PROSTABLOG NZ: New guidelines for general practitioners on how to handle men presenting with possible symptoms of prostate cancer (and other cancers) were released today by the NZ Ministry of Health. READ MORE> and HERE (summary)>
The advice is contained in a 174-page report from the Ministry-backed NZ Guidelines Group called Suspected Cancer in Primary Care – Guidelines for investigation, referral and reducing ethnic disparities, which sets out background data and guiding principles on a range of cancers.
The report avoids getting into population-based screening – a major issue in detecting prostate cancer – saying:
Cancer screening, health promotion and prevention, case-finding in asymptomatic people, recurrence of a previous cancer and metastatic cancer were beyond the guideline scope and therefore are not included.
However, it does relent a little in the section on ethnicity and cancer treatment disparity:
Addressing the issue of cancer screening is outside the broad scope of this guideline. However, because of the impact that screening uptake can potentially have on disease outcomes, it is briefly included as part of this disparity chapter.
In the section on prostate cancer, it outlines the following advice for GPs seeing patients:
- A man presenting with macroscopic haematuria (blood in urine) should be referred urgently to a specialist;
- A man found to have an enlarged, smooth prostate on digital rectal examination and a normal PSA should only be referred to a specialist if they have macroscopic haematuria;
- An older man presenting with lower urinary tract symptoms (frequency, hesitancy, nocturia) should be recommended to have a digital rectal examination and a PSA test.
Men with erectile dysfunction are excluded from the referral guidelines.
The report also contains the latest data on cancer trends and explores in some depth the detection, care and mortality disparities between Maori, Pacific people and European Kiwis.
On the page listing organisations that endorse the report (so presumably have seen it already), the Cancer Society of NZ (which opposes population-based prostate cancer screening) is included – but not the Prostate Cancer Foundation of NZ (which supports it).
The report comes just a week before the Government’s Parliamentary inquiry into prostate cancer detection and treatment, which will hear its first submissions on Wednesday.