August 14, 2014
Māori men at 70% increased risk of dying of prostate cancer than non-Māori men
Graeme Woodside, Chief Executive Officer of the Prostate Cancer Foundation of New Zealand says, “New Zealand has significant disparities in survival for Māori men living with prostate cancer. As a community, it is absolutely critical we support and empower clinicians and Māori men themselves to actively manage their health and seek early diagnosis of prostate cancer in order to reduce the mortality rate”.
A recent report of the Midlands Prostate Cancer Study conducted by University of Auckland (UniServices) and co-funded by the Health Research Council and Ministry of Health identified that there are approximately 3,000 men diagnosed with prostate cancer in New Zealand every year and Māori men are 72% more likely to die of prostate cancer once diagnosed than their non-Māori counterparts.
Principal investigator Professor Ross Lawrenson reports that Māori men are less likely to be diagnosed with prostate cancer than non-Māori men, but when diagnosed are twice as likely to have metastatic disease. Survival at 2 years for men diagnosed with metastatic disease is less than 40% and almost all these men have died from their cancer.
The statistics highlight significant inequities in New Zealand’s healthcare system between Māori and non-Maori men with regard to prostate cancer screening, diagnosis, treatment and health outcomes.
“Not only are Māori men being diagnosed too late, when their cancer is in an advanced stage, but the management and treatment of their prostate cancer is significantly different than that provided to non-Māori men,” says Professor Lawrenson.
“More work has to be conducted to inform and improve the pathways of care for men with prostate cancer. We need to make primary care practitioners aware of the inequities in access to screening between Māori and non-Māori men. Further research is also required to identify causes of the higher prostate cancer mortality rate for Māori men compared to non-Māori men,” added Professor Lawrenson.
It is more likely that Māori men are treated by orchidectomy (surgical removal of the testicles to stop most of the body's production of testosterone – required for cancer growth). They are also more likely to receive androgen deprivation treatment (ADT) than non-Māori men.
Whilst New Zealand has no national guidelines for the treatment of metastatic prostate cancer, European guidelines recommend first line therapy after PSA progression is Androgen Deprivation Therapy (ADT) as standard of care. Second line therapies include docetaxel, cabazitaxel[a], abiraterone[b] and enzalutamide [a].
“These more advanced treatments may provide Māori men with the opportunity to extend their life and enjoy a greater quality of life for their remaining time with whānau and be treated in the community or at home,” says Mr Woodside.
“Our Māori men deserve a higher priority when it comes to treatment options and access to advanced treatments for metastatic prostate cancer. Equity in the healthcare system is well overdue,” adds Mr Woodside.
[a] Not registered in New Zealand
[b] Registered, however still being considered by PHARMAC for funding in New Zealand
PROSTATE CANCER IN NEW ZEALAND:
• In New Zealand, prostate cancer is the most common cancer in men and the third most common cause of cancer death in men after lung cancer and bowel cancer.
• Approximately 3,000 new cases of prostate cancer are diagnosed each year.
• One in 13 men will develop prostate cancer before the age of 75.
• Approximately 600 men die from metastatic prostate cancer each year.
• Mãori men are 72 per cent more likely to die of prostate cancer once diagnosed than non-Mãori men.
• Between 10 and 20% of men with prostate cancer progress to advanced (metastatic) prostate cancer within 5 years of diagnosis.
• 20% of men witih metastatic prostate cancer do not receive Androgen Deprivation Therapy within their first year of diagnosis.
About Prostate Cancer Foundation of New Zealand:
Our mission: To provide an environment empowering men to make informed decisions about the diagnosis and treatment of prostate cancer. Throughout New Zealand, we offer peer support to men, and their families, who have been diagnosed with prostate cancer. We actively promote awareness of this disease through community education campaigns, and we support medical research into improved diagnosis and treatment outcomes. For more information visit www.prostate.org.nz or call 0800 4 PROSTATE