The epidemiology and management of prostate cancer in New Zealand

Abstract

Background: Prostate cancer with its high incidence, prevalence and also relatively high mortality represents a major public health issue in New Zealand (NZ). Ethnic and regional disparities in prostate cancer incidence and mortality have been reported in national and international literature. The aim of this study was to identify causes for the observed differences by obtaining currently lacking information on screening, diagnosis, and management of prostate cancer in NZ men. Methods: The study was divided into three section: 1) to describe incidence and survival trends for Māori and non‐Māori men and rural and urban men, men aged 40+ years diagnosed with prostate cancer between 1996 and 2010 were identified from the NZ Cancer Registry and Mortality Collection; 2) computerised records of 31 general practices in the Midland Cancer Network (MCN) region linked to laboratory data were reviewed to assess patterns of PSA screening in primary care in 2010, and to examine follow‐up investigations, including specialist appointment and biopsy for men with an elevated PSA result by ethnicity, and practice characteristics; and 3) to further assess diagnostic and treatment pathways with a special focus on Māori men, clinical records of all Māori men (150) and three frequency age‐matched randomly sampled NZ European men (450) diagnosed with prostate cancer in the MCN region between 2007 and 2010 men were searched retrospectively for information on cancer stage at diagnosis, co‐morbidities, and treatment type for localised disease. Results: Māori men were almost twice as likely to die of prostate cancer compared with non‐ Māori men. Poorer prostate cancer survival for Māori men is likely explained by lower screening rates, less intensive diagnostic investigations, longer wait times, later diagnosis and differences in treatment observed for Māori men compared with non‐Māori men. Although rural men were less likely to be screened, there were little or no differences in diagnostic pathways, incidence and survival of prostate cancer between rural and urban men. Conclusion: Opportunistic screening for prostate cancer is common in New Zealand but its frequency varies by practice, and by ethnicity. Throughout the prostate cancer care pathway minimal differences were found between rural and urban men, presenting a sharp contrast to disparities observed between Māori and non‐Māori men. This study highlighted areas of need for improvement along the prostate cancer care pathway, which will help in guiding policy decisions and resource allocation.