National Institute for Health and Clinical Excellence (NICE)
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New NICE guideline on the diagnosis and treatment of prostate cancer

The National Institute for Health and Clinical Excellence (NICE) has today (27 February) issued a new guideline on best practice for the diagnosis and treatment of prostate cancer.

Around 35,000 men are diagnosed with and 10,000 men die from prostate cancer in England and Wales every year, making it one of the most common cancers in men. However, it can also be a slow growing cancer and may not necessarily affect a man’s general health for many years. Although it is mostly found in older men, it can be diagnosed in those aged under 65 as well.

The guideline, produced for NICE by the National Collaborating Centre for Cancer, will help clinicians to provide coherent and consistent care for men with suspected or diagnosed prostate cancer across England and Wales.
Recommendations include:

•Men with prostate cancer and their partners or carers should be informed about the effects of prostate cancer and the treatment options on their sexual function, physical appearance, continence and other aspects of masculinity. They should be supported to make treatment decisions, taking into account the effects on quality of life as well as survival.

•To help men decide whether to have a prostate biopsy, healthcare professionals should discuss with them their prostate specific antigen (PSA) level, digital rectal examination (DRE) and comorbidities, together with their risk factors (including increasing age and black African or black Caribbean
ethnicity) and any history of a previous negative prostate biopsy. The serum PSA level alone should not automatically lead to a prostate biopsy.

•Men with low-risk localised prostate cancer who are considered suitable for radical treatment should first be offered active surveillance.

•Healthcare professionals should ensure that men and their partners have early and ongoing access to specialist erectile dysfunction services.

•Healthcare professionals should ensure that men with troublesome urinary symptoms after treatment have access to specialist continence services for assessment, diagnosis and conservative treatment.

•When men with prostate cancer develop biochemical evidence of hormone-refractory disease, their treatment options should be discussed by the urological cancer multidisciplinary team with a view to seeking an oncologist and/or specialist palliative care opinion, as appropriate.

Professor Peter Littlejohns, Executive Lead for the guidance, and Clinical and Public Health Director at NICE said: “Over the past 10 to 15 years there have been a number of significant advances in prostate cancer management but also differing views on the most effective treatments, especially about the clinical management of men with early, non-metastatic disease. These uncertainties clearly cause anxieties for men with prostate cancer and their families. This guideline will help to address these issues and offer guidance on best practice.”

Professor Mark Baker, Guidance Development Group (GDG) Chair and Lead Cancer Clinician at Leeds Teaching Hospital said: “Around 10,000 men a year die of prostate cancer; or almost 200 men each week. It can be a devastating disease that may affect 1 in 14 men* but sometimes has little effect on a man’s longevity. This guidance aims to ensure that wherever people are diagnosed and treated, they will have access to the same high quality standard of care from trained professionals; providing consistent, high quality information to help them make the right decisions for them.”

Dr John Graham, GDG Lead Clinician and Consultant Lead Clinical Oncologist, Taunton and Somerset NHS Trust said: “One of our major challenges is to identify and treat aggressive cancers that may be life threatening while avoiding over treatment of slow growing cancers that may not need treating for many years. Prostate cancer is more common in older men. This is why it is so important that men with prostate cancer are able to understand the treatment options available them and, with the support of their healthcare professional, are able to make a choice to suit their individual needs, both clinically and related to their quality of life.”

Philip Barnard, GDG Patient representative and Honorary Secretary, PSA Prostate Cancer Support Association said: “When you are told that you have prostate cancer it is difficult not to think ‘the big C’ and panic. Men don’t like to ask for help, but this guidance encourages them to. When I was first diagnosed, the treatments I was offered were surgery or radiotherapy, both radical treatments. But looking back, I realise that my cancer was low risk and I didn’t need to rush in. I do not feel I was given enough information at the time to support me in making my decision. This guidance should be warmly welcomed by men with prostate cancer.”

Mr David Gillatt, GDG member and Consultant Urologist, Southmead Hospital, Bristol said: “The potential side effects of radical treatments such as surgery or radiotherapy can be serious and include urinary incontinence and erectile dysfunction. Where appropriate these recommendations can help some men to avoid or postpone undergoing these treatments.”
Jane Gosling, GDG member and Consultant Nurse – Urology at Derriford Hospital, Plymouth said: “This guidance is about empowering men to make decisions that are right for them by providing good information and discussing what options are available. Nurses will play an

Notes to Editors

About the guideline


1.The prostate cancer guideline is available at: www.nice.org.uk/CG058

About NICE

2.The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3.NICE produces guidance in three areas of health:

public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS

clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

* Cancer Research UK (2007). Available from

www.cancerresearchuk.org

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