Doctors slate prostate leaflet
New Ministry of Health prostate cancer leaflets "superficially gloss over" the risks of PSA testing and could lead to the needless mutilation of thousands of Kiwi men, the American scientist who discovered the test says.
The brochures, which encourage 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".
American scientist Dr 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 taskforce 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 with debilitating impotence and incontinence issues.
The debate has now flared up in New Zealand after the Ministry of Health kickstarted a $4.3m prostate cancer awareness programme and posted out booklets, brochures and posters to every general practice in the country late last year.
The resources outlined potential symptoms of prostate cancer and encouraged men to talk to their GPs about the disease and the PSA test.
Critics claim the information tells only one side of the story and does not lay out the risks against the benefits of testing.
One South Island GP is calling for doctors to boycott the entire programme and has written to Health Minister Tony Ryall urging him to withdraw the information. Another GP told The Press he dumped the brochures in the trash.
University of Otago cancer epidemiologist Brian Cox has labelled it as "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."
However, the Ministry of Health (MOH) has rejected the criticism and says the resources were designed to provide men with a talking point about prostate cancer - a disease that kills 600 Kiwi men each year.
The Prostate Cancer Foundation says the pamphlets are perfectly balanced and branded the critics as "pathetic".
The opposing groups accuse each other of politicising the argument and ignoring the research.
Ablin, who is a research professor of immunobiology and pathology at the University of Arizona and discovered PSA in 1970, believed the misuse of the test had crippled millions of healthy men and caused an international public health disaster.
He told The Press he was concerned the MOH brochures would encourage Kiwi men to look for cancer and seek treatment when there was no evidence that screening prolonged life.
Certain statements in the pamphlets were misleading and would "scare the s... out of you", which could likely result in a "gold-rush" of men heading to their GP to get tested, he said.
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 overall risk of dying from prostate cancer is 3 per cent.
Radiation treatment and surgery to remove the prostate often leaves men "mutilated from a standpoint of chronic incontinence and impotence", Ablin said.
"Cancer is probably the most feared word in any language but the decision of whether or not to seek treatment for prostate cancer is like crap-shooting or rolling the dice. The man has to determine the quality of life he wants to have in his remaining years."
John Nacey, chairman of the MOH prostate cancer taskforce and professor of urology at the University of Otago, said the brochures were designed for men who had a family history of prostate cancer or suffered from anxiety over the illness, but "struggled to know exactly what to do about it".
"Prostate cancer is a major, major killer. I understand where these critics are coming from, but for goodness sake we just want to give men a better chance. We don't want to test everyone but we don't want to shut anyone out."
Blenheim GP Dr Jim Vause, who was also a member of the MOH taskforce, was in complete opposition with Nacey and said the brochures were "a failing".
They did not provide men with both sides of the story and Vause feared they would promote "needless screening".
Prostate Cancer Foundation president Mark von Dadelszen supported the pamphlets and said "with all due respect to the critics, a well informed GP should be capable of acting professionally and should be able to give men good and reliable information."
About 600 Kiwi men die from prostate cancer each year.
International research shows if 1400 men underwent PSA testing over nine years, only one life would be saved.
The overall risk of dying from prostate cancer is 3 per cent.
Prostate cancer is age-related and about 70 per cent of men aged in their 60s have the cancer.
- © Fairfax NZ News
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