Speech to The Prostate Cancer Foundation in Wellington

Thank you for inviting me to your annual conference. It is my pleasure to be here to express my support for your organisation and to hear how your work is progressing.

I would like to acknowledge:

• Graeme Woodside (CEO of Prostate Cancer Foundation of New Zealand)

• Dr Anthony Lowe (CEO of the Prostate Cancer Foundation Australia)

• Dr David Sandoe (Chairman – Prostate Cancer Foundation Australia)

Everyone here today understands the impact of prostate cancer on New Zealand men. It is the most commonly registered cancer and it is by far the most common cancer for men.

Close to 3000 men are diagnosed with prostate cancer every year.

About 600 men die from it.

Every one of us will know someone with prostate cancer. Former British Prime Minister Sir John Major spoke of the heartbreak of watching his brother “shrink and fade”, and finally die from prostate cancer.

It’s also well known that Australia’s former Treasurer and Deputy Prime Minister Wayne Swann had prostate cancer diagnosed when he was just 48.

You may have heard the story he often told of how he convinced his mate to get tested.

This involved, as you know, a DRE – a Digital Rectal Examination. So his mate was sitting there, getting increasingly concerned as the doctor started snapping on the rubber glove. But when he saw the doctor start putting on a second rubber glove he began trembling with fear. He mustered up the courage to ask what was going on: "why gloves on both hands?" And the doctor said: "it's just in case you wanted a second opinion!"

For years, there has been local and international debate about the best way to approach management of this disease.

Are we testing too much or too little? Are men better off or worse off as a result? Do the effects of treatment outweigh the benefits? Is the PSA test a help or a hindrance?

As the distinguished urologist Willet Whitmore said, “The quandary in prostate cancer is this: Is cure necessary in those for whom it is possible, and is cure possible in those for whom it is necessary?”

You will know that in 2011 the Government’s Health Committee conducted an inquiry into prostate cancer so it could better understand the issues facing men in New Zealand.

It received submissions and expert advice and reviewed current evidence on prostate cancer testing and treatments.

The Committee recommended against establishing an organised national population screening programme for prostate cancer.

It concluded that while PSA testing saves some lives it must be balanced against the known side effects of further investigation and treatment.

It acknowledged the need for a better, more cancer-specific and sensitive test for prostate cancer and encouraged men to seek advice from their general practitioner.

The Committee made 17 recommendations that were supported by Parliament, including that the Ministry of Health establish a prostate cancer quality improvement programme.

Professor Nacey and Mark Von Dadelszen and perhaps others here today are directly involved in supporting the Ministry of Health to deliver a range of initiatives that will improve outcomes for men with prostate cancer.

This is a Government priority.

In Budget 2013 the Government committed $4.3 million over four years to raise awareness of prostate cancer and improve the care men receive.

This added to the $33 million over four years earmarked in Budget 2012 for the ‘Faster Cancer Treatment’ programme – so better and faster cancer services can be provided for all New Zealanders, no matter where they live,

And this year the Government announced new initiatives as part of Budget 2014 to make sure the emotional needs of cancer patients are properly assessed including:

• Providing specialist psychological staff and

• Up to 20 cancer support workers in the major centres.

There is also a comprehensive programme of work under way that will give men better access to quality information and care.

It will provide better guidance for GPs around who to test for prostate cancer, who not to test, and who to refer to a specialist.

A range of consumer resources has already been released that will help men better understand current testing and treatment options, and the ramifications of these – and there is more to come.

Now work has started on a tool to help men and their GPs have more informed discussions about prostate cancer, and make better decisions about investigations and management.

This year, clinical standards and guidelines will be developed, and there will be enhancements to patient management systems to help GPs manage men with prostate cancer.

Alongside this work is the development of guidance for GPs and specialists about the use of active surveillance, which is a relatively new treatment option for men.

It provides a plan to routinely biopsy and monitor the growth of a prostate cancer tumour.

This pathway gives men with a low risk of life-threatening prostate cancer an opportunity to keep a close eye on any progression of their disease and avoid unnecessary, more aggressive treatments.

Work is also already under way to develop a reporting framework for use by pathologists which will standardise the way a pathologist’s assessment of a prostate biopsy is recorded. It will help to improve the accuracy of diagnosis and staging of prostate cancer across the country.

A monitoring and evaluation framework will measure the impact of the new supports, resources and systems developments and will align with other existing data collection points such as the cancer health target and the cancer registry.

All this work is happening alongside a myriad of other initiatives to improve cancer care in New Zealand, including prostate cancer.

I would like to thank you for the all work you are doing supporting men, and their families, who have been diagnosed with prostate cancer.

In my role as Minister of Health I have overseen significant change and improvement in services. The health system has transformed with a great effort by clinicians and motivated groups across the sector. There's still a lot to do though.

As many of you will know I am leaving politics at the election. It has been a great pleasure working with such high quality people throughout the health system who have real dedication, and a commitment to improving the lives of others.

Thank you for your contribution.

ends

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