A report for ecancermedicalscience by freelance journalist Stephen Pinn:
NICE launches new guideline to encourage best practice in the management of prostate cancer
New recommendations have been published for the diagnosis and management of prostate cancer, 35,000 new cases of which are identified each year in the UK alone. The guideline has been developed by the National Institute for Health and Clinical Excellence (NICE) - and, as is often the case with NICE guidance, it is not without controversy.
Dr John Graham, Lead Clinician on the Guideline Development Group (GDG) and Consultant Lead Clinical Oncologist, Taunton and Somerset NHS Trust, commented: "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.
He added: "We are recommending that all men with localised prostate cancer should be categorised by specialist teams as low, intermediate or high risk - and that this classification should dictate the investigation and management that may be appropriate for each patient."
Explaining the conservative approach being recommended for the management of localised prostate cancer, Professor Mark Baker, GDG Chair and Lead Clinician Cancer Clinician at Leeds Teaching Hospital, said: "In this guidance, we hope to avoid the over-treatment of men who are unlikely to be troubled by prostate cancer during their natural life-span.
Mr David Gillatt, GDG member and Consultant Urologist, Southmead Hospital, Bristol: commented: "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."
The NICE guideline recommends the following management strategies:
1. Localised prostate cancer:
2. Locally advanced prostate cancer:
3. Metastatic prostate cancer:
4. Hormone-refractory prostate cancer:
More controversially, the guideline specifically advises clinicians not to offer:
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