Prostates: testing the waters

FAIRFAX

CANCER: The widespread confusion many men feel over the advice they receive on early detection and treatment of prostate cancer is untenable, writes Paul Hutchison.

Relevant offers

OPINION: The widespread confusion many men feel over the advice they receive on early detection and treatment of prostate cancer is untenable.

That a leading New Zealand urologist, Robin Smart, recently concluded "the evidence suggests that between 200 and 300 of the 600 men who die annually of prostate cancer could be saved by current technology" indicates greater efforts need to be made.

He says, "there have been powerful discouragements to men contemplating PSA [blood] testing, and their family doctors, resulting in uncertainty and confusion".

Because of this, I felt it important to launch an inquiry. This call has been taken up by Parliament's health select committee. The inquiry is into "the early detection and treatment of prostate cancer". Submissions close next Monday.

About 2000 cases of prostate cancer are diagnosed each year. In a helpful but, I believe, cautious pamphlet published last year, the New Zealand Guidelines Group noted the chances of a diagnosis of prostate cancer for:

* A man in his 40s: 1 in 500 men.

* In his 50s: 1 in 50.

* In his 60s: 1 in 14.

* In his 70s: 1 in 9.

What is startlingly clear is that "if you have a close relative with prostate cancer, your risk of developing cancer is increased".

I have no doubt that New Zealand men should be made clearly aware of the risk factors because increasingly effective diagnosis and treatment are available.

There is ongoing debate as to the optimal early detection and treatment of prostate cancer. Dr Smart wrote in the December New Zealand Medical Journal: "An overwhelming body of evidence shows that PSA, prostate specific antigen [a blood test], and digital rectal examination leading on to transurethral ultrasound biopsy and curative treatments [where indicated], has been a major advance for men's health."

On screening, Dr Smart says a common argument used is that 450 men must be screened to save one from dying of prostate cancer (a figure which is disputed), and that this is too large to make screening worthwhile.

But the equivalent figure for breast cancer screening is 1700, and for cervical cancer screening 8000.

Dr Smart's views are more closely supported by other clinicians, such as Professor David Lamb and Professor Brett Delahunt of the Wellington School of Medicine. They wrote in Pathology in 2007 that there is now compelling evidence that:

* "Cancers diagnosed by screening are more likely to be early stage, when most can be cured by several treatment options.

* "The maximum benefits for screening are for men aged 50- 70.

* "Men with one or more first- degree relatives already diagnosed with the disease should be actively encouraged to undergo screening."

Two major trials on prostate screening (one in Europe and the other in US) were published this year and were hoped to bring greater clarity to the issue.

The New Zealand Guidelines Group is due to report by November on an extensive literature review on the effectiveness of screening asymptomatic men.

Associate Professor Brian Cox, an epidemiologist at Otago University, writing in the New Zealand Medical Journal in June, concluded: "Trial evidence suggests that claims of benefit from PSA testing in asymptomatic men have probably been overstated and the recognised harms must be rigorously considered to protect men from iatrogenic (doctor caused) illness."

The Australian Senate received recommendations in May from its select committee inquiry on "men's health".

The Australian report quoted the recommendations of the Prostate Cancer Foundation of Australia, which are that "all men from age 50 onwards would go to his GP and have a conversation about prostate cancer, they should have the blood test, the PSA, and they should have a physical digital rectal examination to feel whether there is any growth in the prostate".

The report concludes: "Prostate cancer is the most diagnosed cancer in Australia. At present the information available to those with prostate cancer and the services to support them are not adequate."

The same situation exists here. The New Zealand Prostate Cancer Foundation is responsible for an awareness campaign, Blue September, starting now.

While it is wrong to raise unrealistic expectations, the aim of stronger action is to avoid preventable deaths. I believe it is fundamental that New Zealand men are able to receive the best possible evidenced-based advice in a clear, concise way.

* Dr Paul Hutchison is MP for Hunua and chairman of the parliamentary health select committee.

- © Fairfax NZ News