Prostate patients to be spared treatment with new NHS guidance
THOUSANDS of men with prostate cancer will be spared aggressive treatment thanks to landmark NHS guidance which advises a ‘watch and wait’ approach for those at low-risk.
Official guidelines for the first time say ‘active surveillance’ – in which a patient is monitored rather than treated – should be presented as an ‘ equal choice’ alongside surgery and radiotherapy.
Doctors called the move a ‘ remarkable’ step which would spare many men from the side effects of unnecessary treatment, such as incontinence and impotence.
The guidance, published by NHS watchdog NICE, makes clear that radical treatment for low-risk prostate cancer makes almost no difference to life expectancy.
Those who choose active surveillance should be given tests every six months and an examination every year – and undergo rapid treatment if their cancer spreads.
The Daily Mail is campaigning for an urgent improvement in prostate cancer diagnosis and treatment.
While breast cancer treatments are increasingly tailored and personalised, prostate cancer still uses a ‘one-size-fits-all’ approach. The new guidance begins to close that gap.
Some 47,000 men are diagnosed with prostate cancer in the UK each year, but the severity of the disease varies hugely. Rapid treatment for men with aggressive forms of the cancer is vital, and 11,800 men still die from the disease each year. But around 30,000 men have localised tumours, which have not yet left the prostate.
Many undergo radiotherapy or surgery but it is often best to offer no treatment at all. Until now, however, doctors have been afraid to offer this advice.
Vincent Gnanapragasam, a consultant urologist at the University of Cambridge, said: ‘Clinicians do not want to be seen to be telling people not to have treatment.’
Patients, meanwhile, will often demand action when they hear the word ‘cancer’.
The new NICE guidance attempts to bridge this problem by spelling out the chances of survival – and the side effects – depending on the forms of treatment.
Two in every 100 men who opt for active surveillance will die from prostate cancer in a decade, compared to one in 100 for surgery and radiotherapy. The chance of the cancer spreading is higher with active surveillance – meaning some men end up having to be treated eventually.
Professor Freddie Hamdy, of the University of Oxford, who led a decade-long study into active surveillance published in 2016, said: ‘It gives the patients choice and options which are based on evidence.
‘The moment patients hear the word cancer they want it treated, and they can pay the price of that treatment in side effects. This is quite remarkable and could really go some way to reducing the risk of overtreatment.’
Prostate Cancer UK said the guidance was an ‘endorsement’ of active surveillance. Heather Blake, director of support at the charity, said: ‘This could potentially provide thousands of men with the opportunity to safely delay or avoid radical treatment and its associated side effects.’