Prostate cancer: Backward-looking views harm NZ men - Danny Bedingfield

Kristine Hayward last year presented a petition, signed for 30,000 people, calling for government action on prostate cancer. Photo / Neil Mackenzie

OPINION

It’s not just our clothing and hairstyles that can become outdated. Our thinking can too. But while no one thinks sporting tie-dye T-shirts, neon leg warmers and poodle perms will take years off your life, outdated thinking can cause deaths.

Members of the Prostate Cancer Foundation are calling out officials clinging to a superannuated mindset that’s holding back something pretty important - a reduction in 750 deaths a year from prostate cancer. On behalf of the hundreds of fathers, sons and husbands who don’t yet know they have prostate cancer, the foundation is pushing back on Ministry of Health advice unwrapped by the Official Information Act (NZ Herald, December 11).

These backward-looking views are holding back progress on launching a pilot of prostate cancer screening that would save lives and return more than $100 million to the health system, plus generate over half a billion dollars in health gains – and that’s just in two regions of Aotearoa.

The comments in official advice to the Minister of Health showed thinking hadn’t progressed since the 1990s. Broadly, the advice said that screening men’s blood for an indicator of prostate problems can lead to negative outcomes, such as overdiagnosis, overtreatment, and unnecessarily invasive procedures.

“There is insufficient evidence that the benefits of a national, organised population health prostate cancer screening programme outweigh the harms,” according to the aide memoire from Te Whatu Ora Health New Zealand.

The foundation’s position is that these are misleading and dangerous perspectives that fail to take account of new evidence and properly recognise current practice. While we wait and dither, thousands of Kiwi men each year are consigned to live with an advanced disease and tragically suffer a premature death.

The leading research now published on screening is clear: The medical tools and technologies available that clinicians use in New Zealand facilitate the identification of significant versus insignificant cancers. They can and do avoid overdiagnosis and overtreatment.

The methods and tools available for screening have changed dramatically in the past three decades, including that:

· Risk groups for developing significant prostate cancer are defined more sharply based not only on age but also on family history and genetics.

· Follow-up intervals for repeat screening can be individualised from one to eight years.

· Biopsy indications do not rely solely on singular PSA (prostate-specific antigen) values but have expanded to include risk calculators and MRIs (magnetic resonance imaging).

· The link between diagnosis and treatment has been broken by using active surveillance that avoids or postpones radical therapy in low-risk cases.

What’s most concerning about the ministry’s advice is it holds back progress towards a pilot of prostate cancer screening. While prostate cancer that is detected early generally has an excellent prognosis, late detection reduces the range of options for treatment and is associated with significant mortality.

A national screening programme for early detection based on risk-stratified PSA testing, as recommended by the European Association of Urology and currently being piloted in 12 countries (PRAISE-U), would address the inequitable and poor outcomes associated with late diagnosis.

Based on modelling commissioned by the foundation, a two-district pilot of PSA-based screening for earlier prostate cancer detection, focusing on Tairāwhiti and Waitematā, offers the potential to better understand the equity dimensions of early detection, and the benefits of a specialist detection workforce and increased use of modern diagnostic technologies.

While the value of PSA-based population screening is debated, the true value for New Zealand cannot be known until a pilot programme is run and evaluated. According to a recent New Zealand Institute of Economic Research report, a prostate cancer screening pilot in two locations would require an initial Budget investment of only $6.4m over four years.

Ongoing investment totalling $32m over 20 years is expected to return more than $100m to the health system in cost savings and generate over $500m in health gains for Waitematā and Tairāwhiti men over their lifetimes.

The Minister of Health and three associate ministers can make a substantial difference to men’s health by investing in a comparatively inexpensive pilot that will ultimately save taxpayer money while generating health gains.

Prostate Cancer Foundation NZ president Danny Bedingfield.

New Zealand needs to build on the existing infrastructure that operates for breast, cervical and bowel cancer screening. We should be inviting all men at increased risk of prostate cancer, whether or not they’re fortunate enough to have or be able to afford a GP, to take a free, simple blood test. If the test shows a risk that prostate cancer is present, men should be able to access an assessment pathway, giving them a decent chance for the best possible outcome.

We know what these early detection assessment pathways are and that they’ve been validated through respected international research. New Zealand should therefore implement a pilot of prostate cancer screening as soon as possible – and move past the old thinking that is risking the lives of our New Zealand men. Everybody agrees that the earlier cancer is detected, the better the clinical outcomes. So why can’t men benefit from that?

Danny Bedingfield is president of the Prostate Cancer Foundation of New Zealand.