A Christchurch man with advanced cancer was talked out of a prostate check by two GPs.
Two weeks ago, Graeme Pollard was told he has inoperable prostate cancer and it has probably spread to other parts of his body.
The diagnosis was a “death sentence”, he said.
“You get told they can’t operate on it and they also said chemotherapy might not do . . . so there’s not many options there.”
The 55-year-old roofer has had to quit the job he loves. His pain is increasing daily and he can feel his strength diminishing.
He recently bought a caravan and was looking forward to travelling and reconnecting with his daughter, who he had lost touch with.
“[I feel] confused at times, angry at times . . . depressed at times. It’s certainly not something you want to face.”
When Pollard turned 50 he was advised by friends to get a prostate check. The tests include a blood test for prostate specific antigen (PSA) and a digital rectal examination (DRE).
His GP told him he was low-risk and the tests were unnecessary.
Pollard asked another GP for a prostate check two years ago.
He was again told the tests were unnecessary.
“I said how about a blood test. He said ‘no, it’s inconclusive’ and it was just left there and I thought well, ‘why not do a blood test’, but I just left it.”
Now facing terminal cancer, Pollard told his doctor he was angry he did not get the tests he asked for.
“He said ‘well it’s got nothing to do with me, you made an informed decision’.”
Prostate Cancer Foundation New Zealand chief executive Graeme Woodside said Pollard’s GP was “passing the buck”.
“He’s basically talked Graeme out of going for a test, saying it was unnecessary and he’s put the the onus back on to Graeme – which is adding insult to injury.”
The foundation recommends men aged 50 to 70 get both tests done every year, but this is not stated in Ministry of Health guidelines for GPs.
Woodside said Pollard would have been deemed to be at less risk because the rates of prostate cancer among his age group were lower. However, when men in their 50s get prostate cancer it tends to be more aggressive.
“My guess is that if he had had a blood test four years ago, and then had one each year subsequently and had been monitored, this would have been picked up much earlier.”
The tests can indicate an abnormality in the prostate, but a biopsy is needed to diagnose cancer.
Some doctors might not be confident to do a DRE. Others could be concerned the PSA test was not definitive and would lead to unnecessary treatment, Woodside said.
While the Ministry guidelines formalise the process for prostate cancer testing, there was no obligation for GPs to adhere to them.
“Our advice is if your doctor won’t do [the tests] find one who will.”
GP Ben Hudson, a lecturer in general practice at Otago University Christchurch School of Medicine, said the medical community was divided over the benefits of prostate screening.
“There’s some evidence that screening for men who are healthy may reduce their risk of dying of prostate cancer . . . but the strength of evidence is not as great as it is for breast cancer in women, for example.”
If an abnormality was detected through a prostate check this could lead to unnecessary interventions including a biopsy which men describe as uncomfortable or painful, Hudson said.
A biopsy may detect a tumour but for a proportion of men these would not cause any symptoms.
“That is a problem because if you’ve got the diagnosis you have to do something about it and the likelihood is you end up getting treated with radiotherapy or surgery both of which have significant rates of adverse effects, or you may live with active surveillance which has a significant psychological cost.”
He said men who were interested in a prostate check should have a conversation with their GP about the benefits and harms of screening. Ultimately, it was the patient who should decide whether to get the check done.
Hudson encouraged his male patients to make their own decision and about half chose to have the test, but half decided not to.
If asked directly for his position, Hudson said he told his patients he believed the evidence of benefits was not strong, there was good evidence of the harm from screening, and he would not be screened himself.
PROSTATE CANCER IN NEW ZEALAND
– Prostate cancer is the most common cancer for New Zealand men and the third most common cause of cancer death in men after lung and bowel cancers.
– 1 in 10 men will develop prostate cancer in their lifetime.
– About 3000 Kiwi men are diagnosed with prostate cancer every year.
– About 600 Kiwi men die from prostate cancer each year, about the same number as women who die from breast cancer.
– Maori men are 72 per cent more likely to die of prostate cancer once they are diagnosed than non-Maori men.
Story by CATE BROUGHTON on Stuff.co.nz
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