of prostate cancer from the initial PSA and DRE tests carried out by the GP, a referral will be made to a urologist (medical specialist in prostate cancer and other urinary conditions) who will conduct further tests to actually diagnose the disease.

Getting Diagnosed

DescriptionGoing through further testing and a diagnosis can be both physically and emotionally challenging. If possible, have someone close to you attend the appointments with you, to help recall the discussions. It can also help to write down questions you would like answered, and to make notes of the information you receive. If all parties agree, you might like to record the discussion on your mobile device.
MRI – Magnetic Resonance Imaging
An MRI scan is ordered to assess the prostate size and look for any abnormal areas. It is used to determine the likelihood that cancer is present in the prostate and which part of the prostate is affected. An MRI is performed as an outpatient procedure, without the need to be admitted to a hospital. Patients lie on a special bed that passes through a narrow tunnel while the scans are being taken. If they experience claustrophobia, they may require sedation for this scan. It is important to tell the doctor about any metallic implants (e.g. screws or plates) in your body or medical devices (e.g. pacemaker or cochlear implant), or if you have had joint surgery.
Multiparametric Magnetic Resonance Imaging (mpMRI)
Is a more accurate and detailed MRI scan that combines the results of at least three different scanning techniques to get a clearer picture of the prostate. Not all DHBs in New Zealand will provide funded MRI scans but they are available for a reasonable cost in private clinics.
Biopsy
A biopsy is a surgical procedure where a needle is used to remove multiple small samples of tissue from the prostate. There are two ways the procedure can be performed:
- Transrectal ultrasound [TRUS] biopsy, which can be done under local anaesthetic in a consulting room or in a hospital.
- Transperineal biopsy – through the perineum, performed in hospital under general anaesthetic.
The biopsy samples will be sent to a pathology laboratory to be examined where the pathologist will determine if there are cancer cells present in the sample. This is how a definitive diagnosis of prostate cancer can be made. If the biopsy does not show any cancer, patients will probably be monitored with regular ongoing check-ups and repeat PSA tests and, if necessary, may need another biopsy or an MRI scan at a later date. A biopsy report that confirms the presence of cancer will provide information about the type of cancer present.
CT (Computerised tomography) Scan
A CT scan uses X-ray beams to create detailed images of the inside of the body. The scan may be done to show where in the body the cancer has spread, based on locating abnormal features such as enlarged lymph nodes or bony outgrowths.
PSMA-PET scan
PSMA stands for prostate specific membrane antigen, a protein found on the surface of prostate cells. A PSMA-PET scan (also known as a ‘gallium’ scan or an ‘F18’ scan) involves injecting a radioactive substance attached to a molecule that can stick to PSMA in the body. This is a very sensitive and accurate way to image and accurately locate prostate cancer wherever it is in the body as cancer cells can show up brighter on the operator’s screen during the scan. It is typically used to see if cancer cells have migrated away from the prostate gland and formed metastases in other sites. Not all DHBs in New Zealand will provide funded PSMA-PET scans but they are available in private clinics.
Bone scan
This involves injecting a weak radioactive substance into the body to see if there are cancer cells damaging the bone. A positive scan may not mean you have prostate cancer – it can also be due to other causes of bone damage such as an old fracture or inflammation. text goes here
Description text goes hereOnce the urologis have the results of the various tests a more accurate diagnosis can be made and the treatment options assessed. There are two main criteria that will be considered:
1. Grade. This assesses the aggressiveness of the cancer cells and how quickly they are expected to grow. A pathologist works out the grade based on the biopsy results. Low grade cancers usually grow slowly and are less likely to spread. Higher grade cancers are more likely to grow quickly and spread to other parts of the body. There are two systems used for grading prostate cancer cells – the Gleason and ISUP grades.
2. Stage. This describes the cancer’s size and whether it has spread beyond the prostate. The stage is based on the digital rectal rectal examination and results of imaging scans such as CT, MRI, bone scan and PSMA-PET scans. The amount the cancer has spread gives an indication of how extensive the cancer is.
  
  Localised cancer (T1 and T2) remain within the prostate gland are potentially curable with surgery and radiation therapy.Localised advanced cancer may include seminal vesicles (T3) and, rectum, bladder, local lymph nodes and pelvic wall (T4). These cancers are potentially curable with surgery and radiation therapy.Metastatic cancer has spread / metastasised to lymph nodes outside of the pelvis or to bones or other organs. These Stage 4 cancers are not curable by surgery or radiation therapy.
Following a prostate cancer diagnosis most people want to know whether their cancer can be successfully treated. The outcome of the treatment will depend on several things such as the type of cancer and whether it has spread, how quickly it grows, and how well the treatment works. If the prostate cancer is localised to the prostate gland, it is sometimes slow growing and may never need treatment. Other localised prostate cancers do require treatment and often is it possible to successfully get rid of the cancer. If the cancer has spread outside of the prostate gland, treatments can often keep it under control for many years.
It can be valuable to get a second opinion about the results and treatment options. This doesn't mean you have less faith in your doctor, but talking it through with another doctor or health professional who understands prostate cancer can help clear up any concerns, and help you understand the best treatment and support options for you.

Treatments

Once diagnosed, you will need to discuss treatment options with your healthcare team, options that depend on a range of factors. These include the grade and stage of cancer, your age, general health and preference for mode of treatment.
Some cancers will not require treatment directly and you may be referred to one of the following non-treatment options:
1. Active Surveillance
  This is a way to monitor low-risk prostate cancer that may not be causing any symptoms. These slow growing cancers may never progress to cause any problems, or they may progress very slowly over years. Active Surveillance is a way to avoid or delay radical treatments that can cause significant side effects, and involves regular PSA tests, digital rectal examinations, biopsies and imaging scans. If the disease appears to be changing – either through an increasing PSA, changes in symptoms, or more suspicious areas showing up on a scan – then a radical treatment that aims to cure the cancer will be offered. This normally involves surgery or radiation therapy.
2. Watchful Waiting
  This is a way of monitoring prostate cancer symptoms and side effects and treating them as they arise. Treatment is for the purpose of symptom relief and slowing the cancer growth, not to cure the cancer. Men may be offered Watchful Waiting if they are older and/or in poor health and the cancer is not likely to progress and cause a problem in their lifetime. It may also be offered if they have other health problems as well as prostate cancer. It involves fewer tests than Active Surveillance. Men may have regular PSA tests and if the level rises or they experience troublesome symptoms, they may also need imaging scans.
Surgery
This procedure is called a Radical Prostatectomy and involves removing the prostate gland and some of the surrounding tissue. The aim is to completely remove the cancer and it can successfully cure the cancer if it has not yet spread outside the prostate gland. A radical prostatectomy can be done in different ways:
- Open radical prostatectomy: A cut is made below the navel to the pubic bone, to get to the prostate gland;
- Laparoscopic radical prostatectomy: Also known as ‘keyhole surgery’. Several small cuts are made to allow a camera and instruments to be inserted. Recovery after the operation is usually faster than for open surgery; or
- Robotic assisted radical prostatectomy: Like laparoscopic surgery but performed with more advanced instruments controlled using a robotic console, which makes the keyhole surgery easier to carry out. In New Zealand robotic surgery is only available in private hospitals.
Radiation Therapy
Radiation Therapy (or radiotherapy) aims to cure cancer by using a controlled amount of targeted radiation to kill cancer cells so they can’t continue to grow or spread. It is typically offered for treatment for locally and locally advanced prostate cancer.
Often there will be a course of hormone therapy prescribed in conjunction with the radiation therapy to reduce the size of the prostate before radiation. Sometimes radiation therapy is used following surgery and may also be used for metastatic disease to control the spread of disease.
There are two main types of radiation therapy:
1. External beam Radiotherapy (EBRT) is an outpatient treatment involving many doses of X-ray radiation delivered 5 days a week over 4-6 weeks. Beams of radiation are delivered by a linear accelerator machine targeting the areas where cancer cells are present. The aim is to kill those cells.
2. Stereotactic Radiotherapy (SBRT) is a similar procedure but a more intense, and targeted radiation treatment delivered in significantly fewer doses over about 2 weeks.
Brachytherapy – is a form of radiation delivered internally with the same aim of killing cancer cells. Radioactive material is inserted directly into the prostate using either of these two procedures:
1. Low Dose Radiation (LDR) – given by implanting permanent radioactive seeds directly into the prostate. The seeds give off concentrated amounts of radiation to the prostate with the aim of killing the cancer cells and curing prostate cancer. They are placed in a surgical procedure that may take a few hours, and may require a stay in hospital overnight. This procedure is only available through private clinics in New Zealand.
2. High Dose Radiation (HDR) – given by inserting radioactive implants directly into the prostate. Unlike LDR seeds, the HDR implants are only placed temporarily and for shorter periods. The procedure takes place in hospital and may require a longer stay than LDR. It is available in a limited number of hospitals in New Zealand.
Hormone or Androgen Deprivation Therapy (ADT)
The aim of ADT is to reduce the body’s production of testosterone which is the main driver of growth of prostate cancer. By reducing testosterone, the cancer cell growth slows, wherever they are in the body. ADT will usually deliver a reduction in the PSA level, indicating it is being effective.
ADT is usually offered to men with advanced or metastasised disease and also before, during and/or after radiation therapy to increase the effectiveness of the radiation treatment and reduce the chance of the cancer spreading. It may be used for a short period of time or for several years. It will not cure the cancer but will slow the growth and keep it under control, often for a number of years.
Prostate cancer may, in time, become resistant to ADT, (known as castrate resistant disease) and its effect will reduce. This is because the body finds alternative ways to produce testosterone that are not controlled by ADT. Other drugs can be introduced at that time.
Hormone therapy can be given in many forms including oral tablets, injections, or as an injectable implant every 1 or 3 months. There are a number of side effects from ADT but these vary among patients. Most men are content to tolerate the side effects knowing the benefits of the treatment in treating their cancer.
Goserelin-Teva. From December 2020, the Pharmac-funded brand of Goserelin changed from Zoladex to Goserelin-Teva and it has come to our attention that some have had negative experiences with the administration of the implants. We are monitoring the situation and if this your experience we encourage you to complete a consumer report to the Centre for Adverse Reactions Monitoring (CARM). You can do this online at https://nzphvc.otago.ac.nz/consumer-reporting/ or visit https://nzphvc.otago.ac.nz/patients-public/#how-to-report for other reporting options. It can be helpful to also include photos in your report.
Chemotherapy
Chemotherapy is used to treat advanced and metastatic prostate cancer. It uses anticancer medication to destroy cancer cells. It cannot eradicate prostate cancer, but it can shrink it and slow its growth. Men may be offered chemotherapy if they have been diagnosed with advanced prostate cancer or if the hormone therapy they were on is no longer working to control the cancer.
Chemotherapy can relieve some of the symptoms of advanced disease and, depending on the cancer, it may help men live longer. A medical oncologist is the specialist who treats men with chemotherapy, and some of the other advanced therapies, assessing what is best depending on the needs and situation of the patient.
Targeted Therapy
These therapies use radioisotopes to treat advanced/metastatic prostate cancer that has spread to other parts of the body. It involves injecting radioactive molecules into the bloodstream. The molecules move through the blood to find prostate cancer cells and kill them. Examples of radioisotopes used in therapy include Radium 223 and Lutetium 177 (Lutetium-PSMA therapy). These may be available through some private clinics in New Zealand.
Palliative Care
Unfortunately not all prostate cancer can be cured and therefore treatment is needed to manage symptoms and relieve pain in advanced disease. Palliative care is not just ‘end of life’ care – it aims to improve or maintain quality of life while living with the effects of advanced disease. Treatments may include radiation therapy to control disease spread to the bones as well as other medications and treatment to control pain.
Medical researchers and scientists continue to look for new and effective ways to treat prostate cancer. Once they have a possible treatment, they will conduct clinical trials to ascertain their effectiveness. Some clinical trials run in New Zealand and men interested should discuss the options available with their medical specialists. Some new treatments in development include:
Focal Therapy – Focal Therapy refers to a number of different approaches which aim to destroy localised areas of cancer within the prostate, using minimally invasive techniques to reduce side effects, leaving the rest of the prostate gland intact (although it can also be used to treat the whole gland). Focal Therapy techniques being investigated around the world include focal brachytherapy, HIFU (high intensity focused ultrasound), NanoKnife (irreversible electroporation), cryotherapy and interstitial laser ablation. Focal Therapy is not widely available in NZ and is only offered in private practice.
Immunotherapy – Sometimes called biological therapy, this is a cancer treatment that works by boosting a person’s own immune system to fight cancer. Though it is promising in other types of cancer, immunotherapy has not yet been found to be effective in prostate cancer and is currently only available through clinical trials.
PARP inhibitors: These medications work by killing cells with damaged DNA, preventing cancer growth. Clinical trials have shown promising results to date. However, routine use of PARP inhibitors is not available in New Zealand at this time.
Treatment sequencing: some trials are investigating using the range of treatments in different sequences to the usual treatment programmes.

Side Effects

There can often be unwanted and unexpected side effects that result from the various treatments for prostate cancer. These are not from the cancer itself, but from the surgery, radiation or hormone (ADT) therapy or chemotherapy that are typically used to treat the disease. All treatments will have some side effects, some short term, and some are long term.
Short-term side effects tend to be common and reversible or diminishing. Long-term side effects are less common and are not always fully reversible. Those side effects vary from person to person and as well as physical, they can also effect men psychologically and emotionally. Men about to undergo treatment should seek out information on what the potential side effects might be from their upcoming treatment.
ACC and prostate cancer
Although prostate cancer is not in of itself an ‘injury’ which ACC covers, complications as a result of treatment for prostate cancer may be covered by ACC. Read more about ACC and how it can impact on the treatment journey for prostate cancer patients here prostate.org.nz/acc-prostate-cancer
Goserelin-Teva
From December 2020, the Pharmac-funded brand of Goserelin changed from Zoladex to Goserelin-Teva and it has come to our attention that some have had negative experiences with the administration of the implants. We are monitoring the situation and if this your experience we encourage you to complete a consumer report to the Centre for Adverse Reactions Monitoring (CARM). You can do this online at https://nzphvc.otago.ac.nz/consumer-reporting/ or visit https://nzphvc.otago.ac.nz/patients-public/#how-to-report for other reporting options.
Urinary Problems
Surgery can affect the ability to control the bladder. It can lead to incontinence (inability to control urination) or leaking urine when coughing or with a sudden movement. Radiation treatment can lead to other problems with urination.
Sometimes men who have had surgery or radiation therapy can experience a slowing of their urine stream and a feeling they are not able to completely empty their bladder. In rare cases, men who have had radiation therapy may also experience blood in the urine. Sometimes it can be due to the prostate cancer treatment, but it can also be a sign of other health issues that should be investigated.
Pelvic floor exercises before and after treatment can reduce the risk of incontinence. A specialist continence nurse or pelvic floor physiotherapist can help men manage incontinence. If severe incontinence continues long term other surgical treatments such as a “sling” or artificial urinary sphincter can be inserted to assist with bladder control. In some cases the cost of this can be covered by ACC.
It is important to report any changes or concerns about your urinary symptoms to your healthcare team. You may also find it helpful to visit Continence NZ and watch the following video Continence and Prostate.
Bowel Problems
Bowel problems may result from radiation therapy treatment both during the treatment and also longer term following treatment. Often this occurs as a change in normal bowel function including diarrhoea, bloating and more flatulence (gas). It may also result in bowel incontinence and a lack of control over bowel function. Occasionally there may be bleeding from the rectum.
Any changes or concerns should be discussed with the treating clinicians as, while they are typical side effects from prostate cancer treatment, they can also be associated with other conditions that should be checked out, usually with a colonoscopy. Sometimes simply making lifestyle and dietary changes may provide relief to these side effects.
Erectile Dysfunction
Erection problems are a very common side effect from prostate cancer treatments. This is mainly due to damage to the nerves surrounding the prostate during the treatment. It can also be caused by loss of libido (sex drive) due to anxiety around the treatments men are going through. Following surgery, there is usually a period of time before erections will recover – this may be a few weeks for some men while for others it is a long term problem. Following radiation therapy, erection problems typically become apparent after some time has lapsed following the treatment. Hormone treatment also effects erectile function and loss of libido due to the reduction in testosterone.There are many medical treatment options to improve erections, including oral medication, injections into the penis, a vacuum device to draw blood into the penis, or a permanent penile implant that uses an implanted device pump to create an erection on demand. One of the leading providers of implant solutions for erectile dysfunction, Boston Scientific, has created an online resource ‘Hard Facts’ which includes general information on this condition, medication approaches and surgical solutions. Hard Facts can be accessed here.
Ejaculation Changes
Prostate cancer surgery removes the seminal vesicles along with the prostate. This means that men will not produce or ejaculate semen at orgasm but will still feel the sensations of orgasm. Radiation therapy can also affect ejaculation. Some men don’t ejaculate at all after radiation therapy, while some experience minimal or no change. Surgery can cause some men to leak urine during sex, called climacturia. Try to empty your bladder first or use a condom if this is a worry for you or your partner.
Fertility
There is a risk to fertility in most prostate cancer treatments so men with concerns should discuss this with their clinicians. There are options available, such as sperm banking available prior to treatment.

Questions to ask

A prostate cancer diagnosis can leave you anxious and confused, likely with more questions than answers. Being prepared with questions and thoughts can help guide conversations with your specialist or doctor, help you make informed decisions about what to do next and choose the best treatment pathway for you. There is no single best approach, your diagnosis, circumstances and other factors all need to be considered. We’ve listed some of the most commonly asked questions below, which you will find in more detail in the Questions To Ask Your Specialist booklet which you can download and print. If you would like to talk things through with our Information Service Specialist please call 0800 66 0800 or email infoservice@prostate.org.nz

Question booklet

Living Well

Most people diagnosed with prostate cancer will live a good life beyond diagnosis and treatment. About 95% of them will survive at least 5 years and 91% 10 years. Survivorship is about making the most of life and dealing with the side effects and ongoing issues that may have been caused by an encounter with this disease. It is very important to let your doctor know if there are any changes to your health, or symptoms, or concerns about your wellbeing following treatment.
Follow-Up Appointments

Following diagnosis and treatment it is inevitable there will be ongoing medical appointments to monitor the condition of the disease. This will likely involve regular PSA tests and possibly further scans and examinations. Men receiving hormone treatment will have a regular (monthly or 3-monthly) appointment for their next treatment. It is normal to feel anxious about upcoming appointments. However if there are no ongoing problems these will usually reduce over time. It may be helpful to keep a notebook of the ongoing appointments, recording details such as PSA levels and any changes to the symptoms.

Learn more

MEN’S HEALTH WEEK NEW ZEALAND TE WIKI HAUORA TÃNE

The men’shealthweek website has some amazing resources for men from all walks of life.

Men’s Health Week is part of a global health awareness campaign marked in the US, Europe and Australasia. The week focuses on the health issues all men face, and raises awareness of steps men can take to help address these.

The New Zealand campaign for Men’s Health Week is run by directors Tim Greene and Mark Sainsbury, both of whom are passionate about helping men get more on top of their health.

Tim is an experienced communicator in the fields of health, education and sports, and Mark is one of the country’s most experienced journalists and presenters, acting as both a director and ambassador for Men’s Health Week.

Men’s Health Week was awarded the 2020 Men’s Health Advocacy Award by the Urological Society of Australia and New Zealand in recognition of the campaign’s continued commitment to lifting the profile and awareness of health issues which particularly impact on men.

Tim Greene tim@menshealthweek.co.nz Mark Sainsbury mark@menshealthweek.co.nz

What’s Your Score? is an adaptation of Foundation 49’s One Minute Men’s Health Check, based on research from Melbourne’s Baker Heart and Diabetes Institute.

This survey is not a diagnosis. It is recommended that all men visit a GP on an annual basis.

GET THE .pdf FORM HERE

Quote from Scotty Morrison - AA website. Link here

The Man WoF with Scotty Morrison

25 April 2023

“We believe it’s time for Kiwi blokes to have a bit of a tune-up of the body and mind variety. Following on from our successes of last year’s Men’s Health Week (MHW) support, we have again teamed up with broadcaster, Te reo Māori mentor and ambassador Scotty Morrison to deliver the ‘Man WoF’.

This year we are spreading the word even further, by translating the 'Man WoF' into three of New Zealand’s most spoken languages - Te reo Māori, Samoan and Mandarin (简体中文).”

What is it?
Diabetes is an enduring disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy.
Diabetes is New Zealand’s fastest-growing health crisis, affecting more than a quarter of a million people.

Risk factors for diabetes
Some risk factors you can’t do anything about, like age, ethnicity, gender, or family history. However, you can change your weight, amount of physical activity you do, what you eat and if you smoke.

What can I do?
Firstly, taking your men’s health check and visiting a health professional is a great way to assess your risk of diabetes.
You can also reduce weight, be active for 30 mins or more most days of the week, eat healthy food, achieve and maintain good control of your blood pressure and blood cholesterol, Get an annual heart and diabetes check from a health professional.
Further information
What is it?
Coronary artery disease (CAD) is the most common type of heart disease and happens when the arteries that supply blood to your heart muscle (the coronary arteries) become hardened and narrowed. A gradual blockage can result in angina. A sudden or severe blockage can cause a heart attack or cardiac arrest.
Most heart attacks happen when a blood clot suddenly cuts off the heart’s blood supply, causing permanent heart damage. Over time, CAD can also weaken the heart muscle and contribute to heart failure (blood pumping problems) and arrhythmias (changes to normal heart beat action).

Risk factors for coronary artery disease
There are several factors that are known to increase your risk of CAD. Some risk factors you can’t do anything about, like age, ethnicity, gender, personal or family history of heart attack or stroke.
Other risk factors you can change and making these changes can have a huge impact on your heart health and general wellbeing. Your risk of developing CAD is significantly increased if you smoke, have high blood pressure (hypertension), have a high blood cholesterol level, don’t exercise regularly, have diabetes or are overweight.

What can I do?
A heart and diabetes check works out your risk of having a heart attack or stroke in the next 5 years. It also tells you if you have diabetes or pre-diabetes (where your blood sugar levels are higher than normal but not high enough to be called diabetes).
The check will let you know what your risk is and give you the chance to talk to your doctor or nurse about ways to improve your health and lead a healthier life.
More information about heart and diabetes checks and heart disease is available through the Heart Foundation website
What is it?
Blood gets pumped around the body when our hearts fill and contract, putting pressure on the arteries. This pressure is highest when leaving the heart and lowest when it returns. Measuring and describing these (high/low numbers) gives your blood pressure. Ideally you are 120/80 (‘120 over 80’) or lower.
Hypertension occurs when there is too much pressure in your blood vessels. This can damage your blood vessels and cause health problems. Think too much air in your tyres.

Risk factors
Anyone can develop high blood pressure, but it becomes more common as you get older. High blood pressure can lead to strokes, heart attacks, heart and kidney failure. It’s a silent killer because we only know it when we measure it.

What can I do?
Get checked regularly as high blood pressure has no warning signs or symptoms.
Also do the sensible stuff: moderate physical activity, eat lots of fruits and vegetables, maintain a healthy weight, cut down on salt and booze, avoid processed meat, and don’t smoke.
The single most important thing that a person with high blood pressure can do is to have an ongoing relationship with a primary care provider. Go to your doctor, establish what your blood pressure is, and then when that changes, your doctor will recommend the next best steps.
Further information

What is it?
Preventative Health is all about the things we can do now to help minimise developing a preventable illness. The stats are sobering, 8 Kiwi families every day lose a loved partner, father or tupuna to a PREVENTABLE illness, one they didn’t need to die from.*

What can I do?
- Visit a GP and know your family history
- Measure your blood
- Get regular exercise
- Healthy eating
- Healthy thinking
- Stop smoking
Worried about how long it has been since you last visited a doctor? Don’t be. Now is the time.
Remember this:
- You won’t get a lecture. Your doctor is not your mum, but is actually your partner in the business of keeping you healthy. You both have a role here.
- It’s important you choose – and yes, you can choose – a doctor that you are comfortable with, that you trust and can be fully honest to. Everything you reveal or discuss is confidential.
- Going to the doctor costs about the same as getting a WoF on your car, and way less than say a new tyre. Don’t let the fee cost your life
There is a growing understanding that although mental health issues can be triggered by stresses in daily life, they are clinical diseases that often require outside help and medical treatment.
They can affect how a man feels, thinks, behaves and interacts with other people, and it is important that men feel they are able to talk about how they are feeling with their family and also their GP.
The most common mental illnesses are anxiety and depressive disorders.
Depression
1 in 8 New Zealand men will experience serious depression during their lifetime. Depression is more than a low mood. It is a serious illness that can need clinical treatment. Those with depression find it hard to function and it can have a serious effect on a person’s physical and mental health.
Factors which can contribute to depression in men:
- Physical health problems
- Relationship problems
- Family problems
- Employment problems
- Drug and alcohol consumption
- Social isolation
- Significant change in living arrangements (e.g. separation or divorce)
There are many things you can do that can help protect you from getting depressed. These include:
- Staying fit and healthy
- Reducing alcohol use
- Getting enough sleep
- Having balance in your life – identifying and managing stress
- Spending time with people you like and trust and doing things you usually enjoy
- Developing skills like problem-solving and communication
Visit www.thelowdown.co.nz if you’re under 20 or www.depression.org.nz for more information
Anxiety
Often people with depression also find they worry about things more than usual. This is known as anxiety. An anxiety disorder is more than just feeling stressed – it’s a serious condition that makes it hard for the person to cope from day-to-day.
It can cause physical symptoms like pain, a pounding heart or stomach cramps and for some people these physical symptoms are their main concern.
Anxiety may be constant, or it may come and go in certain circumstances. Either way it’s important to recognise anxiety when it occurs, and to seek help.
Suicide
In New Zealand the suicide rate for men is 3 times that of women.
Suicide and suicidal tendencies are still some of hardest issues to talk about socially. It can be easier to approach the subject by having a concrete idea of where men are most vulnerable and what triggers can often lead towards an attempt on one’s life.
Those aged between 15-24 have the highest rate of suicide, and Maori suicide rates are significantly higher than non-Maori suicide rates.
Some of the most common triggers for suicide are the breakup of a relationship, debilitating physical illness or accident, death of someone close, a suicide of someone famous or from a peer group, or bullying or discrimination.
For more information or to talk to someone about any difficulties that you or someone close to you might be having in their life, please contact LIFELINE on 0800 543 354 or lifeline.org.nz

What is it?
Melanoma is a cancer of the pigment cells (melanocytes) in the skin, which if not treated can spread very quickly through the body.
Risk factors for melanoma
The most common areas for melanoma are those exposed to the sun, but melanoma can develop in any skin type cells in the body, even areas not exposed to the sun.
Melanomas usually appear as a changed mole or freckle, so if any mole or freckle changes, get it checked out.
What can I do?
One simple way to remember the signs and symptoms of melanoma is the mnemonic ABCDE:
Asymmetrical – the mole, freckle or lesion is not round.
Border – the border is irregular or not well defined.
Colour – melanomas usually have multiple colours or are dark (or have no colour at all).
Diameter – moles greater than 5 mm are more likely to be melanomas than smaller moles.
Evolution – any change should be looked at.

Check your skin regularly, and if you note anything unusual, you must do something about it.
Use this tool to help SCAN your skin.
How to Check Your Skin – Scan Your Skin
Visit your doctor to discuss any concerning spots you may have.
What is it?
Prostate cancer develops when cells in the prostate gland grow abnormally, and can spread either locally or around the body. Around 1 in 10 New Zealand men will develop prostate cancer at some stage in their lifetime.

Risk factors for prostate cancer
The risk factors for prostate cancer are:
- age: the risk of prostate cancer increases from age 50
- a close family member, like a father or brother, had prostate cancer
- Lynch syndrome (a rare genetic disorder)
- Being overweight or obese increases the risk of advanced prostate cancer.
What can I do?
Get tested. There are a range of tests your doctor can arrange which can determine if you have or may be developing prostate cancer. These include the PSA test, physical examination and ultrasound testing. All are painless, simple and easy to get underway.
Further information
www.prostate.org.nz www.kupe.net.nz
What is it?
Testicular cancer is the most common cancer affecting men between the ages of 15 to 39. If it is diagnosed early, it has the highest rate of cure of all cancers.

Risk factors for testicular cancer
About 150 young men are diagnosed with testicular cancer every year in New Zealand. Maori men have a higher incidence of testicular cancer and are more likely to have metastatic disease.

What can I do?
Check your balls. Know your own body and if you notice any lumps or changes see your doctor.
More information
checkyourballs.org.nz