Mr GRIFFIN (5:26 PM) —I rise to speak on this motion put forward by the member for Longman regarding the issue of prostate cancer. I note there are three points to his motion with regard to this issue: (1) placing on record concern about the lack of awareness in the community about prostate cancer; (2) noting that the number of deaths per year ascribed to prostate cancer has nearly doubled, rising from 1,355 in 1982 to 2,669 in 1996; and (3) calling on the government to support the designation of one day or week per year as national prostate cancer day/week as a means of heightening awareness.

This is a fairly complex issue and in some respects a confusing one, as I think the previous speaker mentioned. There is a range of information around the issue of prostate cancer, but there is also a range of information that is not around. That in itself creates difficulties in terms of any proper or reasoned consideration of what to do. We find ourselves, in a matter such as this, in a situation where there are a number of things that could be done around the question of prostate cancer, but there are real concerns as to the efficacy of what might be done.

I think all of us would support increased community awareness in relation to what is a major health problem for men today. But, when we look at the history of this issue, we can say that it has probably been a major health risk for a long time. Part of the problem has been that it has only been in recent years that there has been more awareness from the medical profession's point of view about the actual details of prostate cancer. In fact, with the increased incidence of recognition of prostate cancer, it has been shown that most people who have prostate cancer do not actually die from it. I think the term that has been used is that people often live with prostate cancer rather than die from prostate cancer. Nonetheless, it is still a very serious issue and it is still a situation which is of major concern, particularly to men over the age of 60, although there has also been some incidence in people of a younger age.

One of the problems is that lack of awareness within the medical profession in terms of research. There are a number of research projects on at the moment that are looking at the detail around prostate cancer—for example, risk factors. The question of age appears to be a pretty clear risk factor, that is true, but there are also issues of diet, location, exercise, et cetera. Those sorts of issues are being looked at where it is thought that they may require some consideration with regard to the likelihood of developing prostate cancer. At this stage, the studies still are not firm.

Another problem is one we often find with medical research issues. Proper studies using proper samples that allow for the consideration of the issue in some detail and that give you results that are clinically capable of being utilised can sometimes take a long time, and it can be number of years before those results are known. There are at least two studies on prostate cancer being conducted overseas at the moment from which results are yet to come. It may take several years more before they give us those results.

That raises questions about what you then do. For example, there is the question of the types of treatment. With prostate cancer there are three principal treatments that are talked about: surgery or radical prostatectomy, which is the actual removal of the prostate gland; radiation therapy; and also one called watchful waiting (expectant management).

There is real argument and debate within the medical community about the best way to go if diagnosed with prostate cancer. Some surgeons will argue that removal is the best means to tackle the issue. That can have some bad side-effects for the individuals involved, in the form of incontinence and impotence. It is not the result for everybody, but we are still waiting for clinical tests to be done to give us a firm view. Some specialists swear by that approach, but we still do not know for sure what is the best way to go. Radiation therapy has similar problems. The watchful waiting approach is to monitor over time—once the cancer is diagnosed—look for evidence that there is an inflammation or a development into a further stage of the cancer and then act, although there is an argument that on occasions that can be too late.

On the question of awareness and of promoting awareness in the community, one of the key aspects that needs to be addressed is that of ensuring that patients, particularly people over the age of 50 who may be in danger of getting prostate cancer, are aware of the dangers involved and are aware of the circumstances around what they might do. A number of articles and reports that I have read in recent days on this issue suggest that a lot of doctors have not really informed their patients properly about whether the right treatment for them is screening for prostate cancer. Although it is only one part of the awareness campaign, obviously if you work on an awareness campaign to make people aware of the symptoms and of the dangers associated with prostate cancer, you then come to the issue of screening, because that is an obvious logical next step. And when there are concerns about screening and how it would operate, I think we have to think about it very carefully. I would like to quote from article in the Sydney Morning Herald on this issue headed `Warning on Prostate Test Harm':

Doctors are testing healthy men for prostate cancer without explaining the possible harmful consequences, experts warned.

There are also reports of the prostate cancer screening test being performed without men's knowledge or as part of a series of blood tests during check-ups.

The warnings accompany new research suggesting hundreds of thousands of men have been screened for the cancer, though it has never been proven to be of benefit.

It also has the potential to do ill as it could lead to men having treatments with high rates of complications—such as impotence and incontinence—for cancers which may not have caused harm if left untreated.

From 1995 to 1996, one-third of Australian men age 60-69 had at least one prostate-specific antigen (PSA) blood test, which is used both to diagnose and monitor prostate cancer, as did 27 per cent of men over 50.

NSW Cancer Council researchers said some of these tests would have been done as part of cancer management, but that most were probably done to screen healthy men.

That in itself is not a problem, but when there are concerns about the reliability of the PSA tests initially and also the alternative test, which is the DRE—digital rectum examination, as the two main tests, that can raise concerns about symptoms which, following further testing, are found not to be indicative of cancer. If we go down this track, it is important—and on the awareness point that the member for Longman has raised—that patients are very clearly made to understand that the tests can have some implications for them in terms of what might result and that, if diagnosed, there are issues to be addressed about what you do about the cancer that has been spotted.

Several studies have included surveys which have shown that people who have been tested may not have had a great awareness of the reasons why. I suppose it gets back to that issue of men's health—that it is well known that men have an a aversion to going to doctors and are more likely than not to not seek a remedy to a health problem as it develops until it is too late. I suppose this is just part of a widening circle of these sorts of issues.

Awareness needs to be part of an overall program of awareness in relation to men's health. I would certainly encourage the government to look at the national men's health strategy which the previous government had in place and to look at developing an approach right across the issues of men's health.

Certainly, if anyone finds themselves in a situation where they are showing symptoms of prostate cancer, they should seek medical attention, get tested to see whether it is the case, and move forward to try to deal with the disease. It is important to put in context that the overall majority of men who have prostate cancer in fact live with it, live long lives with it, and in most cases it does not affect their longevity. I would also note that in recent years we have all heard of people who have died of prostate cancer. It is a major men's health issue. On the question of awareness I support the thrust of the motion. I am not sure about having a day or a week of action, but I think it is something that ought to be explored. What we need is more research and more involvement in getting evidence to decide on what the correct sort of treatment is, what the best form of testing is, how we can identify what form of cancer is more likely to be malignant in the context of people who have prostate cancer, and in that way try and target what is done to ensure that people get the help they need for what is a serious health risk. (Time expired)