There was a time when we did not speak of it, refused to recognise it and pretended that it did not exist.

Things have changed for the better now but not for all types of cancer.

Some cancers are still difficult to discuss, and that includes prostate cancer.

This is why we were delighted to hear of how former CIMB CEO Datuk Seri Nazir Razak has decided to step up and speak about his personal experience with prostate cancer and how he is now helping to create more awareness about the disease.

When speaking to Rojak Daily, Nazir said that he first discovered that he had prostate cancer by accident and repeatedly stressed that he was "one of the lucky ones".

“I was recommended an insurance product by my CIMB wealth advisors in October 2018 and I liked the product and said ok. The insurers required me to take a medical test and I said sure, because I’m a very healthy guy,” he quipped.

Because he happened to be in the UK at the time, Nazir went to a GP there to get the test done and suddenly found that his PSA (Prostate Specific Antigen), which is a prostate cancer marker was high.

“They told me that this could be prostate cancer. From there, we moved to the next stage, which was an MRI.

“Here they basically took pictures and we could quite clearly see three or four tumours in the prostate.”

Describing it as the most uncomfortable part of the whole experience, Nazir said that doctors then had to perform a biopsy which basically required them to cut into the area and take a sample from his prostate.

Only after this procedure was his prostate cancer confirmed.

“I had no inkling. I had very little knowledge and I had no symptoms. This is why some people call this thing a silent killer because you have no symptoms and the next thing you know you find out and it’s too late,” he said.

Fighting prostate cancer

Nazir said that once he was suspected of prostate cancer, he started to read as much as he could about it.

“Knowledge can be powerful so by the time I was confirmed as having prostate cancer, I already knew what it was and I knew that provided it was still at an early stage, the chances of decisive treatment and complete recovery was very high.

“The definition of prostate cancer is this. Early stage means that the cancer has remained in the prostate. When the cancer is still in the prostate, they can remove the prostate and the cancer along with it.

“But when it's at an advance stage, this is when the cancer has left the prostate and has started to spread to the rest of the body,” he explained.

Once spread, it gets much more complicated.

“That’s why some people die from lung cancer but the origin was from the prostate because the cancer has spread to other parts.”

Survival chances

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On initiating the campaign itself, Nazir said that it was something he felt he should do because of the high survival rate for this particular type of cancer.

“Our messaging is all about how men can survive prostate cancer IF detected early. If you look at the data, 60% of prostate cancer in Malaysia is discovered at an advance stage. International averages are around 20% to 25%.

“So, we are on an agenda to bring that number down. If I bring that number down, I’m going to save lives and I’m going to save a lot of men, a lot of pain,” he said plainly.

As for early detection, Nazir said that it was slightly tricky when it came to prostate cancer.

He said that the main issue was that the percentage of false positives for the PSA test was relatively high.

“Rather than have everyone test so regularly and keeping in mind that prostate cancer usually happens with older men, we advise that if you’re over 50, you should test it annually.

“If you’re below 50, you should have it tested if you have symptoms. If you have a history in the family, then maybe test it earlier. That’s the official advice that the urologists in Malaysia are giving,” he said.

Treatment options

Treatment for prostate cancer also differs from one patient to another.

Some patients will be advised just to let it be and keep an eye on it while others will be advised to remove the prostate altogether.

“It just depends on how aggressive it is. Every man gets prostate cancer, the vast majority get it after they’re dead or when they’re dead.

“The estimate is that 10% of men will get it in their lifetime and out of that 10% not everybody needs to get it treated. Sometimes the advice would be just to let it be,” he said adding that the decision on what to do should be following advice provided by experts.

As for his own experience, testing the aggressiveness of his cancer was based on the Gleason Score.

“The Gleeson Score estimates how aggressive the cancer is which equates to the chances of it leaving the prostate.

“Men with high testosterone or at a younger age, tend to get a high Gleason Score if they have prostate cancer. The Gleeson Score is between 1 to 10. Mine was 9, so it was very aggressive.

“Eventually when they had it removed and tested it they told me that if I had waited three to four months, it would have become advanced. I was very lucky,” he said adding that if detected early, over 90% of prostate cancer patients survive it for 10 years.

Survival rates plummet to about 20% if detected late.

Opening up about prostate cancer

Discussing cancer can be difficult, and with shy Malaysians, speaking about prostate cancer can be additionally challenging.

This was not the case for Nazir, though. “I’m a very open person and I’m quite chilled about it. But I do know that the reason why we have such a high number of late discoveries is because people don’t want to talk about it,” he said.

He added that it was essential to understand the symptoms of prostate cancer and get proper treatment.

On the symptoms itself, Nazir said that “Firstly men will feel like they have to urinate more frequently and secondly, I’m not sure if you’re going to quote me on this directly, you basically can’t get it up.”

“These are the most common symptoms, and a lot of men get these kinds of symptoms, and they don’t want to talk about it.

“They’re not going to get it tested because it’s quite embarrassing to go to the clinic and say “I can’t get it up”, but that’s why I’m here.

“This whole project is to get it out there and say if you can’t get it up, you may have prostate cancer. I don’t care if you’re embarrassed, you better get it tested because you could die,” he said, with a noticeable change in his tone.

Just push through your fears

When asked what the most challenging part of the whole process was, Nazir said that it was the biopsy as it included minor surgery.

“They basically go in and stick a needle in a very very sensitive area of your body. The biopsy itself took me a little bit of time to recover from, and that’s the painful one.

“The other tests for prostate cancer are the PSA blood test and the digital rectal exam or DRE.

“Some people find it painful, some people tend to enjoy it,” he remarked cheekily.

Nazir said that as with all types of surgery, there were always risks involved.

“You read up about it, and you realise that a lot of things can go wrong. Sometimes removing the prostate is successful, but they cut other parts accidentally, and you have different kinds of problems, infections and so on.

“So, you worry. The recovery process is also quite critical. You want your body to get back to normal. You need to do pelvic exercises very diligently and also “other stuff” to make sure you’re back in "full gear",” he said.

All things considered, Nazir said that discovering the cancer early and getting it treated was the most important.

“Fear of surgery and recovery and so on is something you just have to face. The worst thing is if you fearful and then you don’t get treated, and you die,” he said.

A life changing experience

While recovering, Nazir explained that it gave him plenty of time to think about his life choices and there were a number of things that he regretted.

“Previously, I used to get involved in a lot of things. I don’t sweat on the small stuff like I used to.

“I also wished I lived a healthier life. They don’t know what causes cancer. They all guess but, I smoked too much for a start and stress was my middle name, given the job I had. My mind was always at work.

“I was also not disciplined with exercise and diet, and on reflection, I wish I was better at all those other things,” he noted.

Nazir added that after recovering, he was elated to have survived and felt that it was vital that he did something to give back to society.

“When I came back home, I called renowned urologist Dr George Lee. We’re friends.

"I asked him if he could round up some of the top urologists and come over for tea. So, the five of them came over and I asked them how I could help,” he said.

He added that from there, they identified some of the significant challenges relating to prostate cancer in Malaysia and decided to come up with the awareness campaign and other initiatives.

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“I joined the prostate cancer trust fund by Universiti Malaya and the trust together with the urologists have basically come up with the plans to do what we’re doing now.

“My job is to come up with the money for it and also be out there and be the face of the campaign. So, from the face of CIMB, I’ve voluntarily become the face of prostate cancer now,” he laughed again.

It’s all not fun and laughs, though. The team have a massive target to meet.

They hope to bring down the number of those who discover prostate cancer late in Malaysia to 30% (It’s currently at 60%).

They are also putting together programs to educate general practitioners or GPs on the issue.

“One of the problems in Malaysia is that we don’t have that many urologists, so we’re dependant on GPs to identify and provide the right advice to those suspected of prostate cancer,” he said while revealing that there are currently 128 urologists in the country and only 20 in the public sector.

Nazir said that if all goes well, they also hope to raise more funds to enable free testing for prostate cancer and whatever else needed to help with the cause.

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“The main message is early detection, I was over 50 and I was lucky that I detected it because I was trying to buy an insurance product. I should have detected it because I was diligent in getting my annual checks.

“I am an example of a guy who got lucky. I want everyone to get lucky,” he said.

So, understand the symptoms, read up on the risks and get your checks done.