New prostate cancer guidelines

New prostate cancer guidelines to help reduce mortality rates in New Zealand men

A new set of guidelines for GPs will make an important contribution towards improving outcomes for New Zealand men with prostate cancer by providing a clear clinical pathway for testing, management and referral of men who present to primary care practitioners with prostate-related issues, according to the Urological Society of Australia and New Zealand.

“Our strong hope is that mortality rates from prostate cancer could be reduced by the adoption of these guidelines by the frontline healthcare practitioners,” says Urological Society President, Professor Mark Frydenberg.

Each year around 3000 New Zealand men are diagnosed with prostate cancer and 600 die from the disease. The new guidelines released by the Ministry of Health have been developed with input from urologists, GPs, radiologists, nurses and pathologists.

“Previously there have been varying recommendations on prostate cancer testing and management, creating uncertainty for some men and their doctors. We congratulate the New Zealand Ministry of Health for taking leadership on this issue and bringing these groups together to develop evidence-based guidelines that if integrated into clinical practise of primary care practitioners, will best serve the interests of New Zealand men” says Professor Frydenberg.

“We know that early diagnosis is key to saving lives for men with aggressive prostate cancer. However, we also know that in some men prostate cancer is a slow growing disease that may never be life threatening.

“We believe these guidelines will help clear any confusion among GPs and their patients regarding testing, the use of the PSA (prostate-specific antigen) blood test, DRE (digital rectal examination) and the appropriate management and referral approach for men.”

The guidelines clearly spell out the benefits and risks of testing, biopsy and treatments, to assist GPs have an informed discussion with men who present with prostate-related concerns.

“These draft recommendations will help define which men specifically will benefit the most from testing; who should be referred for further investigation and treatment which may include surgery, radiation therapy, or active surveillance which is already used widely by urologists to delay definitive treatment in men with lower risk cancer,” says Professor Frydenberg.

Importantly, the guidelines also take into account cultural sensitivities that may be a barrier to prostate cancer testing in some men, and considers age, family history, ethnicity and other demographic and lifestyle factors. Prostate cancer outcomes vary among New Zealand men, with Maori men living in rural areas having a significantly higher mortality rate from the disease.

The Prostate Cancer Management and Referral Guidance can be found at: www.health.govt.nz.

They include:

• For Men 50 - 70 years, or over 40 years with a family history of prostate cancer, GPs must obtain informed consent before testing, after discussing the benefits and risks of PSA test and/or DRE and the implications if the result from either is abnormal.

• Men with a raised PSA level should have a follow-up test after 6 - 12 weeks to confirm the result.

• However, men with a raised PSA level as well as an abnormal DRE or a “red flag” - i.e. a symptom that may indicate advanced or metastatic prostate cancer (including acute neurological symptoms, renal failure, bone pain or macroscopic haematuria) should be referred to a urological or radiation oncology service.

• A man with an abnormal DRE should be referred to a urology service.

• Men with a family history who have a normal PSA and DRE result should be offered a PSA test and DRE every 12 months from 40 – 70 years.

• Men without a family history after a normal PSA and DRE result should be reassured they are unlikely to benefit from further testing, particularly after the age of 70. Should a patient, however, request further testing it should be offered every 2 - 4 years.

ENDS

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