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The prostate debate

Reporter: Sophie Scott

KERRY O'BRIEN: There's a fascinating row brewing within the medical fraternity over one cancer specialist who doesn't want to know whether he's got a particular cancer or not.

It's particularly intense because the specialist is also President of the Cancer Council.

Prostate cancer kills more than 2,000 Australian men each year, and almost half of all men over 60 may develop some form of the cancer.

But often it grows so slowly that men can lead normal lives without damage to their health. And that's why Professor Alan Coates doesn't want to undergo a blood test that might identify the cancer in him.

He says it isn't accurate and leads many otherwise healthy men to undergo radical treatment with possible serious side-effects.

His critics want him to resign, as Sophie Scott reports.

WAYNE SWAN, OPPOSITION FAMILY & COMMUNITY SERVICES SPOKESMAN: I just felt a little run-down so I went to the doctor and I had a physical examination and I had a PSA test, and when the results of the PSA came back, it was through the roof.

SOPHIE SCOTT: After undergoing a simple blood test two years ago, Wayne Swan was diagnosed with aggressive prostate cancer.

WAYNE SWAN: I was aware of the medical evidence that if I didn't take some radical action, then the best outlook that I could have would be another 10 years. I wouldn't see my kids grow up and I was quite prepared therefore to have the radical prostectomy.

SOPHIE SCOTT: Now in full remission, the Labor frontbencher is a passionate advocate for prostate cancer screening.

WAYNE SWAN: I believe that screening did save my life. My father had died an extremely painful death from prostate cancer. I think it is absolutely critical that men who are particularly at risk, if there's a history in their family, that they should be tested. I guess the point is that early detection is the best protection.

PROFESSOR ALAN COATES, CANCER COUNCIL OF AUSTRALIA: I decided that personally I will not be tested and I've held that decision for over 10 years, and I believe for me that's the right decision.

SOPHIE SCOTT: As head of Australia's peak cancer organisation, you'd expect Professor Alan Coates to be lining up to take the prostate cancer screening test. But he's reignited a passionate debate within the medical profession about the value of such tests.

PROFESSOR ALAN COATES: If there was a really good effective screening test, then we mightn't be having this discussion because it would be like it is for women with breast cancer or for people with bowel cancer. We know those screening modalities work. We know they save lives. We just don't know that for screening for prostate cancer.

DR PAUL COZZI, UROLOGIST: I don't believe it's appropriate for Professor Coates to give a personal opinion in this media under the auspices of the Cancer Council of Australia. I believe it's up to the individual patient to discuss with the GP the pros and cons of PSA testing prior to proceeding with testing.

PROFESSOR ALAN COATES: It may not be the right decision for other men and I don't advocate it to other men, but I do use it to illustrate that choice means just that: you could choose one thing or the other.

SOPHIE SCOTT: The blood test measures a substance produced by the gland called prostate specific antigen, high levels of PSA indicate there's a problem with the prostate but not necessarily the presence of cancer.

Professor Coates argues that a positive test can lead to otherwise healthy men being treated as cancer patients.

PROFESSOR ALAN COATES: If treatment was harmless, that wouldn't matter. But treatment does have some real side-effects. We don't know exactly how often because numbers vary about that. But impotence and incontinence are unpleasant side-effects. If I knew that there was a benefit to put against those, then I might be prepared to take those risks.

WAYNE SWAN: I'm absolutely appalled by what he has said. This man is the head of the peak cancer organisation in this country. People would regard him as being highly educated and highly knowledgeable. I believe that the statements that he has made run against the weight of medical opinion.

SOPHIE SCOTT: But unlike Wayne Swan, not all prostate cancer patients want or need radical surgery.

PETER BROWNIE: I go to my specialist once every six months and if I'm worried, more frequently, but I haven't needed to do that. SOPHIE SCOTT: Five years ago, Peter Brownie was diagnosed with the disease after a PSA test and a biopsy. But he decided to take a watch and wait approach.

PETER BROWNIE: I'm not very brave so I wouldn't like to go and have that invasive surgery, but I'm not being pig-headed and so on. If I had to do it, I'd do it. But I probably am going to die of heart attack or stroke rather than prostate cancer.

SOPHIE SCOTT: Defenders of the PSA test such as urologist Paul Cozzi from Sydney's St George Hospital argue there's been a marked increase in the number of prostate cancer cases diagnosed since the test was introduced back in the late 1980s. He says the release of a major European study later this year which tracked the outcomes of PSA screening will clearly demonstrate the benefits of the test.

DR PAUL COZZI: I think when the data from this latest trial becomes available, we will hopefully have a lot more scientific evidence as to the benefit of screening.

SOPHIE SCOTT: What's been the fallout from this current controversy over PSA screening?

DR PAUL COZZI: I personally have had several patients that have been very confused by the recent information in the media as to whether they should proceed, even with the prostate biopsy. There is more confusion of course with regard to treatment but certainly these recent events in the media have not helped the general practitioners, the urologists or the patients.

SOPHIE SCOTT: But confusion isn't the only fallout. The Prostate Cancer Foundation says a major sponsor withdrew $1.5 million in funding for a public education campaign to encourage prostate screening once the controversy broke.

MAX GARDNER, PROSTATE CANCER FOUNDATION: That of course frightened off the donor, naturally he didn't want to be in the middle of a dispute, and the whole funding went down the tubes and the opportunity was lost, which we think is detrimental to men's health issues generally.

SOPHIE SCOTT: Professor Coates says while he's aware of the controversy his comments may have caused, he says it simply reflects how complicated the issue is and doesn't regret going public.

PROFESSOR ALAN COATES: If putting a fair presentation of the pros and cons causes confusion, then I'm sorry, but the evidence isn't sufficient to remove that confusion, and I don't think anybody is well-served by pretending that it's better than it is.
