Mike Berton was a fit and strong man with no family history of prostate cancer.
He was diagnosed with an aggressive form of the disease at age 51, after having symptoms of urinating more than usual.
Mike died four years ago from prostate cancer at age 53.
"The first symptom was when he said 'I can't drink beer any more, I need to go to the toilet too much'," his wife Jen Berton said.
Jen, along with kids Bethany, 18, and Kai, 16, believe strongly in the importance of having a conversation about prostate cancer - especially this time of year.
"It's a triple whammy. It's Father's Day on Sunday, it is Mike's birthday on September 6 and it's also Prostate Cancer Awareness Month," Jen said.
To honour Mike, the family will hold the third annual 4X4 fundraiser on September 21 in the Watagans to raise funds for the Prostate Cancer Foundation of Australia.
Jen, of Kanwal on the Central Coast, said the family sought to put the spotlight on "early detection and education of PSA [prostate-specific antigen] blood testing".
Scientific opinions vary on prostate cancer screening with the PSA, which does not diagnose the disease but can be a clue that something is not right.
About 3500 men die of prostate cancer in Australia each year, including about 300 from the Hunter New England/Central Coast health network.
About 600 prostate cancer cases are diagnosed in the Hunter alone each year.
The foundation urges men to ask their doctor about risks, benefits and possible harms before doing the PSA test.
Jen Berton said "at least you're getting monitored and have options" with the PSA test.
"Doctors thought Mike had prostate cancer for five years with no symptoms," she said.
"This is life or death stuff. By the time they found it in Mike, it had spread and there were no options. All they could do was slow it down."
A 2023 article in the Australian Journal of General Practice said "recent studies show improved survival rates with early intervention".
"Men should be aware of the potential risk of significant prostate cancer, despite the lack of symptoms," it said.
"Current evidence shows that a PSA test helps assess that risk. Revisiting the need for early detection ... is critical."
It added that prostate cancer screening was controversial, amid concerns about subsequent treatment such as surgery causing "erectile dysfunction and urinary incontinence".
"If prostate cancer is found, low-grade disease can be managed with surveillance ... reducing the concerns associated with overdiagnosis".
A 2018 systematic review and meta-analysis, led by Monash University, examined the "efficacy and safety" of the PSA test.
It concluded that screening led to "a small reduction in disease-specific mortality over 10 years, but does not affect overall mortality".
"Clinicians and patients considering PSA-based screening need to weigh these benefits against the potential short- and long-term harms of screening," it said.
These included "complications from biopsies and subsequent treatment, as well as the risk of overdiagnosis and overtreatment".
The recent Lancet Commission on prostate cancer said "increased use of MRI in the diagnostic pathway reduces the risk of overdiagnosis".
Prostate Cancer Outcomes Registry data showed "increased use of active surveillance [rather than surgery] in patients with a low to intermediate risk of prostate cancer".
This reduced the "treatment-associated harms in men with low risk of progression", the GP journal article said.
Visit prostate.org.au for guidelines on the PSA test, which vary depending on age and family history.
