More than 4,000 New Zealand men are told they have prostate cancer each year, making it the country’s most commonly diagnosed cancer.
The Prostate Cancer Foundation of New Zealand puts the average annual death toll at 739 and speaks for more than 42,000 men living with the disease. Around one in eight men will develop it at some point.
Those numbers are why the Foundation turns September blue every year. Blue September is its main fundraising and awareness campaign, and the activities are deliberately undemanding.
People ride a distance goal for the month, host something at home, or take on the push-up challenge, which is set at 739 repetitions for the reason you would expect. The Foundation has aimed to raise more than $1 million in recent campaigns, with the money going into support services for men and their families, research, and advocacy.
The awareness part is where it gets genuinely complicated, and it is worth understanding why before booking a test.
Why there is no national programme
New Zealand screens for breast cancer, cervical cancer and bowel cancer. It does not screen for prostate cancer, and that is a deliberate decision rather than an oversight.
The reason sits in the accuracy of the PSA blood test. Routine testing of men without symptoms is not currently recommended here because the test is not precise enough to do more good than harm across a whole population.
The best available evidence, summarised for New Zealand GPs by bpacnz, is that large randomised trials show screening reduces deaths from prostate cancer but does not change all-cause mortality.
In practical terms, screening 1,000 men might prevent around 1.3 prostate cancer deaths and three cases of cancer spreading. The cost is that a meaningful share of the men diagnosed, possibly around 20%, are treated for a cancer that would never have troubled them. Prostate cancer treatment carries real risks to continence and sexual function.
That is an uncomfortable trade-off rather than a clear answer, which is exactly why the official position is informed discussion rather than routine testing.
The Ministry of Health reviewed the evidence for a national programme in 2023 and concluded one was not justified, with a further review scheduled for the end of 2026. The Prostate Cancer Foundation has continued to push, asking the Government to fund a four-year, $6.4 million pilot programme in Budget 2026.
Health New Zealand has built a decision-support website, Kupe, specifically to help men weigh the question with their GP rather than guess at it.
The Foundation has also raised concerns about home PSA testing kits, on the grounds that a result arriving without the conversation attached is more likely to cause harm than prevent it.
A raised PSA has several innocent explanations. A normal one is not a guarantee. Neither number means much without a clinician who knows your history.
The gap that should bother us more
If there is one figure in this area that deserves more attention than it gets, it is the outcome gap for Māori men.
Research published in BJU International by Zoran Obertová and colleagues found Māori men were 14% less likely than non-Māori to be diagnosed with prostate cancer, and 72% more likely to die from it.
Later New Zealand analysis has put the excess risk of death at around 43% compared with European men, persisting after adjustment for other factors. Age-standardised mortality has been reported at 22.1 per 100,000 for Māori against 16.2 for non-Māori.
At 15-year follow-up, cumulative survival was 39.8% for Māori men and 46.5% for European men. Researchers have noted the gap has not narrowed even as survival improved overall.
The explanations that researchers point to are the familiar ones. Later-stage disease at diagnosis, differences in what testing and treatment is offered, and the broader barriers Māori men face getting into and through the health system in the first place.
Some of that is fixable at the point of a GP conversation and some of it is not. It is a strong argument for men in whānau with any history of the disease to be having the discussion earlier rather than later.
What to actually do
The practical version is short.
Early prostate cancer usually has no symptoms at all, so waiting for a sign is not a strategy. Symptoms that do show up, mostly changes in urinating, are far more often caused by an enlarged prostate than by cancer, which is another reason self-diagnosis is unhelpful in both directions.
Risk rises with age and rises considerably with family history. A father or brother with prostate cancer roughly doubles the risk, and that is worth raising with a GP from around 50, or earlier if the family history is strong.
The conversation to ask for is not “should I get tested”. It is “given my age and my family, what do the benefits and risks of testing look like for me”. Kupe is designed to help prepare for exactly that discussion.
And if the whole subject has been sitting in the too-hard basket, September is as good a prompt as any.
The push-ups are optional. The conversation with your doctor is the part that counts, and it takes about ten minutes.
