In an adult population of about 12 million, some 3.58 million people have had voluntary tests for HIV since 1988. Fifty-three percent of the adult population has had a cholesterol test.

Much in the same way that astrology and other forms of fortune telling beckon the curious and those starved of ordinary feedback about their personalities, a medical test offers unique information that may bring relief from anxiety with the probability of good news about one’s most precious yet mysterious possession: one’s body. Occasionally bad news from a fortune teller can result in actions that ruin lives. Mostly, though, it causes momentary disquiet, soon rationalised away. The same benign scenarios cannot be drawn for many medical tests, which is why serious ethical issues need debating before screening procedures are promoted by groups, some of which stand to gain from their use.

Three drug companies (Merck Sharp & Dohme, Schering, and Abbott), the RSL, the Australian Kidney Foundation, the Combined Pensioners & Superannuation Association of New South Wales, and sections of the emerging men’s health movement are currently leading the charge for the Next Big Thing in screening – prostate screening. Surfing the 1990s zeitgeist of men trying to redress the balance lost to affirmative programs for women, the men’s health movement is brandishing a compelling rhetoric that can be summed up as “Women are getting all this stuff for breast cancer, what are we getting?” Bruce Ruxton is among their champions.

Aside from considerations of cost (to screen Australia’s 1.5 million men aged 50-plus, $300 million, 20 times the total cancer research budget, is required), the decision to promote screening for asymptomatic disease ought to be based firmly on evidence that there will be benefit to those being screened.

This benefit can lie in increased lifespan and improved quality of life compared with the consequences of not screening. With breast cancer, considerable evidence shows that early detection can prolong survival. The main argument for HIV screening has always been that knowing one is HIV positive may well promote safer sexual practice, while a high cholesterol reading might motivate dietary change or cholesterol-lowering drug therapy.

It seems that the drift of these analogies, together with the fairness imperatives of the new male health movement, have ignited enthusiasm for men to be next in line for what to some is a screening gravy train. With their very own organ as candidate, some superficially appealing statistics (one in 23 men will develop prostate cancer in his lifetime, compared with one in 14 women who will develop breast cancer) and entrepreneurial sections of medicine and the drug industry beating the drum, this issue won’t be hiding from minister for health Carmen Lawrence’s office in 1995.

Any aggressive and well-promoted prostate-cancer screening campaign will detect many hitherto undiscovered cancers. But this is not the point. The aim of screening, except where it is solely designed to measure prevalence of a disease in a population, is not to find more cancers. It is to find candidates for treatments where there is a high probability of success (although what is “high” enough will always be subject to debate). And this is where the prostate screening exercise starts to go horribly wrong.

Aside from the general trauma of being labelled as having cancer and the traumas of surgery and radiotherapy, international research shows that urinary incontinence occurs in up to 8 percent of men given radical prostatectomy or radiation. Impotence is more frequent and about 1 percent of men die within 30 days of prostate removal. Of more fundamental importance is that while one in 23 men will be diagnosed with prostate cancer, one-third of deaths from the disease occur in men over 80 years. Two-thirds of men with diagnosed prostate cancer die from a cause other than their prostate cancer. Thus any large-scale prostate screening campaign is guaranteed to uncover a large number of men in good spirits and apparently in good health, who would have gone to their graves from something other than prostate cancer, many without any significant symptoms or decrement to their quality of life.

The Australian Cancer Society opposes the screening of asymptomatic men for prostate cancer, arguing that, as yet, there are no prospective studies which demonstrate reductions in death following any treatment currently available. It goes further, criticising “the identification of innocuous disease which would never have made itself clinically apparent is a serious, unethical and iatrogenic consequence of any screening activity, particularly if the complications of unnecessary treatment are substantial”. “Street corner” screening facilities for prostate cancer, now common in the USA, seem certain to develop rapidly here, thanks to entrepreneurial medicine, a community poorly informed about the natural history of disease, and the prevalence of the view that it is negligent not to treat.

We all have to die from something and, as far as we know so far, old age is the best predictor of prostate cancer. A recent national poll showed that Australians’ personal fear of cancer is way ahead of any other disease (77 percent naming it first, ahead of AIDS with 13 percent). Health policy on screening should not be influenced by ideological views about men’s health.