8th January 2014 – New guidance for the NHS in England on how best to diagnose and treat prostate cancer has been published by the National Institute for Health and Care Excellence (NICE).
The guidance aims to ensure that men are given information about the treatment options available, even if they are not available locally, as well as help choosing the best option to suit them.
Since the original recommendations were published in 2008, a number of new treatments have been licensed for the management of hormone-relapsed metastatic prostate cancer, prostate cancer that has failed to respond to hormone treatment and has spread to other parts of the body. There is also more information now available on the best way to diagnose and identify the different stages of the disease in a hospital setting, as well as how best to manage the side effects of radical treatment.
Professor Mark Baker, Centre for Clinical Practice Director at NICE, says in a statement: "The last few years have seen significant improvements in the treatment of men with advanced prostate cancer. NICE has recommended new treatments such as abiraterone, and we have also recommended enzalutamide and degarelix in draft guidance.
"The updated guideline includes a number of new recommendations on the swift diagnosis and treatment of different stages of the disease and a new protocol for men who choose active surveillance, which involves regular check-ups to see if and how the cancer is developing, rather than radical treatment. The aim of this NICE guideline is to ensure that excellent treatment is provided for men who will benefit from it."
Prostate cancer is the most common cancer in men in the UK. In 2010 around 41,000 men were diagnosed with the disease in the UK. Three-quarters of prostate cancer cases are diagnosed in men over the age of 65.
The new NICE recommendations include:
Doctors should discuss all relevant treatment and diagnostic options with men with prostate cancer and their partners or carers, irrespective of whether they are available through local services.
Doctors should consider a specialised type of MRI scan called multiparametric prostate imaging. This allows better assessment of the prostate gland than standard MRI or ultrasound scans. A multiparametric MRI improves the detection of clinically significant tumours, reduces the detection of clinically insignificant tumours and can guide biopsies more accurately. The guidelines suggest use of this type of scan for men who have had negative biopsies to help reduce unnecessary repeat procedures.
Doctors should offer active surveillance as an option to men with low-risk localised prostate cancer for whom radical prostatectomy or radical radiotherapy is suitable.
Offer men with intermediate- and high-risk localised prostate cancer a combination of radical radiotherapy and androgen deprivation therapy, rather than radical radiotherapy or androgen deprivation therapy alone. Androgen deprivation therapy is a hormone treatment that reduces levels of male hormones.
Consider active surveillance for men with intermediate-risk localised prostate cancer who do not wish to have immediate radical prostatectomy or radical radiotherapy.
Dr Sarah Cant, representing patients and carers on the Guideline Development Group, says in a statement: "We want to ensure that all men diagnosed with prostate cancer receive the same high level of care, no matter where they live.
"Men and their carers should be supported at all times by appropriately trained professionals who can explain all the treatment and support options that are available for them. By making sure information and support are important aspects of care, we hope that all men will be better able to make the treatment choices that are right for them."
To provide even greater transparency and choice, we are working on a number of other cookie-related enhancements. More information