Philippa Stevenson: At last, men not forced to bear pain of biopsy

COMMENT

I'm sure I'm not alone in having observed that a man becomes a little tense when threatening objects get anywhere near his groin.

I don't mean a cold spoon. More like a needle.

If the poor guy is already stressed worrying he may have an illness of the worst kind (ie, one that could affect his old fella) then the thought of someone probing with bits of cold steel is likely to send him over the edge. Especially if he's stone-cold sober.

Having had one of my nearest and dearest describe in wincing detail the probing of his rectum to check for cancer - known as a prostate biopsy - I have a lot of sympathy for others undergoing the procedure.

Prostate cancer is a big killer of New Zealand men, accounting for 3.8 per cent of all male deaths, or 524 deaths in 1998.

A prostate cancer advisory group to the Government says a "best estimate" has more than 12,500 New Zealand men aged between 55 and 69 years with prostate cancer.

More than 8300 men each year are thought to march off for a biopsy.

Up until recently, the urologists - many of them male - who perform these biopsies didn't think anaesthetising the prostate would make much difference to their patients' pain. One suspects many men would like to be totally out to it.

Doctors tried sedatives, laughing gas, and pain killers but mostly dismissed the idea that numbing the actual site of the probe would make much difference.

In 1996, an American urologist suggested local anaesthetic could dull men's pain but few followed his advice. In the US, about 5 per cent of working urologists and 20 per cent of university urologists use local anaesthetic.

Back in 2000, Hamilton urologist Michael Holmes was quite keen on testing the use of local anaesthetic but here and in Britain, where he worked for a year, found no one was interested.

"The thought was that if you used it you believed in its use [whether justified or not]," he said.

After returning from Britain and becoming a consultant urologist at Waikato Hospital, Holmes initiated his own study.

For a year from November 2001, 106 Waikato men took part in a double-blind placebo trial. Unknown to the doctors and nurses attending them half of the men had local anaesthetic before biopsy, half had a placebo.

It was a great relief to the men who had the anaesthetic.

The trial has proved a winner in more ways than one. In February, it won the Baus prize for best scientific paper at the Australasian urology conference, and last month won the Chapman Tripp clinical practice improvement award at the Waikato District Health Board Best of Health Awards.

The results have also been presented to the New Zealand and British urology associations' conferences.

Holmes said a general shift to using local anaesthetic occurred soon after his findings but, reluctant to take any credit, he suggests it was more that the idea's time had come. Two subsequent trials overseas have confirmed his results.

Men considering a prostate biopsy will welcome the new attitude.

Meanwhile, screening men en masse for signs of prostate cancer is being considered.

The National Health Committee, a Government advisory body, is calling for submissions on a discussion document by October 17. It is the second time in eight years the matter has been up for debate.

The New Zealand Guidelines Group which wrote the document, concluded it could not support prostate cancer screening because of a lack of proven benefit and the potential for harm.

Evidence suggests that if a thousand men were screened for the disease with the PSA (prostate specific antigen) test, 136 would be referred for a biopsy, 15 would have prostate cancer but would be missed by the PSA test, 94 of the 136 men would not have the cancer and would have had an unnecessary biopsy, 41 men would have prostate cancer but some to such a degree that it would never have troubled them.

Screening would ensure some men were cured of their cancer but others would suffer the harmful effects of treatment for a condition they would never have become aware of. The harm included increased anxiety from false positive results, and false assurance for men with false negative results.

Biopsies could result in pain, bleeding, and life threatening infection.

The group suggested New Zealand men, like their Australian and British counterparts, should be given "evidence-based advice" on prostate cancer and testing.

Waikato's Michael Holmes says he has been working on such a brochure using his own and overseas resources. Perhaps he'll deliver the next biggest development in men's relief as well.

* Email Philippa Stevenson