Prostate patients ‘wait and watch’ instead of treatment

Health service says surgery is not always the best option for men with the low-risk form of cancer

MEN with “low-risk” prostate cancer should not be pushed into treatment, new guidance for the NHS suggests.

The recommendation to adopt a “wait and watch” approach means that thousands of men could be spared surgery and radiotherapy.

For the first time, the official advice from the National Institute for Health and Care Excellence (Nice) says there is no survival benefit to having treatment in cases identified as low risk.

Around 8,000 men of the 47,000 diagnosed annually with prostate cancer fall into this category. The guidance says doctors must give them an “equal choice” between treatment, or “active surveillance” – regular tests and scans.

In the past, so-called watchful waiting has been seen as a “non-preferred treatment”.

The advice only affects men with low-risk localised prostate cancer.

They should be offered a choice between monitoring, radical prostatectomy – an operation to remove the prostate gland and surrounding tissues – or radical radiotherapy, Nice says.

Prostatectomy and radiotherapy are shown to reduce disease progression compared with active surveillance.

However, Nice said evidence shows no difference when it comes to 10-year survival rates. Because the chance of prostate cancer rises with age, those with a slow-growing form of the disease often die of other causes.

Treatment can have side-effects including incontinence and erectile dysfunction.

Heather Blake, from Prostate Cancer UK, said: “It’s great news that the Nice guidelines reflect the latest evidence and recommend active surveillance … as a primary option for men with low risk localised prostate cancer.

“This could potentially provide thousands of men with the opportunity to safely delay or avoid radical treatment and its associated side-effects.”

Dr Sam Merriel, GP and lead author of the advice, said: “Choosing active surveillance over treatment is not necessarily an easy decision as it goes against the natural instinct of wanting to get rid of the cancer immediately.”

He said it was important that those diagnosed received “emotional and psychological support”.

Daniel Beecroft, 45, was diagnosed with low-risk localised prostate cancer in July 2018. His father was diagnosed with a more aggressive cancer in 2012.

Mr Beecroft said he was originally advised that he would need surgery, but opted for active surveillance after discussing it with clinicians.

He said: “In the end it was a nobrainer for me to choose to keep an eye on things for now. I was told my cancer was small and not aggressive.

“I had seen side-effects my father had to deal with after surgery so felt I would prefer to delay going down that route for as long as possible.”