London - Some men with prostate cancer should be offered monitoring of their condition rather than radical surgery or radiotherapy, say new NHS guidelines in Britain.
Doctors treating patients with intermediate or low-risk prostate cancer should consider ‘active surveillance’ – keeping an eye on the problem rather than treating it immediately, according to the NHS watchdog.
Updated guidance from Nice says prostate cancer can be slow growing and that many men will have cancer that will not cause them any harm in their lifetime.
Prostate cancer is the commonest cancer in men. In the UK, more than 40,000 are diagnosed with it each year and the condition leads to approximately 10,000 deaths.
But men with early-stage prostate cancer can live for years without their disease getting worse and many face the dilemma of deciding whether to opt for therapy which may lead to side effects or active surveillance which delays treatment.
The standard treatment of radiotherapy or surgically removing the whole prostate is most effective for those with aggressive, high-risk cancers. But it can damage surrounding healthy tissue, with up to a quarter of men suffering urinary incontinence and two-thirds having erectile difficulties.
Many doctors already use active surveillance, but Nice - the National Institute for Health and Care Excellence - is trying to formalise how it should be put into practice.
The updated guidance suggests that for some men with localised, low or intermediate-risk prostate cancer, active surveillance should be offered instead of more extreme treatment options.
The guidance sets out a new protocol detailing how men who choose this option should be monitored with blood tests, biopsies and physical examinations, to see if and how the cancer is developing.
Dr John Graham, chairman of the guideline development group, said: ‘All treatments for prostate cancer have serious side effects which can affect the quality of life, especially their effects on erectile function, fertility and continence.
‘This is why it is so important that men are able to understand the treatment options available to 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.’
In 2009 a US study found that careful selection of low-risk patients followed by monitoring every six months meant many could avoid treatment without jeopardising their survival.
Most patients choosing active surveillance did not suffer any spread of the disease, while one in six was cured after delayed treatment, the study showed.
It added to evidence that some men can be safely spared unnecessary radical treatment which may cause side effects that can seriously impair quality of life.
Daily Mail