New Zealand needs to do more to promote early prostate cancer detection – Geof Mortlock

The case for a prostate cancer screening programme is at least as justified as for bowel cancer, breast cancer, and cervical cancer screening, given the high mortality and morbidity associated with prostate cancer. And yet nothing is being done about it.

Let’s consider the following:

Each year, over 4000 men in New Zealand are diagnosed with prostate cancer. Around 1 in 8 men in New Zealand will be diagnosed with prostate cancer. Each year over 700 men in New Zealand die from prostate cancer. Prostate cancer is no longer just an “older man’s” cancer. Increasingly, globally, younger men (in their 30s and 40s) are being diagnosed with prostate cancer. Obtaining reliable data on this in New Zealand is hampered by the general lack of regular prostate cancer testing in men under 50. There are more deaths from prostate cancer in New Zealand than there are deaths from breast cancer in women (around 650) or from cervical cancer (around 60). Prostate cancer is generally fatal once it reaches stage 4 (metastatic). However, if it is detected early – e.g. at stage 1 or 2 – then the long-term survival rate is very high indeed.

The number of men diagnosed is predicted to double in New Zealand by 2040. Early detection is therefore crucial.

The widely applied screening test that measures activity in the prostate that could indicate cancer is the Prostate Specific Antigen (PSA) blood test. Although an elevated PSA is not necessarily indicative of prostate cancer, it provides a basis for further investigation, including through an examination by a GP and potentially a referral to a urologist for an MRI scan and possibly a biopsy.

There has been much debate among medical professionals and others about the efficacy of prostate screening. However, the body of international research evidence now shows that the benefits of an age-cohort and risk-based screening programme would bring greater benefits (economic, social, psychological) than costs.

Detection of prostate cancer does not necessarily lead to medical or surgical treatment. If a significantly elevated PSA leads to an MRI scan and potentially a biopsy, and cancer is detected, the medical response will depend on the stage of the cancer and its aggressiveness. If the cancer is at an early stage and is assessed as being relatively non-aggressive, the medical response might simply be to monitor the situation, with no medical treatment required, at least for the time being. If the cancer is beyond stage 1 or 2 and/or is assessed as being relatively aggressive – then it will likely warrant a medical intervention – possibly radiation or prostate removal, and possibly accompanied by an androgen suppressant or other medical options. Each case is different and the medical response option is determined on a case-specific basis.

The point here is that we need to separate early detection, on the one hand, and medical response options if prostate cancer is discovered, on the other. Sadly, the debate over prostate screening has become confused over these two very different matters.

What is beyond any doubt is that early detection is absolutely fundamental. If detected early, a man has a very high survival prospect and relatively low-cost medical treatment. But if prostate cancer is detected at a relatively advanced stage, the survival prospects are worse and the medical treatment options are much more expensive and debilitating.

New Zealand is falling behind many countries in the initiatives to detect and combat prostate cancer. And men are paying a fatal price as a result.

I urge politicians – led by the Minister of Health – to work together, across party lines, to assess the options for prostate cancer screening in New Zealand and implement a cost-effective solution. Various options could be considered, including:

A government-funded annual prostate awareness campaign that encourages men in their 40s, 50s and 60s, and those with a family history of prostate cancer, to see their doctor annually for a prostate health check. This should be supported by the government working with the GP professional bodies to encourage more proactive testing by GPs of male patients in the target cohorts. Many GPs are still failing to be sufficiently proactive in this regard. Targeted subsidies for low-income men in their 40s, 50s and 60s, and those with a family history of prostate cancer, to enable them to see their GP for a prostate health check and to pay for an MRI scan if required. Accepting the invitation New Zealand has received to join the PRAISE-U international consortium to carry out pilot programmes of risk-stratified prostate cancer screening of men, as backed by the international research. Developing a nation-wide programme of publicly funded or subsidised prostate screening for men in their 40s, 50s and 60s, and those with a family history of early onset prostate cancer, similar in nature to that for bowel, breast, and cervical cancer.

We cannot continue to do nothing on this issue. Too many men are suffering and dying from a cancer that, if detected early, would be fully curable.

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