Government opposes prostate screening

By MARTIN JOHNSTON health reporter


The Government has stepped up its opposition to prostate cancer screening in men who have no symptoms of the disease.

Health Minister Annette King has accepted a report from the National Health Committee which advises against prostate cancer screening - the existing policy.

But the report also recommends actively discouraging men without prostate gland problems, such as urination difficulty, from being screened by their doctors.

Many doctors now perform "digital rectal examinations" and order prostate specific antigen (PSA) blood tests for men without symptoms.

The committee believes doctors often offer the PSA test without fully informing men. Its report says men should be given detailed information about the limitations of the screening tests and the possible further tests and treatment.

"They should also be informed that ... it is not known if screening will reduce their chances of dying from prostate cancer."

The committee considered advising that men be forced to pay the cost of about $12 for the PSA test, but decided it was better to educate them and doctors. The decision against screening drew support from the Cancer Society and the Medical Association.

However, there was opposition from the Prostate Awareness and Support Society and derision from Tauranga urologist Dr Peter Gilling

He particularly objected to the plans, involving brochures for doctors and patients, to discourage screening symptomless men.


Prostate cancer is the most commonly diagnosed cancer in New Zealand men and the third most common cause of male cancer deaths. It kills about 550 men a year, two-thirds of them aged over 74.

For New Zealand women, breast cancer is the leading cause of cancer deaths, killing about 650 a year.

The National Health Committee says that the PSA and rectal tests are too unreliable to justify basing screening on them, that many men without cancer would undergo the next step of needle biopsies of their prostates, and that the treatments leave some men, whose disease might never have caused symptoms, incontinent or impotent.

Screening opponents often say that most men who get prostate cancer die with it rather than from it.

But Dr Gilling said the PSA test, which he followed up with additional testing was as good as breast cancer mammography.

Men were getting a raw deal compared with women, who had cervical and breast screening programmes.

"I've got men in their 40s and 50s dying of prostate cancer which might well have been prevented had they been vigilant early on with PSA tests."

But the Health Ministry said strong evidence existed that breast and cervical screening reduced cancer deaths. There was no such evidence yet about prostate screening.

Prostate cancer survivor Trevor Green questioned this.

The 55-year-old building compliance officer from Papakura said his cancer was picked up after his doctor suggested, during a routine medical check in 1995, that he have a PSA test. He went on to have his prostate removed.

"What we've got to get through to men is that prostate cancer [often] gives you no symptoms. If it hadn't been for my doctor saying, 'I'm going to check up on you' and giving me a blood test I would never have known."

The Prostate Awareness and Support Society urges men to discuss prostate health with their doctors from the age of about 50 and earlier if they have a family history of prostate cancer.

HOW THEY COMPARE

Prostate blood test: 9 per cent of results are false positives, 1.5 per cent are false negatives.

Breast mammogram x-rays: 5 per cent of results are false positives, 0.6 per cent are false negatives.

Source: Ministry of Health