Up to 5,000 men a year could avoid potentially harmful treatment for prostate cancer if ‘outdated’ guidelines reflected the latest evidence, a charity has said.
Closely monitoring the disease with regular blood tests and scans can be the best option for those whose cancer is slow-growing and unlikely to endanger their life.
But out-of-date guidance from the National Institute of Health and Care Excellence (Nice) on how this is implemented has created a ‘wild west’ , with some hospitals adopting their own approach.
This has also led to a ‘postcode lottery’ of care, with patients in some parts of the country more likely to have unnecessary surgery, with the risk of side-effects such as erectile dysfunction or incontinence.
Potential overtreatment for prostate cancer ranges from 2% to 24%, depending on where men are in the country, according to Prostate Cancer UK.
One in four men diagnosed with prostate cancer each year have such slow growing disease that it is unlikely the cancer will ever cause them harm.
Modern advances in how we diagnose prostate cancer mean clinicians can now tell which men need immediate treatment to stop their cancer progressing, and which men would be better off being monitored, enabling them to delay or even avoid treatment altogether.
Nice guidance on active surveillance is designed to advise specialists on how to implement monitoring and which men should be monitored.
Man having MRI scan at hospital
However, it has not been updated since 2021, according to Prostate Cancer UK.
Analysis of freedom of information responses by the charity found one in four (24 per cent) hospitals rely on Nice guidance alone to implement active surveillance.
But 35 have created their own guidelines, which Prostate Cancer UK warned can lead to inconsistency and confusion among medics.
The charity is now repeating its call for Nice to update its guidance, warning the outdated version is hindering a screening programme for prostate cancer.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said: ‘To reduce the harm caused by prostate cancer and build the foundations for a screening programme, we need to both save lives and prevent unnecessary treatment but official guidelines still haven’t caught up with the clinical evidence.
‘Concerns about overtreatment are a major reason the UK does not routinely screen for prostate cancer, despite it being the most common cancer in England.
‘Acting on latest research that shows more men can safely opt for monitoring instead of treatment will reduce overtreatment and the harm it causes men.
‘We asked Nice to update their active surveillance guidance two years ago, but our request was rejected.
Daily Mail has been campaigning to end needless prostate deaths
‘Now we have evidence this is potentially affecting thousands of men. Enough is enough.’
The NHS uses a prostate-specific antigen (PSA) blood test to check for prostate conditions including prostate cancer or an enlarged prostate.
Routine PSA testing is not currently offered on the NHS, but patients may be offered a PSA test if a GP suspects they have prostate cancer, while men over 50 can request a test from their GP even if they do not have symptoms.
Vincent Gnanapragasam, a professor of urology at the University of Cambridge, said: ‘Active surveillance is the best treatment option for men whose cancer is unlikely to progress or cause them problems in their lifetime.
‘But Nice’s outdated guidelines have created a deeply concerning wild west on how surveillance is implemented by different healthcare teams.
‘This inconsistency is resulting in a lack of confidence from patients in surveillance, who may instead opt to have treatment they may not have ever needed, risking harmful side effects.
‘Programmes for active surveillance that are standardised and individualised to a man’s risk factors have been tested and proven to work.’
The Daily Mail is campaigning for a national prostate cancer screening programme, initially targeted at high risk men.
This includes those who are black or have a family history of the disease.
The UK’s National Screening Committee is currently assessing whether a national screening programme for prostate cancer should be rolled out.
A Nice spokesperson said: ‘We are committed to ensuring our guidelines continue to reflect the best available evidence and give patients the best possible outcomes.
‘They are developed by an independent committee, including NHS clinical experts, and are kept under review to ensure they remain current.
‘We are updating our prostate cancer guideline, including a review of the recommendations around active surveillance, and will be assessing whether our suspected cancer guideline recommendations around age-related thresholds for PSA tests for prostate cancer for onwards referral from primary care require updating.’
