When Dennis Box thinks of the men living in his small farming community, he loses count of those who have experienced prostate cancer, and he wonders why.
- Prostate cancer survivors are urging more men to have regular health checks
- Rural men are more likely to die from the disease than city men
- Sexologist says surgery does not mean the end of erections
The 68-year-old grain farmer from Northampton in Western Australia’s Wheatbelt has survived Australia’s most common male cancer, something he credits to early detection and regular health screenings.
Now Mr Box and his wife Alison wonder if prostate cancer is more prevalent in rural communities like theirs and what could be causing this.
Mr Box said the pair contemplated factors like diet, genetics, lifestyle or his own personal exposure to agricultural chemicals, particularly during the “early days” of farming, before personal protective equipment and filtered airflow in drivers’ machinery cabs were used by farmers.
He said in the early days of his farming in the 1970s, farmers handled chemicals frequently without protective equipment, a vast contrast to modern practices.
“I drive the boom spray on the farm. I do all of the sprayings and have done since boom sprays came out, and before that with the old misters and stuff like that, so you were open to all of that … all open cabs,” Mr Box said.
“It might not happen straight away, but in 40 years time it might break out and end up in a cancer like that. You really don’t know what causes it.
“It’s just something that the city blokes and the country blokes — it doesn’t matter where you are — have to follow up and do your [prostate] tests.”
Statistically, Mr Box and other men living in rural and regional areas are 24 per cent more likely to die from the disease.
In 2019, 3,306 men died of prostate cancer.
It’s the second most common cancer-related cause of death to lung cancer.
Tony Seabrook farms at York, about 100 kilometres east of Perth, and is the president of the Pastoralists and Graziers Association.
He, too, is staggered by the number of people with prostate cancer in his community.
“I’ve put together a list of my mates, my contemporaries in York, and I’ve got 22 local farmers in York, a heap of them outside York [who have had prostate cancer],” Mr Seabrook said.
“I’ve got family members, members of the PGA [who have had prostate cancer].
Is chemical exposure to blame?
Tom Shannon has more than 20 years of experience as a high-volume prostate cancer surgeon based in Perth.
“I think we do see more prostate cancer in farmers and men in the country, but it might be explainable by exposure to chemicals, or it might be explained by the fact that men who are in the country tend not to get their tests done,” he said.
“Part of that could be explained by some chemical exposure, and I think we need to be concerned about that.”
Mr Shannon said typically later diagnosis of cancers in regional men meant it had a greater impact.
“We know men in the country in Australia get less PSA [prostate-specific antigen] blood tests. They get diagnosed later,” he said.
“They are less likely to have surgery, they’re more likely to fail treatment, and they’re more likely to end up on hormone-blocking drugs and chemotherapy than men in the city.
Nurse practitioner, sexologist and the presenter of podcast The Penis Project, Melissa Hadley Barrett, is also concerned about the minimal health services available in rural and regional areas.
“What I see in my practice is not so much that it’s more prevalent, but by the time we get to see patients who are from rural areas, it’s often much more advanced, which I think is because of the lack of services and the lack of access,” she said.
Like many men Dennis Box had no symptoms.
“All they were watching was the PSA test,” he said.
“I had no symptoms before that like getting up and going to the toilet at night time and that sort of stuff — it didn’t happen.”
Mr Box had a full prostate removal via robotic surgery in early 2018.
“I had three choices: One, to leave it in, and I wouldn’t be here in five years’ time,” he said.
“[I could] have radiation, which he [the surgeon] didn’t recommend at the time, or have it out altogether.”
Bladder control and sex after surgery
Fortunately, Mr Box had been having regular PSA testing since he was 50, and this allowed for early detection.
The cancer was contained within his prostate, meaning he required no further surgery or cancer treatment.
He said good pre-surgery and post-surgery care and bladder control meant incontinence was not an issue.
“We bought a couple of packets of pads to wear to get ready for it because there’s always going to be something there for a little while, but I only used half a pack, and that was it,” he said.
The couple said the support of a sexologist had helped them continue with their sex life.
“Don’t think just because you lose your prostate that’s the end of everything. If you go and see someone and sort it out, then as long as you’re not blind about it like some blokes I’ve spoken to … go and find out information,” Mr Box said.
Mrs Box said there was also rehab available to allow sexual function.
“There’s different stages you can go through. You start with tablets and a pump, and then you move onto injections if that’s what you need. Some people regain sexual function,” she said.
“It doesn’t change things.”
Melissa Hadley Barrett has been dealing with prostate cancer patients for five years, and when she first started, most of her patients never got their erections back.
She said over the last five years, that had changed significantly.
“The patients I’ve seen in the last 18 months to two years often get their erections back,” Ms Hadley Barrett said.
Ms Hadley Barrett said it was also important to realise sex was not always about erections.
“Women don’t actually care that much about erections, to be honest, and relationships break down when the male partner doesn’t want to cuddle their wife anymore,” she said.
“It’s about opening up the conversation.”