Prostate cancer risk in Maori men
Overview by Dr Cynthia O’Sullivan
Advanced training registrar in Urology
Wellington Public Hospital
Māori people, the Tangata Whenua of Aotearoa make up 16.5% of the country’s population. Māori men have a lower overall life expectancy and poorer health outcomes across all conditions, cancer and non-cancer causes compared with their Pākehā counterparts.
Unfortunately, Prostate cancer is no exception. Māori men are about 20% less likely to be diagnosed with prostate cancer than Non-Māori men but 50% more likely to die from the disease once diagnosed.
Māori men should be aware and alert to the risks surrounding prostate cancer. It is important that we work together, both as people of Aotearoa and health care providers to identify Māori patients with prostate cancer early.
Although there are theories as to why these differences exist, none have been confirmed. Research looking into cervical, lung and colon cancer have shown that barriers to health care, along with delayed diagnosis and treatment play a large part in these outcomes. Maori men are less likely to see their GP and when they do, are less likely to see the GP that they wanted or to be screened for prostate cancer. These barriers may explain why Maori men are more likely to present with distant disease or spread of disease at the time prostate cancer is diagnosed. Even when Māori and non-Māori men have the same disease at diagnosis, the long-term outcomes differ, and we do not know the cause for this. A genetic cause has not been identified, and so limited access to care and adequate follow up due to structural and financial barriers for these men and their Whānau, such as the cost of travel and time off work may contribute.
All men should talk to their health care provider and Whānau about prostate cancer screening. This involves having a PSA blood test from the age of 50, or 40 if your father or brother were diagnosed with prostate cancer before they turned 65. If this test is elevated, it will be repeated in 6 -12 weeks. This test should be performed annually for any change.
A digital rectal examination (DRE) can be a useful tool to detect an abnormal feeling prostate. A study carried out in the Auckland Region showed that Māori men were more likely to have palpable disease (cancer that the doctor can feel with their finger) than their Pākehā counterparts. An abnormal feeling prostate with a normal PSA can detect abut 20% of prostate cancers, however, we acknowledge that DRE is a barrier to many Māori men, as it is invasive and can impact on their Mana. You will not be forced to have a DRE and men can still be referred to see a urologist (specialist) without this.
Prostate cancer survival is highly dependent on the extent of disease at the time of diagnosis. Men diagnosed with localised disease have an excellent chance of surviving, however, men diagnosed with advanced/late disease have a limited life expectancy. Therefore, spread the word to your Whānau, increase awareness and let’s work together to diagnose prostate cancer early.
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