How Wayne Swan put Australia at the forefront of prostate cancer research

Aug 28 2018

By Jill Margo

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As Wayne Swan prepares to mark the 10th anniversary of the GFC in New York next week, he will be marking a deeply personal anniversary too. It's a survival anniversary because he firmly believes he would have been dead by September 2008, had he not acted swiftly and decisively to treat his prostate cancer.

He'd watched his father die a slow, agonisingly painful death from the same disease. By his late sixties, Maurice Swan had cancer though his bones and seeing him suffer was "shocking".

When Wayne Swan was diagnosed with the same cancer at the age of 47, he was determined not to go down the same path. Prostate cancer in youngish men is usually aggressive, particularly if they have a family history. But it was 2001 and prostate cancer was mired in controversy. There were claims of over-diagnosis and over-treatment.

With the graphic image of his father's experience front of mind, Swan pushed through the controversy, took two medical opinions and had a radical prostatectomy to remove his prostate.

"I depended on the science, not the ideology," he said. And that, he explains, is exactly what he did as federal treasurer when Lehman Bros collapsed in September 2008 and he led Australia through the GFC, stimulating spending and avoiding recession.

Trusting the science

The value of following evidence rather than the herd, will be the centrepiece of his speech at The Independent Commission for the Reform of International Corporate Taxation in New York next Tuesday, which is themed "10 years from the last crisis, we still need effective financial regulation". 

Swan has been appointed a commissioner to this group of world leaders which believes there is an urgent need and an unprecedented opportunity to bring about significant reform of the international corporate taxation system.

"Had I listened to the ideology on prostate cancer, with no testing, no early detection and no early treatment, I believe I would not have made it to be treasurer or to be deputy prime minister of Australia," he told The Australian Financial Review in Brisbane last week.

Despite the political upheaval in Canberra, he had managed to slip back to his home town to open the 19th Asia-Pacific Prostate Cancer Conference. Presented by the Australian Prostate Centre, it is one of the world's premier international conferences on this cancer.

As Swan stood at the dais, sharing the stage with his surgeon, Associate Professor Peter Heathcote, and with the founder of the conference, Professor Tony Costello, there was a sense of brotherhood.

It was the kind of brotherhood Swan generated after he was diagnosed and began running forums, organising support and personally talking openly about his condition. Over time, wherever he was, strangers felt able to come up and chat to him about this cancer.

"The disease wasn't much spoken about and sometimes, I felt almost as if I was a doctor. No one was talking openly," he said. "Perhaps there was a stigma and some people value their privacy. I had no choice anyway. I was diagnosed as we were going to the 2001 election, so I had to announce it.

"But I've not suffered any stigma. Why would anyone think any lesser of someone what has had cancer? Stigma is in the head."

When his prostate was removed, the cancer was found to be more aggressive than expected. "No question, I would have been dead 10 years ago," he says.

Open discussion

After his diagnosis, Swan surprised everyone with his frankness about the side effects of surgery.

In 2002, he told the AFR his continence was at 90 per cent. "It's not perfect, but there is still the possibility of improvement," he said at the time.

"Potency is a little bit less. It will never be what it was, and no one should ever pretend it can be. I didn't know that when I took the decision, it only comes to me now that I have had the surgery.

"To me it's like the difference between surfing at Noosa when the wind is up and surfing the beach break at Maroochydore. But then I grew up in Maroochydore and spent most of my life surfing the break. "While it can never be the same, it can be OK, and certainly it's better than dying. I want to see my three kids grow up."

Last week, he told the AFR things remain unchanged. "As far as I know, I have made a complete recovery," he said. "But I remember people who came to me and who didn't trust the science. I watched them die."

At the conference, he introduced the international audience to Heathcote, president of the Urological Society of Australia & New Zealand, saying both early detection and this surgeon had saved his life.

"But unfortunately, for many men of my generation, there was no early detection and we didn't save the lives we could have saved. "At the time, the area was completely run over by breast cancer. I thought it was insane, why aren't we doing prostate cancer as well, they have a similar incidence!"

Since his diagnosis, and more so after Labor was elected to government, he used his political power to promote awareness about and drive research into prostate cancer. Today he is grateful to have been able to effect change.  "It validates a political life, which is about making things better for people."

Political weight

Swan will retire from parliament at the next election, but he won't be retiring from politics. In June, he was elected national president of the Australian Labor Party.

Costello, a leading Australian urologist and professor at Melbourne University, introduced Swan saying because of his involvement, $32 million in federal funding had been dedicated to prostate cancer research. Before that, funding was "bitty".

That the contribution Australia makes to the body of international research is well above its size is, in great part, due to Swan. "He dedicated the funding and we've done well with it."

Costello told the packed hall that when this conference began in 2000, the big question was "how do you do an operation to take the prostate out, if you can find it and grub it out?" This conference was dramatically different and reflected how far treatment had come. "Now we are talking about prostate cancer as a chronic disease [like diabetes]. It's been a fascinating journey because now a lot of men don't die from it.

"The changes in our armamentariu have been outstanding since 2004, when chemotherapy was first introduced. We now have so many drugs which are effective in keeping men alive for long periods of time."

Having a conference that focused on treating metastases showed how far management of this disease had progressed from 2000, when the conference debated whether testing for this cancer was harmful or helpful. Costello said the theme now was keeping men, who would previously have died from metastatic prostate cancer, alive.

This could largely be achieved through MDT, metastases directed therapy, which entails taking out the prostate, the driver of the cancer, and treating what is left behind. Taking out the primary tumour, the source of the cancer seeds that would implant around the body, appeared to be doing good. It affected the biology and immunology of the host and resulted in a better long-term outcome.

The bits of cancer still in the body were "spot welded", sending the men into remission with undetectable levels of cancer on imaging.Although this is not a cure, he said it is life prolonging. It puts men into remission and provides many years during which they may die of something else.Bone metastases are now treated much earlier out and, in some cases, treatment is guided by a man's genetic profile.

"The mean life expectancy of a man with bone metastases used to be two years. Now I've got guys out to 10 years."

Swan has been cancer free for 17 years. Following his surgery, he required no further treatment but was a bit jumpy when an unrelated symptom occurred. That anxiety has gone and he regards himself as cured.

Jill Margo is an adjunct associate professor at the University of NSW.

https://www.afr.com/leadership/how-wayne-swan-put-australia-at-the-forefront-of-prostate-cancer-research-20180827-h14l7c

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