Men spared from surgery as NHS adopts ‘active surveillance’ for prostate cancer patients

Thousands of men with prostate cancer may be spared aggressive treatment as health bosses have backed a new treatment method.

In a landmark decision, NHS rationing watchdog NICE has now included active surveillance in its official guidance.

The treatment allows the killer disease to be monitored every couple of months, through blood tests and scans.

It offers patients the option of avoiding or delaying radical treatments, which can cause a host of unwanted side effects.

Active surveillance is a way of monitoring low-risk, localised prostate cancer using blood tests and scans every few months (file image)

Active surveillance is a way of monitoring low-risk, localised prostate cancer using blood tests and scans every few months (file image)

Active surveillance is a way of monitoring low-risk, localised prostate cancer using blood tests and scans every few months (file image)

Prostate Cancer UK has welcomed the move. Each year 47,000 men in the UK are diagnosed with the disease.

Heather Blake, a director at the charity, said: ‘It’s great news that the NICE guidelines now reflect the latest evidence.

‘What is crucial now is that active surveillance is consistently delivered to a high standard across the UK.’

She also urged that personalised information and support need to be given to men to encourage men to choose the approach.

Radiotherapy, while effective, is known to cause nausea, fatigue, erectile dysfunction and incontinence.

Only patients whose cancer is contained within the prostate and not considered harmful will benefit from active surveillance.  

This type of the disease, which grows slowly and has a low risk of spreading, is known as low risk localised prostate cancer. 

The NICE guidelines acknowledge that active surveillance has the same 10-year survival benefit as radiotherapy and surgery.

Dr Sam Merriel, a GP based in Bristol, said: ‘Choosing active surveillance over radical treatment is not necessarily an easy decision.

He added that it ‘goes against the natural instinct of wanting to get rid of the cancer immediately’. 

Vincent Gnanapragasam, a consultant urologist at the University of Cambridge, said: ‘Clinicians do not want to be seen to be telling people not to have treatment.’

Patients, meanwhile, will often demand action when they hear the word ‘cancer’.

Daniel Beecroft, 45, from Epping in Essex, was diagnosed with low-risk localised prostate cancer in July 2018.  

The father- said he was initially advised to have surgery, but after talking it through with other clinicians he was put on active surveillance. 

He added: ‘In the end it was a no-brainer for me to choose to keep an eye on things for now. I was told my cancer was small and not aggressive.’

Mr Beercroft watched his father’s health deteriorate after surgery to remove his prostate following a diagnosis in 2012.

He added: ‘I had seen the side effects my father had to deal with after surgery – such as incontinence.

‘So felt I would prefer to delay going down that route for as long as possible. I’m pleased that I got a second opinion – it was definitely the right decision for me.’

Two in every 100 men who opt for active surveillance will die from prostate cancer in a decade, compared to one in 100 for surgery and radiotherapy. The chance of the cancer spreading is higher with active surveillance – meaning some men end up having to be treated eventually. 

Professor Freddie Hamdy, of the University of Oxford, who led a decade-long study into active surveillance published in 2016, said: ‘It gives the patients choice and options which are based on evidence.

‘The moment patients hear the word cancer they want it treated, and they can pay the price of that treatment in side effects. This is quite remarkable and could really go some way to reducing the risk of overtreatment.’

Prostate Cancer UK said the guidance was an ‘endorsement’ of active surveillance. Heather Blake, director of support at the charity, said: ‘This could potentially provide thousands of men with the opportunity to safely delay or avoid radical treatment and its associated side effects.

WHAT IS PROSTATE CANCER?

How many people does it kill?

Prostate cancer became a bigger killer than breast cancer for the first time, official statistics revealed last year. 

More than 11,800 men a year – or one every 45 minutes – are now killed by the disease in Britain, compared with about 11,400 women dying of breast cancer. 

How quickly does it develop? 

Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS

If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted. 

Some patients can be cured if the disease is treated in the early stages.

But if it diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms. 

Tests and treatment

Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge. 

There is no national prostate screening programme as for years the tests have been too inaccurate.

Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.

Men over 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.

But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not foolproof. 

Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks. 

Anyone with any concerns can speak to Prostate Cancer UK’s specialist nurses on 0800 074 8383 or visit prostatecanceruk.org

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