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Monday, 2 June 2003
Page: 15568


Dr SOUTHCOTT (1:17 PM) —Members of parliament and people in medicine always have an urge to do something: `If you see a problem, do something: correct it.' In the area of prostate cancer, it may seem counter-intuitive that early detection is not always going to lead to lives saved. In breast cancer and colonic cancer, the focus is on early detection and getting the cancer out with surgery, using radiotherapy, chemotherapy, hormone therapy or whatever. Prostate cancer is very different. You have a whole spectrum from almost benign disease to very aggressive disease. I urge members to look at the web site www.prostatehealth. org.au, which is part of the prostate collaboration and which I think has been generated by the repatriation hospital in my electorate as part of the Lions Australian prostate site.

As members of parliament, we should encourage evidence based practice. In terms of prostate cancer and this motion, anything which leads to an increased relationship between men and their GP is positive. I wish to endorse most of the motion by the member for Robertson, but I want to qualify some of it and perhaps question whether widespread screening leading to early detection is actually going to lead to lives saved. The important thing—rather than just having population screening—is to understand the natural history of prostate cancer. The authors of an article in the British Medical Journal of 6 October 2001, looking at the British evidence, talked about surveys which concluded that there is insufficient evidence to recommend the introduction of PSA screening because of concerns that it may not improve survival or quality of life and may thus cause more harm than good.

Having a PSA test is an individual matter. It is important to balance the risk of the cancer—and to understand how it might behave—and the risk of unnecessary treatment and side effects. It is an individual decision. What people need to do is, firstly, assess the threat with their general practitioner, and, secondly, think about what they will do if they find early stage or low-grade prostate cancer. They need to think about whether they will have the cancer treated or not. Then they need to discuss with their partner and their GP where their preference lies between the risk of the threat and the problems with the treatment.

As I said, testing in prostate cancer is an individual decision. It should be an informed decision. Any awareness campaign needs to encourage people to spend at least 20 minutes with their general practitioner and to read the sorts of documents that are available on the prostate health web site. People need to know about prostate cancer. They also need to know about the tests, the diagnosis and the treatment.

Most prostate cancers are slow growing. Ninety per cent of them are in men over 60. Many are not a threat to life. For example, a quarter of men in their 50s, 40 per cent of men in their 60s, and 60 to 80 per cent of men in their 80s will have some microscopic evidence of prostate cancer. In the majority of cases, this is not life threatening.

It is true that surgery or radiotherapy can cure early cancer. A PSA test can show prostate cancer at an early stage, when the cancer is often asymptomatic. But the treatment can also lead to the side effects of impotence and incontinence. The cancers grow at different rates. We do not always know whether treatment is necessary. There are high-risk groups such as people who have had a father and a brother with a cancer at an early age. For these people, a PSA test would be prudent. But then there are people with lower risks—men younger than 40 and people with no family history. Many men over 75 will have prostate cancer. In most cases it is not threatening their life; in most cases they will ultimately die from something else. But there are men aged 50 to 75 who are at moderate risk of cancer and are being threatened by it.

The PSA test is useful—people need to consider whether they are going to have one or an annual screen—it also needs to come with a rectal examination. In the treatment of prostate cancer, sometimes the best thing to do if the cancer is early stage and low grade, is to watch and wait—defer treatment. With prostatectomy and radiotherapy, there are other side effects: impotence, incontinence and sometimes, with radiotherapy, bowel injury. (Time expired)