Inequities In Prostate Cancer Testing Allow Too Many Men To Die, Say Experts

We need to screen, or prostate cancer won’t be seen. That’s the message from the Prostate Cancer Foundation of New Zealand (PCFNZ), which has done a deep dive into new research that shows how effective a screening programme could be.

For its launch of Blue September, supporting the 42,000 men currently battling prostate cancer in our country, PCFNZ CEO Peter Dickens is renewing calls for a national screening programme.

“Each year, about 3,500 Kiwi men are told they have prostate cancer. Instead, we’d like thousands more to be told they don’t,” says Dickens.

“A quick, simple blood test is all it takes to help save the lives of countless New Zealand fathers, husbands, sons, brothers and friends. But the current system – where Kiwi men have to request the blood test through their GP, or wait to be offered it – isn’t working. We need to be smarter about how we diagnose this cancer, because early detection is key.”

And he has the full backing of Associate Professor Kamran Zargar from the Department of Surgery at the University of Auckland. Assoc. Prof. Zargar and his research fellow, Dr Bashar Matti have just completed a wide-ranging study into how prostate cancer – the most common cancer to affect men in New Zealand – is diagnosed.

“Clandestine community based screening which is unfunded, unorganised, and inequitable” are just some of the words Assoc. Prof. Zargar uses to describe the current prostate-specific antigen (or PSA) testing regime in New Zealand.

“At the moment, we test opportunistically, and have done so for the past 25 years,” begins Assoc. Prof. Zargar. “Sometimes, a GP will suggest the test, other times it may be added to another group of unrelated blood tests but largely, men need to specifically ask for it. Worst of all, many men, whom for various reasons, don’t have the opportunity for regular GP visits, are never offered the test.”

Assoc. Prof. Zargar says the evidence of his research – which included assessing every PSA test performed in New Zealand over a 13-year period, between 2006 and 2018 – points to many imbalances in the system. Māori, for instance, were significantly less likely to receive a PSA test compared to Pakeha and other ethnic groups. “Our research shows less than half of eligible Māori men undergo regular PSA testing.”

Furthermore, Māori men are also more likely to die from prostate cancer than non-Māori, as are all men in rural or semi-rural locations. “The higher prostate cancer mortality rate in Māori men may well be related to testing as we have observed that Māori who do not have regular PSA tests are almost five times more likely to die from prostate cancer, than those Māori men who are regularly tested”.

“We should have a contemporary look at the role of PSA testing, in the context of advanced imaging, diagnosis and treatment options. Early diagnosis of significant prostate cancer can be achieved, while avoiding over-diagnosis and over-treatment. We cannot use outdated data and debunked arguments to dismiss the value of appropriately utilised PSA testing.”

“We must aim for a structured, risk adopted population-based approach for early detection of prostate cancer, as we have with breast cancer. This approach would give all Kiwi men the same information, service and support” Assoc. Prof. Zargar says. “It would be equitable.”

One in eight Kiwi males develops prostate cancer in his lifetime – the disease affects more New Zealanders than breast cancer does. About 650 men die as a result of prostate cancer annually.

But the PSA blood test is a simple diagnostic tool, says Dickens, that we must use more wisely – and widely. “We’re urging the Ministry of Health to consider more broadly an effective program for early detection of prostate cancer to help us save the lives of our men. In the meantime, we encourage all men between 50 and 70 to get regular prostate check-ups with their GP or medical centre, and men aged 40 and over, for those with a family history cancer.”

Blue September, which this year aims to raise $1m to fund further research into prostate cancer and support services for men who are diagnosed, begins on September 1st. “We’d love Kiwis to get on board by making a donation, purchasing some of our merchandise or holding a ‘Blue Do’.”

Blue Dos can take the shape of blue-themed morning teas, quizzes, sporting or social events with proceeds going to PCFNZ, which receives no government funding currently. “Of course, we’re asking our supporters to do all of this safely and in a socially distanced environment, should we continue to be under Covid-19 related restrictions,” says Dickens. “But we know how creative our Blue September crew are and we can’t wait to see what they come up with.”

Do Something Blue this Blue September – find out more at www.blueseptember.org.nz.

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