Knowing Your Prostate: Modern Answers and Life-Saving Screening

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Welcome to Why Is It So, your last defence for common sense,

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with your co-hosts Paul Zammett and Vince Locizzano.

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Welcome to Why Is It So. I'm Paul, your host, and today I'm excited to be introducing

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a special guest to inform us all about men's health, specifically prostate.

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Professor Nathan Lawrenshuck is more than qualified to give us facts.

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He is a trained urologist specialising in urological cancer surgery.

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He is a clinical research professor in the University of Melbourne Department of Surgery.

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He is a director of Royal Melbourne Hospital Urology Department and a director of E.J.

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Whitton Prostate Cancer Research Centre at Epworth Healthcare in Melbourne,

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and he's trained in robotic surgery, branchy therapy and focal therapy.

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He also completed a PhD in kidney cancer and a two-year Society of Urological

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Oncological Fellowship and trained in robotics and open cancer surgery at the

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University of Toronto in Canada.

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In addition to his public positions at the Royal Melbourne Hospital and Peter

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McCallum Centre, He has a private practice in North Melbourne and at Epworth

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Freemasons in East Melbourne.

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I don't know how he does it all because on top of that he is a philanthropist

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and he has raised hundreds of

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thousands of dollars for the above research centres and other facilities.

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So I'd like to introduce you now to our special guest, Professor Nathan Lawrence-Shuck.

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Good morning, Nathan, and thank you for your time. Good morning, Paul.

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It's a real pleasure to be here talking about men's health, which is a passion

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of mine, every aspect, whether it's mental health, physical health,

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or what we're going to focus on today, which is prostate health.

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Well, where is the prostate and how does it work?

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Well, that's a really good question, Paul, one that most men are puzzled by when I go to give talks.

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So the prostate is a small organ about the size of a walnut or a horse chestnut or a small mandarin.

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It is nestled carefully between the bladder and the pelvic floor just in front of the rectum.

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So it sort of lives in the lower part of the pelvis.

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It can be thought of as a small, as I said, a small mandarin.

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If we think of it in two parts, it has the flex in the middle with a sclaw going

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through, which is the urethra, the tube that carries urine from the bladder

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to the outside world, and the skin of the fruit, which is the outside,

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which we'll come back to a little bit later on.

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But that's really where it is and where it lives. What does it do and how does it work?

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So how does the prostate work? So the prostate is an interesting organ because

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it serves two purposes, Paul.

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It's a gland that processes hormones or an endocrine gland.

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And in that respect, it converts testosterone to dihydrotestosterone or supertestosterone.

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It's also a gland that excretes fluid, so an exocrine gland,

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and the fluid it excretes is called prosthetic fluid.

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And that fluid is extremely important because that provides food for sperm,

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which allows the sperm to find their way to the eggs inside a female.

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The interesting aspect of that is that within the prosthetic fluid,

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there is a specific enzyme called PSA or prostate-specific antigen.

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Now, that enzyme has an important job. it cleaves the ejaculate or the semen

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so that the sperm can get out.

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So it's a perfectly natural enzyme occurring in the prosthetic fluid.

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Now, what's interesting about that enzyme is that it leaches a little bit into the blood.

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And depending on the size of the prostate and what's going on,

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we can measure how much of that PSA is in the blood.

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And about 45 years ago, scientists discovered that there was a correlation between

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the amount of PSA in the blood and men who had prostate cancer.

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Hence, the concept of PSA or prostate-specific antigen being used as a tumor

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marker was stumbled upon.

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And tumor markers are interesting. So anything in the body can be used as a

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tumor marker, different fluids, predominantly blood.

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Tumor markers are important because they can be utilized to detect cancer.

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They can also be utilized to follow treatment to see if it's been successful

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or not, and also to find if a tumor's recurred.

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And to this date, there is no better tumor marker in the world than prostate-specific

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antigen PSA. Nothing beats it.

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Now, there is controversy around it, of course, but you know and that comes

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about because of its role in screening for prostate cancer.

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I think otherwise before it used to be with the finger as you say now we do with blood.

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Yeah so that's a really really good question there Paul.

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So in the past screening for prostate cancer consisted of a digital rectal exam

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or a finger in the backside which a lot of men weren't particularly happy about

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having done, and also the blood test for PSA.

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Now, many years ago, quite a few years ago now, we no longer need to do the finger test.

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So it's basically just a blood test now. So it's something that men need not fear.

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So you might be wondering, why don't men know where the prostate is?

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And I'll argue this comes back to teaching of sex education.

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And when I had my, I've got three young boys, I would go diligently to these

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sex education classes, and guess what?

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You would find that, of course, female anatomy was taught in exhaustive detail,

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and the male was just brought back to the testicles and penis.

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No mention of the prostate, where it was, what it does, and its importance.

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And I think that's why a lot of men don't know where the prostate is,

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because guess what? We don't teach them from a young age.

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And I published on this in the Australian New Zealand Journal of Surgery,

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lamenting the fact that I've written

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to the organizers of these teaching sessions, and they won't budge.

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So it's not surprising that men don't know where the prostate is.

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In terms of PSA screening, the reason why it became controversial and perhaps,

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you know, we could think about it, there's a national bowel screening program,

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there's a national breast screening program.

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Why isn't there a national prostate cancer screening program?

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Well, that largely relates to historic belief.

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And even I was taught at medical school that men die with prostate cancer and not from it.

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And that does speak to the fact

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that a lot of prostate cancers that were diagnosed were very indolent.

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They were low grade, low risk, unlikely to kill a man. And that remains true.

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However, over the last 20 to 30 years, we've actually been able to conduct some

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trials and they take a long time because the history of prostate cancer is one

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that have a fairly slow going tumor.

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So it does take decades to get answers to these questions. There were two trials,

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it was the European trial and North American trial.

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The North American one was a little bit funny because it was contaminated that

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some of the men in the screening arm versus the non-screening arm were doing the wrong thing.

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But if you look at the European trial, that is really important because that

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has really discovered that we probably only need to screen one in 10 men to

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find a significant prostate cancer and have an impact.

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And that's new data. So that's one aspect to it.

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Also in the last 20 years, we're now doing active surveillance or monitoring

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a lot of men with low-risk prostate cancer and even intermediate risk cancer for that matter.

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And the beauty of that is that men therefore can be monitored and watched and

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we only act when we need to.

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In other words, we only do radical treatments such as surgery or radiation when we really have to.

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So if you take the fact that we know that screening can be helpful,

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if we take the fact that we know that we can watch a lot of men, then we reduce harm.

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So screening programs need to provide benefit, but they also need to not provide harm.

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In other words, the screening program takes normal people without symptoms and

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then suddenly says, guess what? You have a disease.

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So we have to be very careful that the treatment of those men is appropriate

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and also that the treatments minimise, you know, the impacts of all of the,

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not just curing the cancer, but the side effects of those treatments.

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With the testing that we are talking about, there really isn't any way of finding

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it, as you were saying before, that didn't have any symptoms.

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Yeah. So look, a lot of people ask me that.

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I'm a urologist. I see a lot of men with symptoms and they say,

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oh, I'm really worried I've got prostate cancer. I know 90% of the time they won't.

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And to get back to our mandarin allergy, if we think about the straw going through

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the mandarin, you've got the fleshy fruit and then the external skin.

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So benign disease of the prostate or BPH, benign prostatic hyperplasia,

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which squeezes that straw, that's a benign disease, but that's very common.

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That'll occur in 80% of men by the time they hit 80.

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That causes obstructive symptoms, so poor strain, dribbling,

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so on, but it also causes urgency and frequency of urination and getting up

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at night. Now, they're all symptoms that are from benign disease.

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Prostate cancer occurs on the skin of the mandarin, if you like,

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and it has to get very big before it can grow in and push on that straw in the middle, if you like.

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So, in fact, the vast majority of men did not have symptoms at all.

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And that's why for screening, to do a blood test in men who are healthy and

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normal is logical, because we want to find cancers before they're that big that

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they've caused symptoms.

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Prostate cancer. Okay, so prostate cancer currently affects about one in six men in Australia.

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If you have one first-degree relative, like a father or a brother, it goes to one in three.

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If you have two first-degree relatives, then it goes to one in two.

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So that's knowing your risk. And it predominantly occurs in men over the age

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of 50, but much more commonly in men over the age of 65.

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It still kills men, and there are a lot of men living with metastatic prostate cancer.

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So the concept of us of screening is to find men, not just with low-risk cancer

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that we don't even want to find, but finding men with high-risk cancer that

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is going to spread and potentially is life-threatening.

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Ways of treating prostates have changed a lot in the last 20 or 30 years,

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and with a lot of new equipment appearing, is that not so?

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So, I guess when I started urology, you know, over 20 years ago,

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it was a pretty simple paradigm, Paul.

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It was PSA test, rectal exam, you have cancer, you need it out with surgery

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or radiation, and back then it was open surgery only.

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And a lot of men probably had their prostates treated

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that didn't really need to but we it took a long time for

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us to work out that some men can be watched now i was

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lucky enough to work with a guy called professor laurie klotz in toronto that's

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where i did my fellowship in in oncology and cancer and he pioneered this concept

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of watching men with prostate cancer and seeing what happens and a lot of the

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men do very well over time and they're the ones with with low risk and a small

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number of men at intermediate risk of cancer.

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Now, the beauty of that is you have no side effects pretty much from being watched.

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So this concept of active surveillance has really slipped into Australia from

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about 2005 onwards, and we've embraced it. So that means we're minimizing harm.

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We're not acting on all men who have prostate cancer. We're picking out the nasty ones.

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The second aspect is Australia's pioneered the use of MRI for screening for

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prostate cancer. So once you have an elevated PSA or a nodule is found,

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sometimes still predominantly by urologists, we'll send you for an MRI.

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If the MRI is squeaky clean, we're usually pretty confident that you don't have a significant cancer.

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And that means those men avoid a biopsy and hence they avoid finding these low-risk

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cancers we don't want to find.

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The third aspect has been the pioneering work in PSMA PET scanning.

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Now, we've been very lucky. I work with colleagues like Professor Michael Hoffman

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through various avenues.

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We now have a real handle on PET scanning to be used for both staging of prostate

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cancer and finding cancers within the prostate itself and whether they're significant.

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Now, how do we do that? So, we talked about PSA before, but PSMA stands for

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Prostate-Specific Membrane Antigen. Now, this is a special protein made by cancers

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and overexpressed by cancers.

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So if you can hook a little bit of radiation to a molecule, a bit like a lock

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in a key, it'll go and hone in on the cancer cells.

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They light up. We can see those on the television screen, if you like,

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and say, good, that's a spot there that looks like it's spread,

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or that's a spot within the prostate that could be nasty.

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So PERSOMA PET scanning has been pioneered in Australia. we've published on

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it and we've established it now as the best use tool, if you like,

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for staging prostate cancer. But we've taken it a step further.

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So let's say I've got a man in front of me and I want to know,

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oh, well, you've got a bit of cancer there. Can I watch you?

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We're now doing a trial called a confirmed trial through Epworth Hospital where

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I run the research center where we're confirming with PSMA PET scans if men

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have significant cancer.

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In other words, if the scan's all clear, we're much more confident to watch

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them or put them on active surveillance.

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If there's a big red blob there lighting up saying, hey, there's a bad cancer,

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maybe they're the ones who need treatment.

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So we can delineate a lot better, Paul, who needs to be treated and who can be watched.

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The other developments, we've got MRI, which is now freely available to men

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in Australia who've got an elevated PSA.

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We repeat the PSA to make sure it's not a one-off, but they get the MRI.

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Once diagnosed with prostate cancer, we have access to a PSMA PET scan.

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And then thirdly, if you do get cancer, we're not going to treat a lot of it.

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The final aspect of that is when we do offer treatment, we've now got a thing called focal therapy.

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Now, you might say, what's focal therapy? Well, remember breast cancer as an

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example years ago, when you had breast cancer, they took off the whole breast and a mastectomy.

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Now, they discovered that you didn't need to do that and it's disfiguring.

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So, why don't we just take the lump out and that's called a lumpectomy.

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Now, what if you could do a lumpectomy on the prostate? Now,

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it's not easy to take a lump just out of the prostate because where it lives,

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but you can actually treat that little lump, if you like, with different treatments.

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And we have what's called IRE or irreversible electroeporation,

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otherwise known as nanonife, available in Australia.

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So we just go in and zap that part of the prostate that has cancer.

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And not every man will be suitable for that, but the ones who are,

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it's exciting because we can just treat that area, preserve sexual function,

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preserve continence and so on and so forth.

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Now, David Cameron, the ex-UK prime minister came out this week.

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He was diagnosed with prostate cancer at age 59 because his wife convinced him

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to have a PSA test and he's had focal therapy with the nanonife, we believe.

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So, you know, and that's a well published in the media. So I think it's exciting

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that these treatments are now readily available.

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We've been doing nanonife at Epworth since 2018 and we've, you know,

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treated, you know, well over 200 men and it is selective, but we're getting

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much better at finding who the right man is for that focal therapy.

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So that's a really exciting development, just treating that part of the prostate.

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And so on. Now, what if you really do, you have bad cancer that can't have focal

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therapy and the cancer's localized, we've done our fancy PET scan, it hasn't spread.

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Well, then you have either robotic surgery or radiation and radiation can be

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given in seats or by external beam.

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Now, when I started surgery over 20 years ago in the urology field,

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we had one operation, it was open surgery, patients were in hospital for days.

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Now we can do it with robotics, It's magnified stereoscopic vision.

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We've got all sorts of tricks and tools. It's keyhole surgery.

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And in fact, we've even shown through a study at the Royal Mall when you can

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do these patients as day cases. Really? Yeah, absolutely.

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So it's incredible. And our understanding of the anatomy has improved such that

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erectile dysfunction rates are much, much, much small than they were.

00:15:42.208 --> 00:15:46.608
Continence is excellent in the vast majority of men. So we've really made improvements

00:15:46.608 --> 00:15:48.748
when we do need to do radical treatment.

00:15:49.228 --> 00:15:51.808
And in the same breath, radiation has improved significantly.

00:15:51.808 --> 00:15:53.388
The machines are better, they're more accurate.

00:15:53.468 --> 00:15:57.848
We can put spacing devices between the prostate and the rectum to stop damage to the rectum.

00:15:57.948 --> 00:16:03.208
We can put little beacons, gold seeds into the prostate so that the machine knows where to fire.

00:16:03.428 --> 00:16:08.568
So look, everything has really improved in the last 20 odd years such that this

00:16:08.568 --> 00:16:12.608
concept of screening now becomes viable because guess what?

00:16:12.988 --> 00:16:16.468
Not only are we avoiding treating the patients we don't need to treat,

00:16:16.628 --> 00:16:19.808
we're also avoiding finding the patients we don't need to find.

00:16:19.928 --> 00:16:24.088
And finally, if you do need treatment, we have better treatment with fewer side effects. Yeah.

00:16:24.368 --> 00:16:27.548
With screening, you remember all that sort of stuff.

00:16:28.388 --> 00:16:32.088
You've usually just mentioned that I have screening for bowels.

00:16:32.128 --> 00:16:33.928
I have screening for breasts.

00:16:34.582 --> 00:16:37.662
The government obviously hasn't got enough money to give us,

00:16:37.982 --> 00:16:39.942
so you've got to raise your own.

00:16:40.242 --> 00:16:44.542
But one of the ways you can do it is to advertise, if you like,

00:16:45.022 --> 00:16:50.142
to maybe the doctors or the GPs and get everyone that goes through there,

00:16:50.142 --> 00:16:55.562
the GP offers them the opportunity to be scared with the SBA, is it?

00:16:55.722 --> 00:16:58.542
Piers, sorry. Piers, sorry. The prostate-specific, that's it. Yeah.

00:16:58.742 --> 00:17:03.002
So, look, what you're saying is really true. So, we don't have a national screening program.

00:17:03.422 --> 00:17:07.042
We'd like to, but probably we would initially target men at higher risk.

00:17:07.162 --> 00:17:10.162
So those with family members who've had prostate cancer, those from certain

00:17:10.162 --> 00:17:14.002
genetic backgrounds like African background have a higher risk and so on.

00:17:14.182 --> 00:17:17.702
But to wind that back a little bit, we say, well, what's the current process?

00:17:17.962 --> 00:17:21.462
So there were guidelines written almost a decade ago, which are being rewritten

00:17:21.462 --> 00:17:24.462
this year, Paul. So look out for them. These are really important guidelines.

00:17:24.662 --> 00:17:28.722
They've been overseen by the NHMRC or the National Health and Medical Research

00:17:28.722 --> 00:17:31.822
Council. They've been written by the Urological Society of Australia and New

00:17:31.822 --> 00:17:35.062
Zealand, the Prostate Cancer Foundation, the College of General Practitioners,

00:17:35.362 --> 00:17:38.682
the College of Pathologists, you know, members of the public and so on.

00:17:38.722 --> 00:17:41.422
A lot of people have had a say in the writing of these guidelines,

00:17:41.602 --> 00:17:44.302
which will come out probably in early 2026.

00:17:45.122 --> 00:17:49.362
They're exciting because they give direction. And what they say is to every

00:17:49.362 --> 00:17:53.742
man who's 50 or over, have a conversation with your GP and the GP,

00:17:53.742 --> 00:17:57.622
he or she will tell you the benefits and risks because they know about them.

00:17:57.922 --> 00:18:00.622
And you can decide whether you have that blood test done. You don't need to

00:18:00.622 --> 00:18:01.822
have the finger anymore, just

00:18:01.822 --> 00:18:04.522
a simple conversation, add it on to your cholesterol and other things.

00:18:05.002 --> 00:18:08.682
So that's the current state of play. And if you have a PSA done,

00:18:08.902 --> 00:18:11.422
the federal government will fund a PSA test every two years.

00:18:11.622 --> 00:18:15.362
Now, if you're at a higher risk group, you should start at age 40, okay?

00:18:15.482 --> 00:18:19.762
Because we want to pick it up before it has, you know, become evident.

00:18:20.062 --> 00:18:23.602
So there are two groups. So average man, start at 50.

00:18:23.902 --> 00:18:27.382
Someone with a first degree relative or other risk factors such as genetics

00:18:27.382 --> 00:18:29.142
and so on, you should start at 40.

00:18:29.739 --> 00:18:33.019
Now, that is just a conversation between the patient and GP.

00:18:33.239 --> 00:18:35.799
Very easy to have. And if you don't want to have the test done,

00:18:35.899 --> 00:18:38.839
don't. But if you are going to have the test done, just know that it's not a

00:18:38.839 --> 00:18:41.019
pathway like the old days to having your prostate out.

00:18:41.239 --> 00:18:45.279
It's a pathway to have your PSA checked, rechecked, an MRI.

00:18:45.639 --> 00:18:49.179
You might get a biopsy. And if you do get a biopsy, there's a good chance,

00:18:49.199 --> 00:18:52.799
even if we find the cancer these days, we'll be able to treat it with active

00:18:52.799 --> 00:18:56.199
surveillance rather than surgery or radiation or even focal therapy.

00:18:56.719 --> 00:19:04.799
Like any cancer, they're better treated if they're treated or diagnosed early. Correct.

00:19:05.239 --> 00:19:08.759
This is the same, isn't it? Yeah, that's right. So if we can find prostate cancer

00:19:08.759 --> 00:19:12.219
when it's localized, you're looking at cure rates well above 90%.

00:19:12.879 --> 00:19:18.199
Absolutely. Once it's metastasized, we can't cure you, but with our current

00:19:18.199 --> 00:19:21.839
crop of drugs, we're hoping to turn them into a chronic disease as much as we can.

00:19:22.019 --> 00:19:25.639
Obviously, we'd prefer to get it before it's metastasized. But that brings me

00:19:25.639 --> 00:19:27.899
to other really interesting developments.

00:19:28.159 --> 00:19:31.119
So if you think of prostate cancer, think of it like a greedy,

00:19:31.279 --> 00:19:35.739
guzzling American car that loves petrol. Prostate cancer's petrol is testosterone.

00:19:36.119 --> 00:19:40.519
So the very first treatment of men with metastatic prostate cancer was to take away the testicles.

00:19:40.699 --> 00:19:43.979
Now, we don't do that anymore, but we do it with metainjections.

00:19:44.099 --> 00:19:45.399
But the same principle remains.

00:19:45.599 --> 00:19:49.579
Starve a cancer, androgens or testosterone, and you'll slow it down.

00:19:49.959 --> 00:19:54.639
We've now got super drugs that have evolved from that, these new inhibitors. Thank you.

00:19:55.171 --> 00:19:58.751
Importantly, we've also developed our chemotherapy agents are better.

00:19:58.951 --> 00:20:03.431
And also we have access to things like PSMA PET scanning I mentioned before.

00:20:03.431 --> 00:20:07.391
If you put a greater amount of radiation on that molecule, you can destroy cancer

00:20:07.391 --> 00:20:09.131
cells. So that's a whole era.

00:20:09.251 --> 00:20:13.391
It's called Theranostics, which is basically using doses of radiation that go

00:20:13.391 --> 00:20:14.891
directly to the cancer to kill it.

00:20:15.171 --> 00:20:19.611
So we have access to that in Australia. The problem has been recently that a

00:20:19.611 --> 00:20:23.771
large American pharmaceutical company has decided that no one else in the world

00:20:23.771 --> 00:20:27.571
can use this treatment without using their specific brand, even though we used

00:20:27.571 --> 00:20:29.011
to make our own in our own backyard.

00:20:29.191 --> 00:20:34.571
So it's a little bit frustrating, but we are in the cutting edge of prostate cancer treatment.

00:20:34.871 --> 00:20:39.991
And I go around to international meetings in Europe and North America and other

00:20:39.991 --> 00:20:41.231
parts of the world, Asia.

00:20:41.771 --> 00:20:45.971
I would say pretty much Australia is at the forefront of prostate cancer treatment.

00:20:46.151 --> 00:20:48.471
We're probably a decade ahead of the US for two reasons.

00:20:48.691 --> 00:20:54.071
We've embraced imaging over genetic blood testing, which means it's accessible and available.

00:20:54.431 --> 00:20:56.511
Plus, we've also embraced active survivors.

00:20:56.891 --> 00:21:00.551
In other words, we've recognized that not every person needs radical treatment

00:21:00.551 --> 00:21:01.711
with surgery or radiation.

00:21:01.931 --> 00:21:06.391
And these are huge factors. So I think men ought not to be worried about being

00:21:06.391 --> 00:21:07.471
screened for prostate cancer.

00:21:07.611 --> 00:21:10.971
They ought to think about it, act on it, and realize that it's giving them an

00:21:10.971 --> 00:21:13.991
edge. It's actually putting them back in the driver's seat.

00:21:14.371 --> 00:21:20.531
Which countries in the world would you go to sort of get the latest things that

00:21:20.531 --> 00:21:21.651
are happening from what dates?

00:21:21.811 --> 00:21:24.431
Well, with imaging, I wouldn't go to North America.

00:21:25.171 --> 00:21:28.531
They're miles blind. Maybe Canada's an exception there. Obviously,

00:21:28.531 --> 00:21:34.411
I think the Netherlands, France, the UK, a lot of these places are doing exciting

00:21:34.411 --> 00:21:37.431
stuff, but more and more, we're collaborating with these countries, Paul.

00:21:37.531 --> 00:21:41.531
We're doing world-leading research here. We've pioneered person-made PET scanning.

00:21:41.811 --> 00:21:45.491
We've been ahead of the world with MRI. We've been ahead of the world with transparinial biopsy.

00:21:45.571 --> 00:21:47.691
So biopsying through the skin rather than through the rectum,

00:21:47.831 --> 00:21:50.851
reducing infection rates, finding cancers we couldn't find before.

00:21:52.029 --> 00:21:55.289
To be honest, I would say if I had to choose a place in the world that's ahead

00:21:55.289 --> 00:21:59.789
of the game with prostate cancer, it's Australia. Because we can take the best from everywhere.

00:22:00.129 --> 00:22:03.669
And if we've got the research money and we do lobby for it from time to time.

00:22:04.289 --> 00:22:06.249
Unfortunately, we don't do as well as some other malignancies.

00:22:06.409 --> 00:22:11.749
We could do better. But, you know, we have made a huge impact on the world and we continue to do so.

00:22:12.129 --> 00:22:18.289
Yeah, you do a lot of fundraising and you get some fantastic machines that we're getting out here.

00:22:18.329 --> 00:22:20.909
But that's not the only place you use the funding, is it?

00:22:21.089 --> 00:22:24.689
Oh, yeah, absolutely. So look, I run the, I'm the director of the E.J.

00:22:24.769 --> 00:22:27.709
Whitten Prostate Cancer Research Center at Epworth in Melbourne,

00:22:27.849 --> 00:22:33.389
but we offer our treatments to people outside Victoria, but it's not just buying

00:22:33.389 --> 00:22:36.329
fancy machines like the brand new robotics that we have.

00:22:36.489 --> 00:22:38.829
And, you know, Epworth pioneered robotic surgery 20 years ago.

00:22:38.989 --> 00:22:43.509
It's become old really in a way, and we're up to a fifth version of robots coming out shortly.

00:22:43.709 --> 00:22:47.509
But what's exciting is that we're doing other research as well.

00:22:47.509 --> 00:22:52.069
So, for example, the CONFIRM trial, I said we're using PSMA PET to confirm which

00:22:52.069 --> 00:22:55.269
men should be on active surveillance and confirm which men shouldn't be.

00:22:55.489 --> 00:23:00.869
We're also using other machines, Histolog, which is looking to improve nerve-sparing surgery.

00:23:01.049 --> 00:23:05.269
So, that's scanning prostates in real time. We're doing a lot of exciting things.

00:23:05.429 --> 00:23:09.229
And, you know, it's not just about fancy machines. It's also about understanding

00:23:09.229 --> 00:23:13.709
our patients, understanding literature, applying it, and then improving patient outcomes.

00:23:13.869 --> 00:23:17.289
Because that's what we want. We want to pick the right patients to treat with

00:23:17.289 --> 00:23:18.589
the right treatment. Yeah.

00:23:18.929 --> 00:23:20.929
I don't think I asked you this question before.

00:23:21.429 --> 00:23:25.869
What actually made you go to urology? That's a really good question.

00:23:26.009 --> 00:23:28.089
So when you're a medical student, you're exposed to everything,

00:23:28.249 --> 00:23:32.409
you know, whether it's cardiology for hearts or surgery and radiology and.

00:23:33.250 --> 00:23:37.250
I was lucky enough that I had an interest, I think, by the time I finished medical

00:23:37.250 --> 00:23:40.090
school and surgery, but I was lucky enough to be rotated through Ballarat,

00:23:40.290 --> 00:23:43.010
which had an extremely good urology, and it still does.

00:23:43.170 --> 00:23:47.050
It was headed up by a fellow, Don Moss, who really inspired a lot of people.

00:23:47.190 --> 00:23:50.090
And I think the beauty of urology in Australia, we have great figures.

00:23:50.230 --> 00:23:53.470
Helen O'Connell became the first president of the Urological Society of Australian

00:23:53.470 --> 00:23:57.910
News and got great role models for men and women to go into urology.

00:23:58.030 --> 00:24:01.770
And urology is an exciting field because it's got the high-end technology with

00:24:01.770 --> 00:24:05.030
robotic surgery, use of lasers and all this sort of thing.

00:24:05.190 --> 00:24:09.210
But also, we still have the one-on-one discussions with men about all sorts

00:24:09.210 --> 00:24:13.230
of things, prostate cancer, erectile dysfunction, benign disease of the prostate.

00:24:13.510 --> 00:24:18.910
So we can sort of do high-end surgery, but also maintain that ability to treat

00:24:18.910 --> 00:24:20.610
men with medicines and other things as well.

00:24:21.010 --> 00:24:26.070
Yeah, with surgery, we're talking now about the cancer, but with surgery,

00:24:26.250 --> 00:24:27.550
when did you become a surgeon?

00:24:27.730 --> 00:24:33.790
Why did you just become a specialist? Yeah, I think doing surgery is fantastic

00:24:33.790 --> 00:24:35.410
because you can have an impact straight away.

00:24:35.630 --> 00:24:38.670
You get the cancer, you find it, you take it out, the patient's cured.

00:24:38.830 --> 00:24:42.470
And if you can do that by minimizing the side effects of that surgery, even better.

00:24:42.770 --> 00:24:45.750
And I think it's very rewarding. There's nothing better than saying to a patient,

00:24:45.770 --> 00:24:47.730
you're all clear, no cancer anymore.

00:24:50.468 --> 00:24:55.408
They don't have an option, do they? Look, we're lucky in Australia that we get

00:24:55.408 --> 00:24:58.488
opportunities to create friendships with people around the world.

00:24:58.828 --> 00:25:02.908
We often are taking our research overseas to present, whether it's in Europe

00:25:02.908 --> 00:25:05.428
or North America and other parts of the world.

00:25:05.628 --> 00:25:09.108
And, you know, these are great opportunities, not just for us to present what

00:25:09.108 --> 00:25:11.068
we're doing, but collaborate and learn from other people.

00:25:11.228 --> 00:25:16.048
So we're watching closely what others are doing, and we're trying not to reinvent the wheel.

00:25:16.188 --> 00:25:18.708
We want to work with them or do something different. And, you know,

00:25:18.808 --> 00:25:22.788
that's the opportunity we have in Australia is we can actually take the best

00:25:22.788 --> 00:25:25.968
of all those different parts, whether it's from North America or Europe or Asia.

00:25:26.228 --> 00:25:33.208
Yeah, so you're actually taking the lead, actually, in this area, in the prostate area.

00:25:33.468 --> 00:25:38.248
Yeah. And the world is following us. It says, well, the best place to say that.

00:25:38.388 --> 00:25:41.028
Well, sometimes they are. And, you know, that's a good place to be.

00:25:41.148 --> 00:25:45.268
And it means we can, you know, really come out with some exciting things.

00:25:45.268 --> 00:25:49.588
Renu Eapen, a colleague of mine, she was giving lutetium that therapy I mentioned

00:25:49.588 --> 00:25:52.988
earlier with combined with PSMA before men have their prostates.

00:25:53.188 --> 00:25:55.788
Can we make the risk of recurrence lower?

00:25:56.028 --> 00:25:59.108
Things like that. So there's exciting research happening, particularly in Melbourne.

00:25:59.468 --> 00:26:01.008
But other parts of Australia and New Zealand.

00:26:01.168 --> 00:26:05.348
But we certainly feel that in Melbourne, we help lead the way.

00:26:05.568 --> 00:26:10.768
But at the end of the day, everything we do is about better patient outcomes.

00:26:10.908 --> 00:26:13.808
And we have to remain focused on that.

00:26:14.008 --> 00:26:17.468
The better the outcomes, the better we do as a profession.

00:26:17.708 --> 00:26:22.088
But overall, it's better for the community because we want men to be alive,

00:26:22.088 --> 00:26:27.048
but also alive and living good quality of life. So not having metastatic disease.

00:26:27.368 --> 00:26:31.788
So getting these cancers really early, minimizing the impacts and making really

00:26:31.788 --> 00:26:34.308
something that used to be big,

00:26:34.428 --> 00:26:38.988
nasty, horrible into something that's tolerable, bearable and livable.

00:26:40.507 --> 00:26:45.047
Professor Lawrence, thank you very much for giving us your time. No trouble at all.

00:26:45.207 --> 00:26:48.567
Really informing us. And there's a lot of things there I didn't even know before.

00:26:48.907 --> 00:26:52.247
And one of them was that the women don't have a prostate.

00:26:52.647 --> 00:26:56.907
Yeah, absolutely. And my last point, Paul, is having a conversation with your

00:26:56.907 --> 00:26:59.227
family this Christmas. You know, understand your risk.

00:26:59.547 --> 00:27:02.167
Talk to your uncles. Talk to your brother. Talk to your father.

00:27:02.587 --> 00:27:05.767
And talk to your family members. Say, hey, you know, Dad passed away a few years ago.

00:27:06.107 --> 00:27:08.787
What exactly was the problem? Because if it was prostate cancer,

00:27:08.907 --> 00:27:12.587
your risk is higher. And these conversations can extend to other things as well.

00:27:12.647 --> 00:27:15.827
But I think knowing your risk, talking about it is a really big thing.

00:27:15.927 --> 00:27:19.527
And men's health is something we don't talk about enough and we should.

00:27:19.847 --> 00:27:25.787
And men live a lot, men's lifespan is a lot less than women's.

00:27:25.847 --> 00:27:28.787
And part of that reason is because we tend to bury our heads in the sand and

00:27:28.787 --> 00:27:33.607
not talk about these things like prostate, prostate health, PSA testing and so on. And we need to.

00:27:33.827 --> 00:27:36.867
We're a lot more liberal now than we used to be back in my day.

00:27:36.867 --> 00:27:43.327
It was a boo to be speaking about anything like bowel cancer or BVAC. That sort of stuff.

00:27:44.007 --> 00:27:47.447
Absolutely. We sweep that up under the carpet.

00:27:47.647 --> 00:27:50.447
Well, I think with men, we've got to focus not on their mental health alone,

00:27:50.567 --> 00:27:52.727
but physical health and cancer prevention.

00:27:52.867 --> 00:27:56.527
And that means participating in national bowel screening, having a conversation

00:27:56.527 --> 00:27:58.007
with your GP about prostates.

00:27:58.667 --> 00:28:04.767
And, of course, the prostate diagnosis is really not anywhere near as intrusive

00:28:04.767 --> 00:28:07.007
as it used to be a few years ago, of course.

00:28:07.427 --> 00:28:10.927
There's no more finger testing. It's just a simple blood test.

00:28:11.147 --> 00:28:16.507
And as you say, have that conversation with your GP. All of these things are really important.

00:28:17.627 --> 00:28:21.387
Thank you very much again. And it has been good talking to you.

00:28:21.547 --> 00:28:25.367
And I hope we can catch up again, not in a professional situation.

00:28:26.487 --> 00:28:30.787
Absolutely. Thank you very much. A pleasure. Okay. Thank you, mate.

00:28:32.549 --> 00:28:36.909
And to our loyal listeners, I trust that our conversation with Professor Lauren

00:28:36.909 --> 00:28:43.789
Shuck has demystified the prostate and as he has stressed to the men out there,

00:28:43.989 --> 00:28:49.749
talk to the male members of your family because the more males in the family

00:28:49.749 --> 00:28:51.469
that have been diagnosed,

00:28:51.869 --> 00:28:55.829
the more tight chance there is that you may need to be tested.

00:28:56.489 --> 00:29:02.949
I trust you found our episode of Interest. Until next time, be safe and enjoy Christmas.

00:29:03.569 --> 00:29:08.109
Thank you for listening to Why Is It So? Make sure you tune in to our next episode.

00:29:08.289 --> 00:29:11.409
Remember, it's your last defence for common sense.