Simon Wilson: Is 'ignorance is bliss' the official cancer policy?

Cheap, reliable new test may not be far away, experts believe.

Most people know women tend to live longer than men. Life expectancy in New Zealand is currently 83.2 for women and 79.5 for men, according to Statistics New Zealand. Visit a retirement home and you'll see many more women there than men.

But it's not because most men die just a few years earlier than most women. It's because 30 per cent more men than women die between the ages 50 and 75.

Why? Cancer and heart disease. And, says the Ministry of Health, "Prostate cancer is the most commonly diagnosed cancer in men."

Although it's not the biggest killer. That's lung cancer (5.8 per cent), followed by bowel cancer (4.3 per cent). Prostate cancer accounts for 3.6 per cent of male deaths.

One celebrated American study found that 31 per cent of men in their 30s had prostate cancer, along with 40 per cent of men in their 40s and 70 per cent of men in their 60s. That's the good news, actually: most men die with it but few die of it. What's more, the older you are the less aggressive it's likely to be.

Still, it kills 600 New Zealand men each year. The risk is real, especially if you're over 50 – or 40 if there's family history.

So what's a middle-aged man to do? Find out if you've got it, obviously, so you can work out what to do.

Try telling that to the Ministry of Health.

There are two early tests: a digital rectal exam and a PSA (prostate specific antigen) blood test. The finger test is unreliable and, supposedly, so is the PSA. The ministry says it's up to you whether to have it. If you're concerned talk to your doctor.

It says to doctors: offer the PSA test to men who have a family history of prostate cancer, but don't raise the issue with all men. That is, do not use the PSA as a de facto screening programme. Why not?

Graeme Woodside of the Prostate Foundation says attitudes to the PSA test have been informed by US practice, where doctors want to "cover their backsides" by using only the most reliable tests. Yes, he really did say that.

The symptoms of prostate cancer, like difficulty urinating, can also have other causes, such as an infection or a benign prostate enlargement. The PSA and digital rectal exam (the finger test) are unreliable because they don't always rule out those things.

For a reliable test, you need a biopsy and/or an MRI. But they're far too expensive to use in a screening programme.

However, the Prostate Foundation, like the ministry itself, doesn't regard the PSA as a diagnostic test. They both see it, instead, as a tool for risk analysis. Get the blood test, and if your PSA level is up, showing you're at greater risk of having prostate cancer, then you get a biopsy or MRI.

In this way, the PSA could easily be used as a screening tool.

But there's another issue and its much more complicated. Say you're 55 and your PSA count is up. You have an MRI and it reveals cancer in your prostate gland, but it hasn't spread. What do you do?

Surgery and radiotherapy offer a good chance of eliminating the cancer. But they're invasive. There will be pain and a weakened immune system. With surgery, you could become permanently incontinent and your sex life could be over. Hormone therapy is another option, but that will affect your personality and it could kill off your sex life too.

You might be better off doing nothing, just living a healthy life and monitoring it. In 80-90 per cent of men with untreated prostate cancer, the disease doesn't spread within the first five years after diagnosis. For many it's way longer than that. If it does start to spread, then you sign up for treatment.

But prostate cancer is much easier to cure before it spreads.

This is not an easy decision. Not having a screening programme avoids putting many men through the anguish of having to make it, but it also condemns some of them to an earlier death.

That's especially true for Maori men: among those who contract the disease, Maori are 72 per cent more likely than non-Maori men to die of it.

Ignorance is not bliss. It kills. So why don't we do the tests and have the conversation? What other policy is acceptable?

The Prostate Cancer Foundation's annual conference takes place in Wellington tomorrow, with a focus on ways to improve diagnosis and treatment strategies. Much of the talk will be on the likelihood of a new test for prostate cancer that's cheap and reliable. Woodside says it might be a genetic test or it might involve blood or urine.

He thinks it's not far away and I hope he's right. But here's another statistic: according to the Health Research Council, for every dollar spent researching women's health, the amount we spend researching men's health is six cents.