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Regular monitoring better for men with low-risk prostate cancer

Men with low-risk localised prostate cancer for whom prostatectomy or radiotherapy is suitable should be offered active surveillance, says the National Institute for Health and Care Excellence.

This is one of the recommendations that appear in NICE’s new clinical guideline on diagnosing and treating prostate cancer, which was published yesterday (8 January 2014) and updates its 2008 guideline. Prostate cancer is the most common cancer in men, accounting for 26 per cent of all male cancer diagnoses in the UK, and causing nearly 10,000 deaths a year.

Men undergoing active surveillance for prostate cancer should have their prostate specific antigen levels measured every three to four months initially, dropping to every six months from the fifth year of surveillance, says the guidance. This is a way of monitoring slow-growing prostate cancers that might never progress or cause any symptoms, and can help avoid or delay treatment such as radiotherapy or surgery which might otherwise be unnecessary, adds NICE.

The guideline also recommends that men with intermediate- and high-risk localised prostate cancer be offered a combination of radical radiotherapy and androgen deprivation therapy, rather than radiotherapy or androgen deprivation therapy alone. Active surveillance is recommended as an option for men with intermediate risk localised prostate cancer who do not wish to have immediate radical prostatectomy or radical radiotherapy. But NICE says active surveillance should not be offered to men with high-risk localised prostate cancer.

For men with locally advanced prostate cancer, radical treatment through surgery or radiotherapy is often considered. However, these can have side effects such as erectile dysfunction and urinary incontinence, which can greatly affect quality of life, adds NICE.

Two technology appraisals due this year

The institute is expected to publish technology appraisals for two prostate cancer treatments in 2014: enzalutamide in February and degarelix in May. NICE recommended abiraterone for castration-resistant metastatic prostate cancer in June 2012 and is currently appraising it for another prostate cancer indication.

Drew Lindon, head of policy and campaigns at Prostate Cancer UK, said: “Not only are there too few treatment options [for prostate cancer] but those which do exist often leave men facing side effects like erectile dysfunction. Where a cancer isn’t aggressive many men may in fact be better off working with their doctor to keep a close eye on the condition rather than undergoing treatments. It’s good to see NICE setting out a guide to help clinicians talk through all the options that men have available to them, while still preserving treatment as an option.”

However, he noted that it is still not possible to say with certainty whether a man has an aggressive form of the cancer, or one which will not cause harm in his lifetime. “This leaves many men faced with difficult decisions about which route to take,” he added.

Although prostate cancer mostly affects older men, men under 65 years old can be affected too. Men from a black African-Caribbean family origin are three times more likely to develop the disease than white Caucasian men.

The guideline also covers how to manage the adverse effects of long-term androgen deprivation therapy, including hot flushes, sexual dysfunction osteoporosis, gynaecomastia and fatigue.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11132649

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  • Phil Kissi MBE (Prostate Cancer UK)

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