National Health Committee says “No, not yet” to prostate cancer screening

<H1>Media Releases</H1><H2>National Health Committee says “No, not yet” to prostate cancer screening</H2><H4>1 April 2004 </H4>]
The National Health Committee (NHC) is recommending against the introduction of prostate cancer screening in New Zealand.

In a report to the Minister of Health today, the NHC says the most commonly available screening tests are not good enough. The NHC provides advice on the kinds of health and disability services that should be publicly funded and their relative priorities.

The NHC reached its recommendation following a comprehensive review of the issue and says there is still no conclusive evidence to show that screening for prostate cancer makes any difference to how long a man will live. Furthermore, the committee says there is no conclusive evidence that early detection and treatment of prostate cancer will result in improved quality of life for men.

“The prostate specific antigen, or PSA test, may detect the presence of prostate cancer in a man, albeit with a significant error rate,” says Dr Api Talemaitoga, a Christchurch general practitioner and a member of the National Health Committee. “What it won’t do is tell us accurately enough which cancers are slow-growing and not life-threatening and which are aggressive.”

Dr Talemaitoga says the majority of men with prostate cancer will not die from it. However, the majority of men with a positive PSA test who proceed with further investigation and treatment will end up with a poorer quality of life than if they had not had any treatment at all.

The investigative and treatment procedures that follow a positive PSA test may have significant adverse outcomes, which can include impotence, urinary incontinence, diarrhoea, and even death.

“Some men who will suffer these effects would never have been aware that they had prostate cancer during their lifetime had they not undergone screening. This is because screening detects slow-growing prostate cancers that may never cause problems nor shorten a man’s life,” says Dr Talemaitoga.

Post-mortem studies show that prostate cancer is very common and increases with age. The large majority of cases of prostate cancers are very slow-growing and not life-threatening. About 90% of men diagnosed with early stage prostate cancer will still be alive10 years after being diagnosed even if they don’t have any treatment. A minority of prostate cancers progress rapidly, invading surrounding tissues and spread to other parts of the body. It is not currently possible to accurately determine the difference between the two.

The NHC recognises some men have strongly held beliefs on the value of prostate cancer screening and is recommending that men requesting the test be provided with information about the diagnostic limitations and the possible harms and benefits of screening and subsequent treatment. They should also be advised that routine screening is not recommended in New Zealand for men not showing any symptoms of disease.

“Prostate cancer is a serious health issue for New Zealand men and one all health professionals would like to be able to deal with more effectively. It is to be hoped that further research will lead to a way to distinguish between localised prostate cancers and aggressive prostate cancer,” says Dr Talemaitoga.

For more information contact:

Dr Api Talemaitoga - NHC member and Christchurch GP
(bus) 03 355 8262 (cell) 021 2208269
Mark Booth - NHC Manager – (04) 496 232 (cell) 027 803 920
Trish Green - NHC Communications - 021 687 201 or (04) 4753702

Questions and Answers - prostate cancer

What is prostate cancer?
Prostate cancer is the most commonly diagnosed cancer in New Zealand men and the third most common cause of male cancer deaths. It accounts for 3.8% (555 in 1999) of male deaths in New Zealand, with about two thirds of those occurring in men aged 75 years and older. Prostate cancer is rare in men below the age of 50. More than 60% of all new cases of prostate cancer are in men aged more than 70 years.

The prostate is a small gland that sits just below the bladder and surrounds the top part of the urethra. The growth and development of the prostate depends on testosterone. It is common for the prostate gland to get larger as men grow older and this enlargement is called benign prostatic hyperplasia (BPH). Men with early prostate cancer are unlikely to have any symptoms as these only occur when the cancer is large enough to put pressure on the urethra or disturb bladder function. Many older men have enlargement of the prostate due to non-cancerous BPH.

A blood test may be done to check for the presence of prostate specific antigen (PSA). The PSA test is currently the best method of identifying localised prostate cancer. A raised PSA can be an early indication of prostate cancer. The PSA test can fail to detect prostate cancer. If the level of PSA in the blood is raised, this may indicate that prostate cancer is present. However, most men with a raised PSA will not have prostate cancer: only one out of five men will turn out to have prostate cancer.

If cancer is detected, there is currently no way of telling which cancers will cause harm. About 90% of men diagnosed with early stage prostate cancer will still be alive 10 years after being diagnosed even if they don’t have any treatment. In some cases, prostate cancer never causes problems or shortens life. It is not yet proven that treating prostate cancer is better than not treating it.

Treatment options for prostate cancer:

Radiotherapy: This involves a course of radiotherapy on the prostate gland at an outpatient clinic. The aim is to cure the cancer, although there are possible side-effects. Erection problems may be suffered by between two and six of every 10 men. Up to one in every 10 men may experience diarrhoea or bowel problems and up to one in every 20 men may experience bladder problems.
Surgery: This involves an operation to remove the prostate gland. The aim is to cure the cancer, although again there are possible side effects, including death. Up to two in every 10 men may experience some bladder problems and between two and eight out of every 10 men may experience erection problems after surgery.
Active Monitoring: This involves not treating the cancer but undergoing regular check ups to monitor the cancer and check that it is not growing. Many cancers do not cause any problems. The advantage is that for many men it avoids the side effects of radiotherapy and surgery. If there are signs that the cancer is growing, treatment will be offered. The disadvantage is that the cancer may grow to a more advanced stage. Some men find not knowing difficult.

Can a man still ask for a test ?
Although there is concern over the potential harms of prostate cancer screening, men should not be denied the ability to request the test if they are fully informed. The committee considered recommending that if men wished to have a PSA test they should pay for it themselves. However, it felt that the better approach would be to educate and inform men and health professionals about the evidence around prostate cancer screening and allow men to make an informed decision based on good information.

Why has there been an increase in prostate cancer screening?
There has been a rapid increase in screening for prostate cancer despite there being no conclusive evidence that prostate cancer screening is effective in reducing deaths associated with prostate cancer. It is likely that this increase has occurred because of growing public concern about health issues generally and a greater demand for the PSA test by men and their families worried about the disease.

What should men do if they have symptoms?
If a man notices any changes or problems with their urinary function they should consult their doctor. Symptoms such as a weak urinary stream or difficulty starting or stopping urination, can be caused by a number of medical problems like an enlargement of the prostate.

Why do women have two national screening programmes when men have none?
There is good scientific evidence that breast cancer screening reduces deaths from breast cancer and that cervical screening reduces the risk of developing and dying from cervical cancer, which is why there are national screening programmes for these two cancers.

As the NHC review has confirmed, that evidence - which is essential if you are going to start a screening programme -isn't there for prostate cancer screening at this time.

What happens next?
The committee is recommending that the Ministry of Health should review evidence from Randomised Control Trials (RCTs) on the benefits and harms of prostate cancer screening and conduct a formal assessment in 2008.