Review of prostate screening

The Cancer Society is reviewing its opposition to prostate cancer screening, after evidence from overseas research this year and urologists' advocating testing from the age of 40.

Public health specialists criticised the transtasman Urological Society yesterday over its new position that men without any symptoms of the disease should be screened from 40.

The society, until Tuesday, had advocated that asymptomatic men start having prostate-specific antigen (PSA) blood tests and digital rectal examinations by a doctor from 50.

Both positions are in conflict with New Zealand Government health agencies' advice, which does not recommend screening asymptomatic men of any age because its worth is not proven and it can cause harm - mainly impotence, urinary incontinence and bowel problems - through unnecessary treatment. But they say men should be given the tests if they are fully informed and request them.

The Cancer Society does not recommend screening well men. But its medical director, Professor Chris Atkinson, a Christchurch oncologist, said it was reconsidering this policy because of a large European trial's finding of a reduced prostate cancer death rate among screened men, and the Urological Society's new position.

"I believe we may never get the answer with respect to population screening and its survival benefits. "We are better to advocate that men get good advice and are not put off digital rectal examination and PSA if they present to their GP and request it."

"The phrase [sometimes used by screening opponents] that more men die with prostate cancer than of it is particularly unhelpful and belittles a very important cancer that affects thousands of men in New Zealand."

Professor Atkinson said the side-effects of treatment had reduced markedly.

Australian public health expert Professor Simon Chapman and a colleague wrote in the Sydney Morning Herald that advocating screening all men from 40, "without considering the potential to do harm to men and to the healthcare budget is irresponsible".

Otago University cancer epidemiologist Associate Professor Brian Cox said although the European trial found a reduction in mortality, a Swedish trial of PSA screening, reported in April, did not find a reduction in prostate cancer mortality after 15 years of follow-up.