The pros and cons of screening for prostate cancer should be discussed with your doctor to help guide you in deciding if it is the right course of action.
Routine screening for prostate cancer in all men without symptoms is not recommended in New Zealand at present.
To help you decide if a prostate check is right for you, the Ministry of Health has developed the Kupe website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor.
Video: The prostate-specific antigen test. To test or not to test? Michael Evans and Reframe Health Films Inc, 2014.
Do all men need to be screened for prostate cancer?
There is no clear yes or no answer to this question. The following story is how Dr Richard Ablin, the American founder of the prostate-specific antigen, illustrates the health dilemma his discovery created:
The story of Bill and John
"Bill and John. Both men are 65 and don't know they have prostate cancer.
Bill decides to have a prostate-specific antigen (PSA) test. The test leads to a biopsy which finds a cancerous tumour. He has surgery to remove his prostate gland and is left impotent and incontinent. He dies aged 75.
John has read up about PSA testing and decides not to get tested unless he has symptoms. At 70, he starts having problems, goes to his doctor and has a PSA test. John is diagnosed with prostate cancer and dies five years later.
Those who believe in PSA screening will claim Bill lived for 10 years after his diagnosis, whereas silly John lived for only five.
The truth of the matter is, both men died at the age of 75 and who do you think got it right?"
This question is still being debated, with no clear right or wrong answer yet being established.
Who can get tested?
Any man over the age of 50 who wants to know, should be offered a digital rectal examination and PSA test. If either is abnormal, your doctor will refer you to a specialist (urologist) to be considered for a prostate biopsy, in which small samples of the prostate gland are taken for examination.
The aim of these investigations is to find out if you might have early prostate cancer and, if so, whether it needs treatment. The treatment options can then be discussed with you.
If the biopsy shows no evidence of cancer you will be advised to attend future check-ups.
Family history is important
Any man around the age of 40 years who has a close relative with prostate cancer, especially if that relative had cancer diagnosed before the age of 60-65 years, should consider seeing his doctor for the above assessment. Discuss this with your doctor.
Every year 3000 men are found to have prostate cancer and 600 die from the disease. This publication will help primary care practitioners provide men and their family and whānau with consistent, culturally appropriate information on prostate cancer testing and treatment.
It includes an algorithm to help primary care practitioners have informed discussion with men who present with prostate-related concerns, and to support men to make informed decisions about prostate cancer testing. Explanatory notes provide more detailed information on each of the steps involved.
The guidance provides referral criteria including definitions of high suspicion of prostate cancer for the Faster Cancer Treatment Programme.
This guidance has been endorsed by the:
The Royal New Zealand College of General Practitioners
The Prostate Cancer Foundation
The Urological Society of Australia and New Zealand
The New Zealand Urological Nurses Society
The New Zealand Society of Pathologists.
Need for this guidance
New Zealand men currently receive conflicting advice about prostate cancer testing and treatment. Some men may benefit from early diagnosis and treatment, but have limited opportunity to access appropriate health services.
Unlike other cancers, prostate cancer often grows slowly. With routine prostate specific antigen(PSA) testing, many men can be diagnosed with a cancer that is not going to progress during their lifetime. Such a diagnosis may increase men’s exposure to unnecessary treatment-related harms.
On the other hand, some men will still develop aggressive and potentially life-threatening prostate cancer. These men may benefit from prompt diagnosis and treatment.