Prostate cancer screening in New Zealand

Abstract

Advice to the Minister of Health on the issues and latest evidence concerning prostate cancer screening. The National Health Committee (NHC) first reviewed the possibility of population screening for prostate cancer using the Prostate Specific Antigen or PSA test, in 1996. At that time, it recommended against population screening. Due to high public interest in prostate cancer screening and increasing use of the test, the NHC reviewed its earlier advice and published its findings in 2004. The NHC undertook its second review because it felt health care practitioners, men and the wider public needed up-to-date information based on the best available evidence to help them make decisions. It used the screening assessment criteria it had developed in 2003 (Screening to Improve Health in New Zealand) to assess prostate cancer screening in New Zealand. Consultation with organisations and individuals with an interest in prostate screening was undertaken to inform the report – see Summary of submissions in response to National Health Committee consultation paper on prostate cancer screening in New Zealand, January 2004. The NHC’s 2004 report notes there continues to be no conclusive evidence that undergoing the PSA test or digital rectal examination (DRE) for prostate cancer reduces mortality or morbidity associated with prostate cancer. The report further notes the PSA test is not completely reliable and can miss some cancers or alternatively, may set in train a cascade of interventions offering little benefit and potentially, significant harm. But, the NHC believes, concern over potential harms of screening is not sufficient reason to deny a man the test if he is fully informed and requests it. Men considering the PSA test are entitled to detailed information about its limitations, the possible diagnostic and treatment choices and outcomes and the fact that PSA screening is not recommended in New Zealand. The NHC recommends the benefits and potential for harm from prostate screening should continue to be reviewed as new evidence emerges. It recommends the Ministry of Health monitor the advances in diagnosis and treatment of prostate cancer.