Ministry defends cancer test criticism
New Ministry of Health advice on prostate cancer testing could lead to the needless mutilation of thousands of Kiwi men, the American scientist who discovered the test says.
Brochures encouraging men to talk to their GPs about prostate cancer have been attacked in prominent international medical journals, and New Zealand experts claim they are "taking a gamble with men's health".
Richard Ablin, who discovered the prostate specific antigen (PSA), said the leaflets were "waving a red flag in front of a bull" and could lead to a public healthcare disaster.
"What this leaflet is doing is telling you that, if you get to 50 and there is nothing bothering you, then you should go to your GP and start fishing around looking for trouble - and that could lead to a tremendous burden on New Zealand's healthcare system," he said.
Invasive PSA testing, the most commonly used tool for detecting prostate cancer, caused an international health controversy in 2011 after a leading United States Government task force found the test did not save lives and caused more harm than good. PSA testing can lead to the unnecessary treatment of non-lethal cancer and leave men impotent and incontinent.
The debate has now flared up in New Zealand after the ministry kickstarted a $4.3 million prostate cancer awareness programme and posted out booklets, brochures and posters to every general practice in the country late last year.
The resources outline potential symptoms of prostate cancer and encourage men to talk to their GPs about the disease and the PSA test.
Critics claim the information does not lay out the risks of testing.
Wellington GP Chris Kalderimis said he threw the brochures away and contacted his Primary Health Organisation and medical college to complain about them.
"Like a lot of the members of my profession, I'm not happy with them," he said. "Instead of giving [patients] balanced information, it really pushes them into an anxiety about what may be going on and I don't think it's helpful."
University of Otago cancer epidemiologist Brian Cox has labelled the resources "the poorest information packs sent out by the ministry in a very long time".
"It is important the MOH is not responsible for a large cause of ill-health in men in New Zealand, and that is very much likely to happen under this information. This is a big gamble, and unfortunately it is a gamble with men's health."
The ministry has rejected the criticism and says the resources were designed to provide men with a talking point about prostate cancer, which kills 600 men each year in New Zealand.
The Prostate Cancer Foundation says the pamphlets are perfectly balanced and has branded the critics "pathetic".
It was backed by Rodney Studd, a urologist based at Wakefield Hospital, who also believed the ministry information was balanced.
Criticism of PSA testing was often based on flawed US research, while European research showed screening was beneficial, Mr Studd said.
But he said doctors needed to be more selective when advancing patients from the biopsy stage to radiation or other cancer treatments. There was little value in treating old men who would not have their lives extended by treatment.
"You want to treat men who are young enough to benefit, not old crumbly men."
Dr Ablin, who discovered PSA in 1970, said he was concerned the ministry brochures would encourage Kiwi men to look for cancer and seek treatment when there was no evidence that screening prolonged life.
But Mr Studd said unnecessary "overtreatment" of prostate cancer was not as common in New Zealand as it was in the US.
PSA testing, which includes a blood test and rectal examination, often prompts a biopsy and, because prostate cancer is age-related, when an older man is tested there is a 70 per cent chance he will have cancer - but it is impossible to know if he will ever see any symptoms or die from the disease.
The Dominion Post