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Combine treatment for moderate to high risk prostate cancer, says NICE

Radical radiotherapy and androgen deprivation therapy combo better than either one alone for localised disease

Caroline White

Wednesday, 08 January 2014

Men with intermediate or high-risk localised prostate cancer should be given a combination of radical radiotherapy and androgen deprivation therapy, rather than radical radiotherapy or androgen deprivation therapy alone, recommends newly updated guidance from the National Institute of Health and Care Excellence (NICE), published today. 

And doctors should offer active monitoring as an option to men with low risk localised prostate cancer even if they are suitable for more radical treatment, it says.

Active monitoring includes regular prostate specific antigen tests, digital rectal exam, and re-biopsy (year 1).

The guidance on the management of prostate cancer has been updated in light of several new treatments becoming available for advanced disease since 2008 when the last recommendations were issued.

And there is now more information on the best way to diagnose and identify the different stages of the disease, as well as how best to manage the side effects of radical treatment, says NICE.

The updated guideline includes several new recommendations on the swift diagnosis and treatment of different stages of the disease and a new protocol for men who choose active surveillance, which involves regular check-ups to see if and how the cancer is developing, rather than radical treatment.

More than 37,000 men are diagnosed with prostate cancer in England and Wales each year. Older men and those of black African-Caribbean family origin are at greatest risk.

Dr John Graham, consultant lead clinical oncologist at Taunton and Somerset NHS Trust and chair of the Guideline Development Group, said that all treatments for prostate cancer have serious side effects which can affect the quality of life, including 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,” he said.

NICE recommends that information and decision support for men with prostate cancer, their partners, and carers should be readily available and accessible. Doctors should discuss all relevant management options recommended in this guideline with them, irrespective of whether they are available through local services

Multiparametric magnetic resonance imaging should also be considered for men transrectal ultrasound 10–12 core biopsy specimen is negative to determine whether another biopsy is needed, says NICE.

And active monitoring should also be offered to men with intermediate-risk localised prostate cancer who don’t want to have immediate radical prostatectomy or radical radiotherapy, the guidance recommends.

Professor Mark Baker, Centre for Clinical Practice Director at NICE, said: “[Prostate cancer] can be very slow growing and whilst many men will have a cancer that won’t cause them any harm in their lifetime, nearly 10,000 men still die every year in England and Wales.”

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