New Zealand Prostate Cancer Rates Are In The Global Top 20, But Updated Diagnostic Practices Could Improve Outcomes

Updating medical practices to diagnose prostate cancer by conducting transperineal biopsies under local anaesthetic could help thousands of New Zealand men each year.

New Zealand has one of the highest rates of prostate cancer worldwide, but men can live longer if the disease is caught early.

According to the World Health Organization’s International Agency for Research on Cancer (IARC), New Zealand has a rate of 83 cases per 100,000 people, this puts prostate cancer incidence in New Zealand above Australia, the USA, the UK and Canada [1].

The IARC numbers equate to almost 4,000 New Zealanders each year being diagnosed with prostate cancer and over 800 dying of the disease [1].

There is a stark disparity across New Zealand in access to diagnostic procedures recommended by international guidelines [2].

The process to diagnose prostate cancer usually begins with a prostate specific antigen (PSA) blood test, and patients with a persistent high PSA level are referred for an MRI scan.

Should the MRI scan show a possible cancer, a biopsy is conducted to confirm whether cancer is present.

A transperineal biopsy is recognised best practice because this method almost eliminates the risk of sepsis occurring, compared to a 2% risk with last generation transrectal biopsies,[2] which require the needle to be inserted through the rectal wall.

A transperineal biopsy also gives the ability to sample the anterior prostate, which is difficult to access with a transrectal biopsy.

However, transrectal biopsies remain the standard of care in much of New Zealand.

According to the Prostate Cancer Outcomes Registry of Australia and New Zealand (PCOR ANZ)Annual Report 2023, only 29% of biopsies performed in New Zealand during 2021 were transperineal,[3] compared to more than 80% of biopsies in Australia.

Dr Simon van Rij, is a urologist based in Auckland who performs transperineal biopsies under local anaesthetic, he said:

“About 95% of the prostate biopsies I perform are done under local anaesthetic. I gained my experience with transperineal biopsies working in cancer centres in Melbourne and London, where all we did was transperineal prostate biopsies. Coming back to Auckland, I was very keen to institute that because I think it is a more accurate, and a safer way to do a biopsy.”

The transperineal biopsy method has existed for several years and with the right equipment the procedure can be performed under local anaesthetic, making it less onerous for patients and saving precious operating theatre time.

Dr van Rij believes that there are significant benefits to health services moving to transperineal biopsies under local anaesthetic.

He said: “With the increasing amount of pressure on wait times for hospital procedures this move could free up theatre time, so we don’t need to delay other surgeries. Under local anaesthetic a biopsy can be done in a clinic, outside of an operating theatre setting so it could also make biopsies more accessible around the country.”

Alongside the savings to the health system, and improved safety for patients, performing biopsies under local anaesthetic can also reduce the burden for patients.

“The biopsy itself is quick, around 10-15 minutes, so if patients are able to have the procedure under local anaesthetic, they don’t have to give up a whole day to have a general anaesthetic, arrange for someone to drive them home from the hospital, and have adequate recovery time. It is less of a burden.”

Dr van Rij says the stress patients experience during the diagnostic process should not be overlooked; “For a patient, going from unknowing to knowing as quickly as possible is important. When a patient is referred to me with a raised PSA, they're concerned that they could have cancer and they want to know, it’s a very stressful time. We need to acknowledge the anxiety people experience while they are waiting, the faster we can find out, the better.”

“If we can find cancer early, it gives our patients the space and confidence to take their time to choose the treatment that's right for them.”

References:

1. International Agency for Research on Cancer, accessed 1/3/24

2. Prostate Cancer Outcomes Registry of Australia and New Zealand Annual Report 2021 3. Prostate Cancer Outcomes Registry of Australia and New Zealand Annual Report 2023

3. Prostate Cancer Outcomes Registry of Australia and New Zealand Annual Report 2023

About BXTA

Founded in 2013 as a specialist provider of low dose-rate (LDR) brachytherapy seeds for prostate cancer treatment, BXTA has become a leading international uro-oncology organisation, committed to providing the most innovative solutions in cancer diagnosis and treatment. https://bxta.com/uk/

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