Watchful waiting approach for prostate cancer

The National Institute for Health and Care Excellence (NICE) have issued new guidelines that state that men with low or intermediate-risk prostate cancer should be offered the option of so-called “active surveillance” in the place of radical radiotherapy or surgery.

Prostate cancer is the most common cancer in men in the UK with 40,000 new cases diagnosed each year and 11,000 deaths. It is usually diagnosed following a blood test showing elevated levels of prostate-specific antigen (PSA). However, the usefulness of this has been questioned for some time. The reason for this is that it cannot distinguish between cancers that will grow very slowly and cause little problem and those that are dangerous. In these circumstances many men are receiving radical radiotherapy and surgery unnecessarily, both of which carry the risk of serious side effects including incontinence and erectile dysfunction. In addition, there are a number of conditions other than cancer that can cause raised PSA levels.

The new NICE guidance provides a monitoring protocol that should be offered to those men with low or intermediate-risk localised prostate cancer for whom radical prostatectomy or radiotherapy is suitable but who would prefer to wait and see.

Prof Mark Baker, the director of the Centre for Clinical Practice at NICE, said: “Prostate cancer can be very slow growing and while 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.

“The updated guideline includes a number of 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. The aim of this Nice guideline is to ensure that excellent treatment is provided for men who will benefit from it.”