Inquiry into early detection and treatment of prostate cancer

Prostate cancer is the most commonly diagnosed cancer in New Zealand men, and the third most common cause of cancer deaths. Approximately 3000 new cases are diagnosed each year and around 560 die of the disease each year. The Health Committee was advised the mortality rate is similar to that of breast cancer.

Each year approximately 40 percent of New Zealand men over 50 years of age have a PSA test. “There has been vigorous debate between public groups, some clinicians and epidemiologists about the value of screening using the Prostate Specific Antigen (PSA) blood test, and the benefits of early detection and treatment,” committee chairperson Dr Hutchison says.

In 2004, the National Health Committee in New Zealand stated “the NHC does not recommend screening men without symptoms for prostate cancer regardless of age, because the risks associated with screening and subsequent treatment exceed any benefits”. “This led to confusion amongst men as to what sort of action they should take, with some doctors not informing men or dissuading them from having tests. In contrast, urological surgeons submitted that they would regularly see men with advanced prostate cancer who were frustrated and angry they had no knowledge or choice to seek a PSA test. Subsequent advice from the Ministry of Health in 2005, 2007 and 2008 did not actively discourage testing for prostate cancer, but considered the evidence was not strong enough for a national screening programme,” Dr Hutchison says.

The committee’s report also focuses on recent international randomised trials examining prostate cancer screening. The trials compare the health outcomes for men who are screened for prostate cancer and men who are not, and had varying results. The Health Committee does not support the establishment of a national prostate screening programme at this stage, but strongly advocates for New Zealand men to be encouraged to make informed choices.

The committee heard that there are inequities in the process of investigation and treatment after diagnosis. Maori men in particular tend to be diagnosed during later stages of the disease and have a higher mortality rate than non-Maori. “There is a strong case to establish a quality improvement programme relating to the early detection and treatment of prostate cancer, within 12 months” committee chairperson Dr Paul Hutchison says.

The Health Committee drafted a statement after hearing evidence from a variety of interested parties and this is on page 8 of the report.

“In contrast to recommendations of the National Health Committee in 2004 not to screen for prostate cancer, the Health Committee is seeking major changes,” Dr Hutchison says. “The committee’s recommendations include that the Government -

• encourage and promote the case for men to seek up to date evidenced based information from their general practitioners about the advantages and disadvantages of screening and treatment for prostate cancer.
• encourage and promote the case for general practitioners to provide men with initial consultations about the advantages and disadvantages of screening and treatment for prostate cancer. The initial consultation should take place during the cardio-vascular risk assessment which is recommended in the national guidelines, and is conducted upon men at the age of 45 or 10 years earlier for men with known risk factors.
• encourage general practitioners to advise men with a strong family history of prostate cancer that they have the choice of having their full history noted and then undergo a clinical examination, PSA testing and rectal examination from the age of 40.
• establish a quality improvement programme relating to the early detection and treatment of prostate cancer. The programme should ensure that all men with prostate cancer have fair access to good quality care (to be achieved within 12 months).”

The full report can be found on the parliament website, along with the submissions received by the committee and the advice it received. The Government’s response to the committee’s recommendations must be presented by 25 October 2011.

For more information contact:

Dr Paul Hutchison

Chairperson, Health Committee

021436389