Psychological side effects for common prostate cancer treatment raise concerns
Androgen deprivation therapy — known as ADT — is a hormone treatment that's commonly prescribed for men with advanced prostate cancer because it blocks the testosterone on which the cancer feeds.
It slows the progress of the cancer, but the side effects can be so debilitating that some men have chosen to take their own lives.
Prostate Cancer Foundation of Australia (PCFA) wants all men diagnosed with prostate cancer to be screened for distress and referred to a specialist nurse trained in providing ongoing psychological care.
This should include conversations with partners or loved ones when appropriate, education about the potential side effects of the treatment and strategies for maintaining quality of life.
PCFA chief executive Anne Savage said both doctors and patients need to be made more aware of the mental health risks of ADT.
"We are aware of a number of cases where ADT is believed to have played a role in the deterioration of men's mental health, leading to suicide," she said.
"Overall, around 12 per cent of men impacted by prostate cancer will experience suicidal ideation, which is significantly associated with hormonal treatment."
Every year, more than 26,000 Australian men are diagnosed with prostate cancer.
About 4,000 of these men have stage 3 or 4 cancer, which will likely require ADT. Many more previously treated for prostate cancer will be recommended for the therapy if their cancers recur or progress.
Research reported by PCFA has warned that men on ADT for prostate cancer face a higher risk of suicide.
According to Ms Savage, the potentially deadly side effects have been well established by international and Australian studies, but are not well known.
But she said it's important to remember that ADT remains an effective method to slow the cancer for most patients.
"What we don't want is for men to stop taking hormone therapy. This is a life-saving treatment that stops prostate cancer from spreading," Ms Savage said.
Melbourne prostate cancer specialist professor Declan Murphy said no-one would argue with the call to provide better support to patients.
He said the likelihood of suicide is extremely low, but it does appear to be higher in men who have started ADT.
"I think it's likely that the burden of being diagnosed with metastatic prostate cancer itself is also contributing to depression and suicide risk, so the relative risk increase may be overstated," he said.
Surfing writer Tim Baker had just turned 50 when he was diagnosed with advanced prostate cancer, which had metastasised into the bone.
Put onto ADT hormone treatment, he soon began to feel emotionally vulnerable.
"The hormone therapy amounted to chemical castration. It meant loss of libido, loss of erectile function, loss of bone density, and it causes breast swelling, genital shrinkage and loss of muscle mass," he said.
"I remember thinking, 'I'll never be whole again, and I'm not sure how I survive this. The treatment, let alone the disease.'"
He doesn't remember any warning about the risk of suicide, but within months, he found himself lying awake at night feeling that his family would be better off without him.
"I felt like the warnings around ADT were entirely inadequate, and I do think prescribing ADT to men and not providing better support is medically negligent."
Unknown to Mr Baker, his experience was one shared by a stranger on the other side of the country.
WA farmer Craig Heggaton was diagnosed with prostate cancer at age 56 and soon after underwent a prostatectomy, which he assumed would be the end of the matter.
But the cancer returned four years later.
His doctor recommended he go onto ADT, a treatment that his wife, Liz, queried at the time.
"I asked the specific question about how it may impact Craig's mental wellbeing because he's on antidepressants," she said.
When the doctor told her he'd only had one patient with an adverse reaction to ADT, she didn't think much more about it.
Within two months, she noticed him becoming irritable, not sleeping well and having zero libido — something that troubled Mr Heggaton himself.
"It was just this insidious slide of him not being his normal happy-go-lucky self," Ms Heggaton said.
But it was a shock when Mr Heggaton took his own life last year while on a camping trip with friends to the Big Red Bash music festival near Birdsville in Central Australia.
At first, his wife had no answers as to why her husband had taken such an extreme step.
Months later, she listened to an ABC Conversations interview with Mr Baker and had a "light bulb moment" when he described his emotional meltdown while on ADT.
"The night that Craig died, I hadn't really suspected that it was the ADT. The thing that really struck me was that Tim had been on the same treatment that Craig was on," she said.
"This drug, the power of this drug could in fact have caused Craig's suicide."
She emailed Mr Baker and was "shocked and excited" to receive a response from him within 30 minutes.
"Liz's story about her husband's suicide touched me so deeply because I'd been there," Mr Baker said.
"I'd been in his position where I'd questioned whether life was worth living, and I could entirely relate to his decision."
After hearing more of Mr Heggaton's story, he believes the popular farmer and sheep breeder was given inadequate warning about the side effects of ADT treatment, particularly since he was on antidepressants.
"He should have been told that the drug carries the very real risk of inducing depression and mood swings, and that it carries an increase in your risk of suicide," Mr Baker said.
Mr Baker and Ms Heggaton have now joined forces to drive an awareness campaign about prostate cancer, which is the most commonly diagnosed form of cancer in Australia.
They describe themselves as an odd pairing, an unlikely alliance of a WA farmer and a northern NSW surfer, who would otherwise have never crossed paths.
With the support of PCFA, they hope to start an annual sporting event — like the Pink Test for breast cancer — to raise funds and research into prostate cancer.
Mr Baker has written a book, Patting the Shark, about his cancer experience and has since become a respected patient advocate.
After 10 years on and off ADT, he has come to accept the treatment as a necessary evil.
"Oh look, if I hadn't done ADT hormone treatment, I don't think I'd still be here," he said.
But the effectiveness of the treatment for him is waning, which means he'll have to consider targeted radiation or look for a clinical trial of an alternative approach.
"But there are no curative options ahead of me. So it's really a matter of managing it and staying fit and healthy for as long as I can," he said.
Ms Heggaton believes every man and his partner need to be counselled about the side effects of ADT before going on the drug, to ensure they are fully warned about how their body is going to feel when they start treatment.
She hopes that something good may flow from her husband's tragic death.
"I want to find my voice and not let Craig's death be in vain. Make good of a really shitty situation, and try and help others through this process."
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
News.com.au
17 minutes ago
- News.com.au
Biocurious: with fresh grant funding, Emvision's Emu stroke device won't take a step backwards
A fresh $5 million government grant takes Emvision's cumulative non-dilutive funding to $25 million The company is trialing its Emu stroke detection device with a view to FDA clearance The lightweight variant First Responder could give ambulances rapid stoke detection capabilities With US biotech grant funding under pressure, drug and device developers need to delve more deeply for sources of valuable non-dilutive capital. Happily, numerous programs are still available for Australian life sciences plays willing to do their homework. In the case of stroke and traumatic brain injury (TBI) detection device developer Emvision, grant funding and partnerships have underpinned the company since it was formed in 2017. Co-founder and CEO Scott Kirkland puts the running tally at $25 million. This month, Emvision was awarded a $5 million Australian Government Industry Growth Program Commercialisation and Growth Grant. The funding is to accelerate development of Emvision's portable brain scanner, First Responder. Other funding sources have included the Australian Stroke Alliance, the NSW Medical Devices Fund and – we kid you not – the Modern Manufacturing Medical Products Manufacturing Translation Stream Project. Take nothing for grant-ed Kirkland says applying for grants takes significant time and management focus – and companies usually need to kiss a lot of frogs. 'You really need to dig around on the guidelines and look at what they have funded previously,' he says. 'But there are plenty of opportunities where objectives are boosting domestic manufacturing, creating engineering roles, generating IP and tackling the big health and societal burdens.' In the case of the US, the military complex can fund programs of specific interest, such as TBI assessment. The company is likely to progress TBI – a 'significant unmet need' – via a collaboration or grant. The Golden Hour As far as 'big health societal burdens' go, Emvision is tackling the need for more portable – and thus faster – ways to detect a stroke. The first 60 minutes post-event is known as the Golden Hour. But even the second hour – dubbed, you guessed it, the Silver Hour – is vital. 'With a stroke, time is brain,' Kirkland says. 'The faster it is diagnosed and treated; the more of the brain function that can be saved'. If treated early, a clot is softer and more treatable via clot-busting drugs or surgical removal of the blockage. In the US, a study of Mobile Stroke Units (MSUs) with a CT (computed tomography) scanner reported 33% of patients being treated in the first hour. This compared to just 3% for the normal ambulance arm. 'If you can bring the diagnostics tools to the patients, you save a lot of time to achieve better functional outcomes and less disability,' Kirkland says. Different strokes for different folks Clinicians and paramedics need to know whether the stroke is a blockage (ischaemic) or a bleed (haemorrhagic) as different treatments apply. To date, patients have been imaged with bulky, centralised scanners in hospitals. Emvision is developing a portable bedside scanner – Emu – which can be moved bed to bed on a cart. These units weigh about 100 kilograms, compared with a few tonnes for a typical CT unit. A trained healthcare professional can operate Emu, whilst a CT requires a radiographer. In a regular neurological intensive care unit, Emu's ability to hop from bed to bed is better than carting fragile patients to radiology. Emvision hopes Emu will pave the regulatory pathway for First Responder, its backpack-sized version for use in road and air ambulances and remote locations. On trial Emvision's work currently revolves around a pivotal trial for Emu, to support US Food & Drug Administration (FDA) clearance under the De Novo (novel device) pathway. The company hopes this will pave the way for First Responder approval under the less arduous 510(k) predicate device route. The US trial sites consist of New York's Mt Sinai, Florida's Mayo Clinic and Houston's Memorial Hermann Texas Medical Centre. A west coast site is pending. Locally, the trial has enlisted the Royal Melbourne Hospital and Sydney's Liverpool Hospital. They are all high calibre research centres handling high stroke volumes. The study aims to enrol up to 300 suspected stroke victims, who will receive the usual clinical care along with an Emu scan. Overlaying that, Emu then determines whether the stroke is a bleed or not, with a primary endpoint of at least 80% sensitivity and specificity for haemorrhage detection. Sensitivity is the ability to detect positive results, while specificity is the ability to discount false positives. The patients might have a different 'stroke mimic' condition, such as a migraine or epileptic seizure. 'We are seeking to also demonstrate that a 'mimic' does not confound our algorithms,' Kirkland says. Never a step back with Emu In an earlier domestic trial called Emview, Emu achieved 92% sensitivity and 85% specificity for bleed detection in a smaller cohort. For blockages, the results showed 95% sensitivity and 85% specificity. Kirkland says CT is good for detecting bleeds, with a 90-99% sensitivity. Without the use of contrast agents, it's less so for blockages (30-70%). (About 80% of stroke cases are blockages). Kirkland says while CT (or MRI) scans provide the 'ground truths', Emu's performance doesn't need to be identical to these machines. Especially in the case of First Responder, operators will use them where traditional neuroimaging is unavailable. Eyeing the US market While strokes afflict 15 million people annually – one-third fatally – there are fewer than 50 dedicated Mobile Stroke Unit ambulances globally. (Melbourne hosts two of them). That's because they cost upwards of $1 million to set up and a similar amount to operate annually. First Responder could provide every ambulance with a stroke and stroke type detection function. The US market eclipses anywhere else: 60,000 road ambulances – half the global tally – and 1500-1800 air ambulances. Post approval, Emvision's initial focus is likely to be in the expanded 'stroke belt' of southern states including Texas and Florida. For lifestyle and other reasons, the incidence of strokes there is much higher than the rest of the country. First Responder takes to the skies Alongside the Emu study, Emvision expects First Responder pre-hospital studies to get underway with the Royal Flying Doctor Service (RFDS), a Melbourne MSU and a standard road ambo. 'The initial focus is on feasibility, usability and how it fits into the workflow,' Kirkland says. 'In parallel, we are doing product development translation from advanced prototypes to commercial production units.' To date, RFDS scanning of healthy volunteers in real-world conditions has confirmed First Responder's durability. The company is obtaining ethics approval to scan actual RFDS patients. A cost-effective solution In theory, Emu and First Responder should walk off the shelves, given the age-old problem they promise to solve. But for cash-strapped healthcare systems, cost is always a factor. Kirkland expects an Emu to cost around $US175,000 – about a third of the price of a decent CT machine. First Responder is likely to be half or a third of the cost of an Emu. The company also expects to charge US$25 per Emu scan and US$50 per First Responder scan for a 'consumable'. This single-use item is a liquid that flows through a silicon membrane used to adjust to varying head sizes. 'We think we have a compelling, cost-effective solution,' Kirkland says. Kirkland says chasing grants requires patience as the process winds from initial application to presentations, due diligence and contract negotiations. 'I won't give away too many secrets because there are still a lot of grants we want to apply for."
News.com.au
an hour ago
- News.com.au
Fitness coach exposes 5 fitness industry secrets
It seems that Instagram nowadays is flooded with ripped physiques and TikTok is full of 'What I eat in a day' videos. As a result, the impact of fitness influencers on Aussies' eating habits and body image has never been stronger. Recent research from The Butterfly Foundation revealed that 59 per cent of Australians say diet and fitness content on social media affects how they see themselves, while 63 per cent admit to comparing their appearance to what they see online. But behind the aspirational, time-stamped videos showing 'A day on my plate,' experts warn of a darker side to this wellness wave – one that encourages disordered eating, confusion, and unattainable ideals. Here are five little-known secrets about the fitness industry that experts want you to know. 1. 'Clean eating' and 'diet resets' are often restriction in disguise The language people use to talk about dieting is constantly evolving, and there are some common phrases gaining popularity that you should be aware of, as they might not mean exactly what they suggest. According to eating disorder therapist Jaime Dimarco, 'Using the term 'clean eating,' 'healthy eating,' and 'diet reset' are just more acceptable ways creators let their followers know they are heavily restricting their intake because they have body image issues'. While an influencer's fans might look to their diets for inspiration, Ms Dimarco says that behind the scenes, many 'have hormone issues, are malnourished and struggle with a silent eating problem'. Ms Dimarco, who has been an eating disorder therapist and recovery coach for five years, says that any diet where specific foods are completely avoided (unless for medical reasons) is simply 'fearmongering'. She points out that frequent and public vilification of certain food groups – such as carbs, meat, sugar, and fat – can contribute to widespread disordered eating. 'The truth is, no foods can actually cause health issues on their own … excessive amounts consumed can (just like anything in life),' she explains. Melissa Wilton, Head of Communications and Engagement at the Butterfly Foundation, echoes this, saying that such messaging 'can have a negative impact on our body image and relationships to food, eating, and exercise, because these posts invite comparison, and many people feel guilt or shame if their own intake or exercise regimes doesn't match up'. Certain wellness trends, she explains, are often 'diet culture in disguise' and can promote the idea that a smaller body weight and size equals health, with food being categorised as 'good' and 'bad'. This, in turn, can perpetuate the harmful 'thin ideal,' fatphobia, weight stigma, body dissatisfaction, and a disordered relationship with food. 'Dieting is the most common form of disordered eating, and the act of starting any diet increases the risk of an eating disorder developing in young people by five times,' she says. 2. Supplement promotions often focus solely on profit Scroll through any fitness influencer's page, and you'll likely see discount codes for supplements promising miraculous results. But nutritionist and qualified online coach Max Dimarco (who is married to Ms Dimarco and whose businesses work closely together) urges people to look beyond the tempting deals. 'Many influencers promoting supplements, especially those with larger followings, do so for commission on each sale, not because they genuinely care or even understand what they are promoting,' Mr Dimarco, who has 13 years in the industry, says. 'There is no such thing as a fat-burning supplement. It's just an appetite suppressant, typically triggered by caffeine. Yes, a long black could do the same.' He adds that top-tier influencers are often paid significant sums upfront to promote certain supplement brands, while micro-influencers might do it for free products and the validation of being associated with well-known brands. 'Most of these influencers couldn't tell you what's in the supplement or its supposed benefits,' he claims. 'They post the script provided for a video but are easily exposed when replying to followers' comments.' 3. Yes, many people still heavily edit their photos Even those who seemingly 'have it all' feel pressured to edit their images, Ms Dimarco reveals – even in a world where people are more aware than ever of photo editing. She explains, 'The need to edit photos usually comes from body dysmorphia or the desire to keep up with other influencers who also edit their images. 'It is so accessible now, and because technology is so advanced, an image can be enhanced within seconds. Many influencers have become so skilled at editing that their followers can't even tell the difference.' However, this illusion may drive followers, often young and impressionable girls, to adopt overly restrictive diets in an attempt to reach the same standards as their favourite influencer. 4. Not all coaches are qualified to give nutrition advice The online coaching industry is booming, but Mr Dimarco warns that many have limited credentials. 'Many give out personalised nutrition advice to clients without the proper qualifications, which is actually illegal,' he explains. 'A coach offering nutrition coaching or meal plans must be registered as a qualified Nutritionist or Dietitian. Most coaches out there don't have these qualifications.' He advises to watch out for red flags, such as generic meal plans, calorie targets, or strict restrictions, and to always verify a coach's credentials before committing. Also, if a coach provides nutritional advice without asking about your menstrual cycle, digestive health, hydration, or mental health related to training and eating, Mr Dimarco says to steer clear. 'They are neither qualified nor educated enough to give health advice,' he warns. 'This can lead to hormone issues, eating disorders, and toxic habits.' 5. Performance-enhancing supplements are widespread The myth of a 'natural' transformation is everywhere but may be seriously misleading, as many fitness influencers secretly use performance-enhancing substances. Mr Dimarco says, 'It's more common than most realise. I'd estimate over 90 per cent of popular fitness influencers use them. 'What was once considered a very 'taboo' subject is now becoming normal.' He says there is an increasing number of women using these substances, who claim their results are just due to standard supplements. 'There are many female influencers promoting their body changes as 'hard work' or because they started taking creatine. I've been in the industry long enough to see the signs from a mile away,' he reveals. 'When you see someone with a dramatic transformation in a short time – especially a huge change in their glute to waist ratio – it's obvious. 'This is often accompanied by skin issues like severe acne or a deepening voice.' The hidden use of these enhancements worsens the already unrealistic standards in the fitness community.
News.com.au
an hour ago
- News.com.au
Big pharma takes notice as Novo Nordisk puts Clever Culture's APAS to the test
Novo Nordisk kicks off APAS test drive Clever Culture eyes global rollout The company's pharma pipeline is swelling It's a big moment for any Australian company when a global pharmaceutical giant comes knocking. But for Adelaide-based Clever Culture Systems (ASX:CC5), this wasn't just a knock; it was a deliberate move by a global heavyweight in drug manufacturing, Novo Nordisk. On Monday, Clever Culture confirmed that it had received a purchase order from Novo for its flagship APAS Independence instrument. The machine will be delivered to Novo's central team in Denmark, where it will undergo a full-scale evaluation to assess its suitability for deployment across Novo's global manufacturing network. The Danish giant will be comparing Clever's automated plate reading technology against its existing manual microbiology workflows. The evaluation will cover both standard 90mm 'settle plates' and the more nuanced 55mm 'contact plates' – the two staples of pharmaceutical environmental monitoring. Why this matters Novo Nordisk is a global leader in diabetes and obesity treatment. The company currently pumps billions into its manufacturing footprint to keep up with global demand for its blockbuster drugs, Ozempic and Wegovy. Its facilities are massive, complex, and stringently sterile; and that's exactly where Clever's APAS technology enters the frame. The APAS Independence uses AI technology to automate one of the most time-consuming parts of microbiology – analysing agar plates for contamination. It can assess hundreds of plates per hour, filtering out the negatives, and flagging anything that might require closer inspection by human microbiologists. That's a big deal in an industry where even minor contamination can derail production, trigger recalls, and in extreme cases, harm patients. APAS essentially transforms a manual, repetitive process into a standardised digital workflow, creating a clean audit trail. Novo will now test APAS across both plate types, aiming to validate its ability as a complete solution. The fact that Novo is doing this at its central 'centre of excellence' site is no small detail; it suggests potentially broader applicability for APAS across Novo's global network. The long-term strategy For Clever Culture, this sale is a key milestone in a long-term strategy to focus on top-tier pharmaceutical manufacturers. CEO Brent Barnes, who's been leading the company's shift toward applications in pharmaceutical manufacturing, said the adoption by these top-tier pharma firms helps establish credibility across the entire industry. 'Novo is amongst the largest sterile drug manufacturers globally and have been great to work with, adding significant bench-strength to customer advocacy and the industry with respect to APAS," he said. 'By doing it in this manner, they also have the most to gain from automation and standardisation." From a sales execution perspective, it also means that Clever Culture is working with a centralised point of contact that could then introduce APAS to their global manufacturing sites. These organisations have both the resources and infrastructure to evaluate new technologies centrally and deploy them at scale. 'This is therefore a very targeted and efficient sales process.' How big could it get? The short answer: potentially very. According to Novo Nordisk's own website, the company operates 16 large manufacturing sites around the world. And just like AstraZeneca, which started with one APAS system and now has nine installed, it's likely that multiple units could be required at each facility if the evaluation is successful. But Barnes is careful not to overstate things, saying that the company isn't in a position to put out forecasts at this early stage. 'We have stated that for larger manufacturing sites, multiple APAS instruments may be required, this has been the case for AstraZeneca as an example. 'You could take an external view on what the opportunity could look like based on this information.' Clever Culture now counts five top-tier pharmaceutical customers that are either evaluating or already using APAS: AstraZeneca, Bristol Myers Squibb, Thermo Fisher Pharma Services, an unnamed multinational that recently completed a major settle plate evaluation and, now, Novo Nordisk. Together, these five customers alone represent a potential opportunity of 60–80 APAS instruments, according to Barnes. Stacked pipeline Once evaluations begin, the question becomes: how long before they lead to actual rollout? 'Customers will typically go through an evaluation that could take 4-6 months,' Barnes said. 'During this process, they are evaluating performance of APAS in addition to considering where APAS could be adopted throughout their global sites.' To put this in perspective, in FY25 Clever Culture sold and shipped 9 instruments to AstraZeneca within a 12 month timeframe. That kind of timeline is encouraging for investors, especially when you consider that more than 40 pharmaceutical companies are currently in Clever Culture's active pipeline. Collectively, those opportunities represent about $75 million in potential upfront sales, and another $15 million in recurring annual revenue, said Barnes. For now though, the first APAS unit has landed in Denmark. What happens next depends on performance, process, and plenty of plates. But Clever Culture has the platform, the momentum, and now one more giant evaluating it with serious intent. At Stockhead we tell it like it is. While Clever Culture Systems is a Stockhead advertiser, it did not sponsor this article.
