Briefing to the Health Committee Enquiry on the Early Diagnosis and Treatment of Prostate Cancer

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1 Briefing to the Health Committee Enquiry on the Early Diagnosis and Treatment of Prostate Cancer Prostate Specific Antigen (PSA) Testing in New Zealand Background 1. The Committee have requested information on PSA testing in New Zealand in particular information regarding the testing of asymptomatic men. 2. There is limited information available to analyse the patterns of PSA undertaken in asymptomatic men however estimates of PSA testing are available from two sources. 3. As part of the 2006/2007 New Zealand Health Survey, all men aged 20 years and over were asked if they had a PSA blood test for prostate cancer in the past 12 months. If they answered yes, they were asked the reasons for this. 4. The MOH Cancer Programme Team undertook an analysis of data from the Laboratory Warehouse data on publicly funded PSA tests for the period 2004 to This study could not identify the reasons for PSA testing but did provide information on the trends of total PSA testing in New Zealand for this period. The incidence and prevalence of PSA testing was estimated by comparing the number of distinct National Health Index (NHI) numbers recorded against a PSA test in the Labs Warehouse with the number of men in each age group reported in 2006 Census data. Findings on prostate specific antigen testing from the 2006/2007 New Zealand Survey 5. One in five men aged 20 years and over (approximately 20%) reported having a PSA blood test for prostate cancer in the previous 12 months. 6. Men aged 55 years and over were significantly more likely than younger men to have had a PSA test in the previous 12 months. Testing rates were higher than those estimated by the Labs Warehouse analysis, with 39 percent in the age group and 51 percent in the age group having a test in the past 12 months. Page 1 of 5

2 Figure 1: Men aged 20+ years who had a PSA test in the previous 12 months, by age group 60 Percent Source: 2006/07 New Zealand Health Survey Age group (years) 7. European/Other men aged 20 years and over were significantly more likely than the total male population aged 20 years and over to have had a PSA test in the previous 12 months, while Māori, Pacific and Asian men were significantly less likely (Figure 2). 8. Approximately 82% of men who had a PSA test in the previous 12 months had no symptoms: over half (56.3%) did so because a GP recommended the test even though they did not have symptoms or specific concerns a quarter (25.7%, ) were concerned about prostate cancer and did not have symptoms 11.4% ( ) had symptoms of prostate cancer 5.4% ( ) had already been diagnosed with prostate cancer. 9. Men aged years were more likely than older men (65+ years) to have had a PSA test due to concern about prostate cancer without any symptoms, while older men were more likely to have had a PSA test because they had already been diagnosed with prostate cancer. Page 2 of 5

3 Findings from the National Laboratory Warehouse Data 10. Information on PSA testing from the Labs Warehouse, a database held centrally by the Ministry of Health shows that total PSA testing has increased steadily over the past few years, from around 228,000 tests in 2001 to 281,000 in 2007 (an increase of 23 percent). Figure 3: PSA Testing in New Zealand 2001 to 2008 by age group < > Source: MOH LabWarehouse Data Key findings from the analysis were: The proportion of men over 50 having a PSA test in any one year increased from around 29 to 33 percent from 2004 to 2007 The proportion of men over 50 who had a PSA test at any stage during was around 54 percent Men aged had the highest rate of PSA testing, with 42 and 62 percent having a test over one and three years respectively The greatest increase in the proportion of men having a PSA test was in the age groups Māori and Pacific men were less likely than the general population to have a PSA test, with the greatest difference in the younger age groups. 12. Although further review would be needed to confirm the robustness of this analysis, it is consistent with results from the New Zealand Health Survey 2006/07 (data unpublished). Page 3 of 5

4 Appendix Figure 2: New Zealand Health Survey- Men aged 20+ years who have had PSA test in the previous 12 months, by ethnic group (age-standardised rate ratio) 1.2 Ratio European/Other Māori Pacific Asian Ethnic group Source: 2006/07 New Zealand Health Survey Notes: Age standardised to the WHO world population. Reference group, with a rate ratio of 1.0 (indicated by the bold line), is the total male population aged 15 years and over. Total response standard output for ethnic groups has been used Fig 4: National Laboratory Warehouse Data - Incidence and prevalence of PSA testing for men >50, by ethnicity 60.0% 50.0% 40.0% 30.0% 20.0% Incidence 2007 Prevalence % 0.0% Total Māori Pacific Page 4 of 5

5 Fig 3: National Laboratory Warehouse Data Incidence and prevalence of PSA testing for men >50, by age band Incidence 2007 Prevalence % 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Page 5 of 5