PSA testing and DRE, TRUS scanning with sector biopsy, improved histology, curative treatments, and active surveillance for prostate cancer: a success story for men's health.
PSA, DRE, and TRUS sector biopsy have been used clinically internationally for almost two decades and have been available in New Zealand since 1993. The incidence of prostate cancer has approximately doubled. Many countries especially in Western Europe, North America and including Australia report decreases in prostate cancer mortality due to this change ranging from 10 to 39%. This has not so far occurred in New Zealand, however, and likely reasons for this are discussed. They include a negative approach encouraged by the New Zealand Guidelines Group and others, and more difficult access to investigations and treatments for New Zealand men than other countries. Technological advances in TRUS sector biopsy, histological diagnosis, and management are discussed. Changes in international prostate cancer mortality data and results from several clinical trials are also discussed. It is concluded that the weight of evidence in favour of PSA/DRE testing is now overwhelming and that potentially between 200 and 300 of the 600 men who currently die of prostate cancer in New Zealand could be saved by the application of current technology.
Smart
Robin
R
robinfsmart@xtra.co.nz
D001706:Biopsy / Q000379:methods; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D054526:Men's Health; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D036761:Ultrasound, High-Intensity Focused, Transrectal
D017430:Prostate-Specific Antigen