“Men living in rural locations face higher mortality rates from prostate cancer and have lower screening rates, less intensive diagnostics, longer wait times, and later diagnoses,” head of radiology Te Whatu Ora Tairawhiti and Matai clinical lead Dr Daniel Cornfeld said.

 

“The pathway aims for an equitable service to improve prostate outcomes for all men in Tairāwhiti/Gisborne with the goal of eliminating late diagnosis of prostate cancer in the region.”

 

A clinical partnership with Te Whatu Ora Tairāwhiti, the innovative diagnostic pathway promises greater diagnostic accuracy, less inequalities in prostate cancer outcomes (especially for Māori and men in under-served and remote communities), and potential broader benefits such as shorter wait lists

 

“In the last few years, the pathway has become more widely available in New Zealand but is still mainly limited to urban and private settings,” he said.

Every year, around 700 New Zealand men die from prostate cancer.

The five-year survival rate is 98% with early diagnosis and drops to less than 20% if diagnosed late.

 

Cornfeld said the project’s advanced MRI techniques help determine whether a biopsy is needed and assist in performing targeted biopsies.

“A targeted biopsy allows for better understanding of the size, grade and location of prostate cancers.

“The best practice approach reduces the overall need for biopsies, helps diagnose more serious prostate cancers and reduces diagnosis of less serious cases.”

 

Cornfeld spearheaded an MRI prior to targeted biopsy pathway in Tairāwhiti.

 

“They can avoid an initial biopsy 45% of the time, which reduces the risk of having a biopsy.

 

“Eighty-five percent of patients we biopsy have prostate cancer.

 

“Approximately 10% have a low-grade cancer that most likely can be watched as opposed to treated,” he said.

 

“Approximately 75% have a high-grade cancer that should be treated (but in some cases can be watched). Exact treatment or follow-up is based on image characteristics, biopsy characteristics and patient preference.

 

“This means that we are avoiding unnecessary biopsies, which is good for men and good for the efficiency of the system.”

 

The model of care pathway was already standard in some overseas jurisdictions, such as Europe and Japan, and the work at Mātai Medical Research Institute was intended to serve as a benchmark for the rest of New Zealand, he said.

 

“The funding from Perpetual Guardian Foundation also supports verifying the approach towards it becoming the general standard for prostate cancer diagnosis in New Zealand.

 

“New Zealand was 10 to 15 years behind the rest of the world in embracing this pathway, so we have worked hard to implement the pathway here.”

Cornfeld is working on demonstrating the results so that model of care pathway is an example for the rest of the country.

 

“I hope the demand for this type of care will necessitate that it become the standard.”

Peter Dickens, chief executive of the Prostate Cancer Foundation of NZ, said it was an important initiative in efforts to bring Aotearoa New Zealand into line with best diagnostic practice globally.

 

“We absolutely need more accuracy and equity in prostate cancer diagnosis in New Zealand.

 

“Over 700 men died of prostate cancer last year and these numbers are increasing and forecast to double by 2044.

 

“The Government has not yet committed to funding a screening programme for a cancer that is specific to men.”