Dr. Iain Corness

Wednesday, 19 November 2014 16:16

Prostate Cancer - is the PSA worthwhile?

It is “check-up” time again with ‘cut price’ examinations between now and the end of the year. For many males, a PSA test is added to investigate the health of the prostate gland. Unfortunately, the PSA test is not the be all and end all of prostatic health.

Of course what I am referring to here is fear of cancer of the prostate. And unfortunately prostate problems are extremely common, a situation we men have to live with. Like all things, there is a downside as well as the fun side. In fact this year in the United States, almost 180,000 men will be told that they have prostate cancer.

With all our older friends getting prostate problems, does this mean there is a rise in the incidence? Are our underpants too tight? One reason for the ‘apparent’ increase is the fact that prostate cancer is a condition of aging, and we are all living longer. The statistics show that by age 50, almost 50 percent of American men will have microscopic signs of prostate cancer. By age 75, almost 75 percent of men will have some cancerous changes in their prostate glands. Do the maths. By 100 we’ve all got it!

So does this mean that life really ends at around 76? Fortunately no. Most of these cancers stay within the prostate, producing no signs or symptoms, or are so slow-growing, that they never become a serious threat to health. The good news is you die of something else before the prostate gets you! You die with it, rather than from it. That is an important fact to take in.

The real situation is that a much smaller number of men will actually be treated for prostate cancer. About 16 percent of American men will be diagnosed with prostate cancer during their lives; 8 percent will develop significant symptoms; but only 3 percent will die of the disease. Put another much more positive way, 97 percent won’t die from prostate cancer.

While some prostate cancer can be ‘aggressive’, breaking out from the prostate gland itself and attacking other tissues, including brain and bone, fortunately this is the minority scenario. The great majority of prostate cancers are slow growing, and it can be decades between the early diagnosis and the cancer growing large enough to produce symptoms. That’s the second important fact to take in.

So let’s look at diagnosis and get the “blood test” out of the way first. The blood test is called Prostate Specific Antigen, or PSA for short (we medico’s love acronyms). Up till then we had another test called DRE (digital rectal examination), which, quite frankly, was not all that popular. As medical students, we were taught “If you don’t put your finger in it, you’ll put your foot in it!” Despite this, ‘buyer resistance’ was high, so when news came through about a “blood test”, millions of men began rejoicing and the sale of rubber gloves plummeted. Unfortunately, PSA is not a go/no-go test. A normal range test doesn’t guarantee you haven’t got it, and an elevated result doesn’t automatically mean that you are about to claim early on your life insurance (or your dependents, anyway).

However, there is good news. Serial PSA examinations can show the rate of cancer growth, and the rate of increase is more significant.

Like many other cancers, prostate cancer can only be fully diagnosed and ‘staged’ by biopsy. ‘Staging’ has four main grades. Stage I cannot be felt and is diagnosed through pathological testing. Stage II can be felt, but it is confined to the prostate. Stage III is coming out of the gland and Stage IV has grown into nearby tissues.

This is where you need to discuss your options with your doctor. If you are a young man with stage IV, then you have to make up your mind quickly. But if you are 75 with stage I or II, then you have more time, as you will most likely die of other causes before the prostate cancer gets you. For these people, “Watch and Wait” has much going for it, but you must be prepared to get to know your urologist. Pick one younger than you!

According to Kawasaki, they have just unveiled a motorcycle that is so fast even daredevils are wondering if it is too powerful.

With a design inspired by Formula One motor racing cars and a supercharged engine that uses aerospace technology, the Kawasaki Ninja H2 covers from 0 to 100 km/h in less than 2.5 seconds.

Well, we learned that Rosberg has the mental strength to resist Hamilton and that the two Mercedes drivers are streets in front of the opposition. And when I write “streets ahead” I mean it. Third placed Massa (Williams) was 41 seconds behind the Mercedes duo.

The battle at the front was interesting, without being nail-biting, quite frankly. It was obvious that Hamilton could catch Rosberg, but was never so close as to make a pass anything but optimistic.

Massa was given a five second penalty for speeding in the pit lane, and at that point it looked as if the diminutive Brazilian’s hopes of a podium were dashed. However, he recovered and continued, and then survived going into the McLaren box instead of his own, but this was probably because he couldn’t see over the dash? Whatever, it was a very popular podium for the Brazilian crowd.

With the driver pairings at McLaren still not made public, Jenson Button, now an old man in F1 terms, has been trying very hard and has bested his team mate recently, and his fourth place was the result of an intelligent drive. Whilst Kevin Magnussen has done a sterling job, he has been eclipsed by the very experienced Button, and if one has to go to make the place for Alonso, results would say to keep Button. However, how much does Button think he is worth, compared to how much he will accept?

Vettel, who is off to Ferrari next year, had a steady drive without being switched on at all. He seems to be just stroking it home and ready to say goodbye, if he hasn’t done so already.

Alonso put in his normal 110 percent drive, but it was noticeable that the Ferrari pit wall did nothing to help him when he was bottled up behind Raikkonen. If they had made Kimi move over Alonso could have challenged Button. Fernando is no longer the shining light at Maranello.

Raikkonen woke up for Brazil and tried for the two stop strategy, which almost worked. How will he go next year with Vettel alongside? I predict it will be back to sleep again. Enzo would not have put up with such flouting of the Ferrari rules.

The last driver on the same lap as the leaders was Nico Hulkenberg in the Force India, coming in behind the two Ferraris. When will someone give this driver a good car?

What was noticeable was the lack of penalties for having four wheels off the racing surface. There was one particular corner where everyone was cutting off the apex with all four wheels off the racing surface. Stewarding not consistent (as usual).

Finally, tyres again. With the soft tyres not lasting, most drivers had to come in and change for the more durable compound after only five laps. Race rubber that lasts five laps? Give me a break, Mr Pirelli. That is ridiculous.

So the WDC goes on to the final race at Abu Dhabi with the very contrived points available for the last GP of the year. Hamilton is in the box seat with a 17 point advantage, and he only has to finish one place behind Rosberg and the title is his. With the Mercedes dominance, it is almost a foregone conclusion that they will return with a 1-2, which again gives Hamilton the title, even if he is second.

So now we go into fortune telling mode, trying to work out who will have the best car for 2015, and who will be sitting in it? Looking at this year, you would have to say that Mercedes has the best platform to work from - but we shall see.

During the three month layoff, the powers that be (read B. Eccles) and the FIA have to work out what to do about the dwindling number of teams being financed by the dwindling number of sponsors with dwindling purses. The free lunches are well and truly over, gentlemen.

Thursday, 13 November 2014 10:56

Mazda MX-5 one make series

Mazda has announced that the upcoming fourth-generation MX-5 will form the basis of a new global race series starting in North America, Europe and Asia in 2016.

The track-prepped MX-5 racer was previewed at this week’s SEMA show in the US, with the show car wearing a discreet aero body kit, single outlet exhaust and larger wheels than the road going example revealed in September.

The interior has also been stripped out to make room for a race-spec roll cage, steering wheel and instruments, along with a racing seat and harness for the driver.

MX-5 racerMX-5 racer

What is shown may not be the final form that takes to the grid in 2016. Further development will occur over the coming months, with the final specifications confirmed when the car goes on sale in 2015.

Mazda has confirmed that the Global MX-5 Cup racers will use the 2.0 liter Skyactiv-G petrol engine destined for the road car in some markets.

Each regional series of the Global MX-5 Cup will run identical production-based machinery, and the season will culminate in with a Global Shootout grand finale at the end of the year held at Mazda Raceway Laguna Seca in the US.

The prize for winning the Shootout will be a one-day test in Mazda’s Skyactiv-D LMP2 prototype racer, which competed this year in the Tudor United SportsCar Championship in the US.

Single-make global series like this are not new, with Porsche’s Carrera Cup running in Asia for a decade and in Germany since 1986. However this is Mazda’s first tilt at a factory-backed single-make series.

Previously, their involvement has been limited to the US-based MX-5 Cup and Spec Miata series. There was also an MX-5 Challenge held between 2011 and 2013, which pitted motoring journalists from Australia and Europe against each other in conditions not typical of the topless sports car. It was indeed a snow challenge, and I would have certainly put my hand up for that one, as I am a great fan of the MX-5, having had one as a daily drive car for three years.

They also make very good track cars with Brian Farrabee, a friend of mine in Australia, running a fleet of older MX-5’s as rent-a-racers.

Thursday, 13 November 2014 10:54

Toyota steamrollers the others

Toyota Motor Corporation, the world’s largest auto manufacturer, is looking at a record full year profit. How much? $17.5 billion. This represented a 3.3 percent increase. Total sales for 2014 is estimated as 10.22 million vehicles.

However, Honda claimed 19 percent profit, but Nissan trumped them all with a 25 percent half year increase in profit. Some of the increase in profits has come from the lower Japanese Yen in the money market, making exported cars relatively cheaper.

The marketplace in China remains a problem for the Japanese automakers, as the anti-Japan sentiment is still strong, while the total Chinese market has slowed (as has the Thai market).

It will be an interesting time ahead for the local vehicle and parts manufacturers.

Thursday, 13 November 2014 10:48

Autotrivia Quiz

Last week I asked what was the significance of XOO 349 F? Hint: Ford. It was the registration number of the championship winning Ford Escort Mk1 driven by Australian Frank Gardner in 1968. That car was fitted with a 240 BHP FVA engine, which was legal under the 1968 rules.

So to this week. The AC Ace did not start its production life as an AC, but as something else, which was purchased by AC and its Bristol engine removed. Of course, the ultimate form of this car was the 7 liter Ford Shelby Cobra. What was that original car?

For the Automania free beer this week, be the first correct answer to email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Gardner and XOO 349 F.Gardner and XOO 349 F.

Wednesday, 12 November 2014 15:27

Medically assisted suicide and Living Wills

A poor young woman in the US just took her own life with a medically assisted suicide, rather than face a lingering painful death from an aggressive brain tumor. This is legal in only five states in the USA. Was this a Living Will or not? I also received a request from an ex-pat friend of mine to enquire as to whether euthanasia was offered by my hospital.

Unfortunately, there is confusion in the minds of many people, as to what a “Living Will” actually is and what it covers. Borrowing from the Mayo Clinic in the US, it states on their website “This written, legal document spells out the types of medical treatments and life-sustaining measures you do and don’t want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation.” The important words to note are “life sustaining” and “resuscitation”. Neither of these concepts implies medically assisted suicide, or euthanasia.

In Thailand, I can state categorically that medically assisted suicide is against the law. Period. No further discussion.

Once again from the Mayo Clinic, “Injury, illness and death aren’t easy subjects to talk about, but by planning ahead you can ensure that you receive the type of medical care you want, to take the burden off your family of trying to guess at what you’d want done.”

Remember that we are talking about terminal situations here. Not situations from which it would be reasonably expected that you will recover and still have a good quality of life. A fractured hip when you are 90 is a serious situation, but provided you are healthy otherwise, then it would be expected that you would recover. You might need a stick for a while, but you would still be able to have a beer with your mates or play Scrabble or whatever your pursuits were before the incident. In other words, the expectancy of a reasonable quality of life is there.

However, if you are in the terminal phase of metastatic cancer, which has progressed despite treatment, the future quality of life is not there. Artificially prolonging life under that situation is then covered by the Living Will.

As an example, I ask you to note the following:

The Living Will is made while in sound mind. It is not something you scribble out while lying in God’s waiting room. An example of a Living Will. “Being of sound mind and understanding all the implications, I ask that this document be brought to the attention of any medical facility in whose care I happen to be, and to any person who may become responsible for my affairs.

“This is my ‘Living Will’ stating my wishes in that my life should not be artificially prolonged, if this sacrifices my Quality of Life.

“If, for any reason, I am diagnosed as being in a terminal condition, I wish that my treatment be designed to keep me comfortable and to relieve pain, and allow me to die as naturally as possible, with as much dignity as can be maintained under the circumstances.

“As well as the situation in which I have been diagnosed as being in a terminal condition, these instructions will apply to situations of permanently unconscious states and irreversible brain damage.

“In the case of a life-threatening condition, in which I am unconscious or otherwise unable to express my wishes, I hereby advise that I do not want to be kept alive on a life support system, and I do not want resuscitation, nor do I authorize, or give my consent to procedures being carried out which would compromise any Quality of Life that I might expect in the future.

“I ask that you are sensitive to and respectful of my wishes; and use the most appropriate measures that are consistent with my choices and encompass alleviation of pain and other physical symptoms; without attempting to prolong life.”

Now those are only examples. The Bangkok Hospital Pattaya has a pro forma Living Will, which is also repeated in the Pattaya City Expats website, I believe.

But remember that the message is that a Living Will is not euthanasia, and that you must lodge it, before you need it!

Thursday, 06 November 2014 10:12

Brazil GP this weekend

The Autodromo Carlos Pace in Sao Paulo Brazil plays host to the F1 circus in this their last race for the season. However, with the Constructors championship already sealed, and the Driver’s Championship all but sealed, there will be no nail biting down to the wire racing at this meeting.

Thursday, 06 November 2014 10:09

Mazda BT 50 gets great rap in Oz

An extended road test was done by one of the car magazines in Australia of the Thai-built Mazda BT 50. It was one of the most glowing reports I have ever read!

Thursday, 06 November 2014 10:05

Rare 1957 Mercedes-Benz 220 SL

The Motorclassica Concours d’Elegance held in Melbourne had an ultra-rare Mercedes-Benz 220 SL roadster prototype from 1957, one of just four experimental W127 cars built and this one was the only known example left in the world. Celebrating 60 years since the 300 SL ‘gullwing’ coupe and 190 SL convertible were unveiled at the 1954 International Motor Sports Show in New York, Mercedes-Benz Australia/Pacific arranged for the 220 SL classic prototype to be displayed alongside a special 60th anniversary edition of the latest SL-Class coupe-convertible.

Mercedes-Benz 220 SL

The SL prototype on display was the only version of the six-cylinder roadster ever built in right-hand drive and belongs to an Australian collection.

Its rarity is recognized by the Mercedes-Benz Museum in Stuttgart, which confirmed the model never went into series production and that only four experimental cars were built.

The whereabouts of the other three W127 220 SLs built - all left-hand drive - remains unknown.

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