Prostate Cancer Screening - It's Time To Re-Think The Current Inconsistent 'Opportunistic' Approach
Research published in the New Zealand Medical Journal on 9 October 2020 clearly points to the need to reconsider the current inconsistent approach to prostate cancer screening for Kiwi men.[i]
Prostate cancer is the leading cancer diagnosed in New Zealand men and the numbers have increased by over 25% in the last five years, with nearly 4000 men diagnosed in 2019.
The Prostate Cancer Foundation shares significant concerns that are highlighted in this recent research. While there has been a general understanding that numbers receiving PSA testing have been relatively low, based on earlier studies, this new research shows that despite there not being an organized screening programme, prostate cancer testing rates (65% for men 50-69 years) are comparable to current national targets for breast (70%) and colorectal (62%) cancer screening programmes.
Internationally there has been a growing change in attitude to the value of PSA screening for prostate cancer. As long-term studies gather more data, clear benefits are now being seen in the value of PSA screening in reducing the death rates from prostate cancer. This is evident in New Zealand, where death rates have been gradually declining since the introduction of PSA testing in the mid-1990s.
Currently PSA screening in New Zealand has been described as "opportunistic"- meaning that it is dependent on either men asking their GP for a test, or GPs taking the initiative to order the test. Neither is satisfactory and leads, in some cases to over-testing (more than every 1-2 years) or under-testing where many men are simply missing out on being screened.
This inconsistency leads to a poor understanding among men on the importance of being tested, and also to some men who missed being tested subsequently being diagnosed with advanced disease leading to worse outcomes.
New Zealand needs to reconsider the current "opportunistic" approach, where many men miss being screened, to an "organised" system where men are routinely offered PSA screening, based on their age and risk profile and receive consistent advice and information.
Past concerns of overdiagnosis and overtreatment have now largely been dispelled by improved diagnostics and surveillance programmes.
An organized screening programme will also remove one of the major barriers men have currently to being screened - the need to visit the GP and pay for the cost of the appointment. This highlights a significant equity issue where being screened relies on the ability to pay for a visit to the doctor and is a significant deterrent to many men who should be screened.
Maori and Pasifika men are under-represented in current PSA screening based on this current research, inevitably leading to poorer outcomes for these men, which highlights a further equity issue.
An organised screening programme where there is no cost will make prostate cancer screening available to all men aged 50-69 or who have other risk factors and result in significantly improved outcomes from prostate cancer in Kiwi men.
[i] Matti B. Zargar-Shoshtari K Prostate Cancer Screening in New Zealand: lessons from the past to shape the future in the light of changing evidence. NZMJ 133:1523