750 Deaths A Year: Why New Zealand Needs Prostate Screening Programme

Inviting all New Zealand men over 50 for a simple blood test will advance early treatment and reduce deaths from the most common male cancer, says a Europe-based cancer researcher.

Dr Renée Leenen said organised screening programmes flagged warnings of prostate problems including cancer, an unpredictable disease hard to detect because it lacked symptoms in early stages. Once symptoms emerged, treatment options were more limited.

“What we’re calling for in Europe now, and also applicable in New Zealand, is to implement an organised screening programme, to ensure that men who need to get tested, do get tested,” Dr Leenen told Radio New Zealand.

One of the international speakers at the Prostate Cancer Foundation conference in Christchurch on Sunday, May 19, Leenen is a key member of the PRAISE-U project team, an EU-funded initiative piloting early detection and diagnosis of prostate cancer through customised and risk-based screening programmes.

The number of New Zealand cases and deaths from prostate cancer is rising. In 2021, the most recent data, 762 men died of prostate cancer, about 50 percent higher than the mid-1990s. And the registered number of prostate cancer cases has nearly doubled over the same period, to 4356.

Rotterdam-based Leenen said in future there will be more detections and deaths due to men living longer. The risk of getting prostate cancer depended on factors including age, family history and genetic makeup. She will outline at the conference the importance of detecting these cancers early, when curative treatment is possible.

In Europe and New Zealand, currently men at risk wanting to gauge their prostate-specific antigen (PSA) level must ask their GP or urologist for a PSA test, or rely on doctors to initiate a discussion and suggest a test. As a result, many men are not tested. A PSA centralised screening programme would involve a state agency inviting all men over 50 for a test, when men’s risk of prostate cancer rises significantly. This would be a population-based approach echoing the New Zealand screening programmes for breast, bowel and cervical cancer. The work of Dr Leenen and the PRAISE-U team is leading to the implementation of such a programme for prostate cancer across Europe.

The Prostate Cancer Foundation is calling on the Government to fund a $6.4 million, three-year screening pilot in two locations. Lessons would inform a national screening programme which health officials say will eventually be implemented due to numbers of prostate cancer cases and deaths and absence of warning signs.

Leenen said pilots underway in Europe were about identifying the cohort of men at elevated risk of developing prostate cancer.

“We want to screen the right men. Eventually we want to get the numbers of men dying of prostate cancer lower because there are treatment options. We want to catch these men at an early stage so we can give them treatment which will cure them.”

High PSA levels could mean a man has an enlarged prostate, an infection, or prostate cancer, which could be benign or aggressive. A single abnormal reading is followed by further PSA testing, ultrasound or MRI scans and, with enough evidence, a biopsy.

Leenen said two large studies had proved the benefits of PSA blood testing and ended debate in Europe about the efficacy and safety of the screening and diagnostic process. They showed PSA based screening reduces specific mortality and metastatic disease.

PRAISE-U is focussing on the feasibility of population-based screening, including how to engage with men through “decision aids” such as environmental and social influences, and the strong influence of women on their partner’s health.

Prostate Cancer Foundation chief executive Peter Dickens challenged the government was to make a public commitment that it will implement an early detection programme starting with a two-location pilot in an urban and rural region.

“A prostate cancer screening pilot in Waitematā and Tairāwhiti would require an initial Budget investment of only $6.4 million over four years. Ongoing investment totalling $32 million over 20 years is expected to return over $100 million to the health system in cost savings and generate over half a billion in health gains for Waitematā and Tairāwhiti men over their lifetimes.” Mr Dickens said.

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