28 Mar 2014

The Daily Express recently released a story with the headline ‘ Cure for prostate cancer that has NO side-effects could be available on NHS in just TWO years’. This sounds great, but is in fact hugely misleading. While dose-painting radiotherapy, the treatment they’re talking about, could be a promising new addition to the arsenal of available treatments for men with localised prostate cancer, the claims regarding side effects and availability on the NHS have been rather overstated.

What is dose painting radiotherapy?

Radiotherapy usually works by applying the same dose to the whole prostate. This means that clinicians need to find the right balance in choosing the dose. It needs to be high enough to kill the cancer cells, but can’t be too high, or the side effects become too severe. What makes dose painting radiotherapy different is that clinicians first use imaging techniques, such as MRI, or PET-CT, to find out which parts of the prostate have the biggest clusters of cancer cells. They then use higher doses of radiotherapy in these areas, while still applying the standard dose to the rest of the prostate.  In theory, this method should be able to improve outcomes for high-risk patients, because the cancerous parts of the prostate get zapped with a higher dose of radiotherapy, but the risk of side effects shouldn’t increase, because only very targeted areas are getting this extra dose.

It’s important to say here that the headline's claim of ‘no side effects’ is also misleading. While this treatment could have reduced side effects compared to standard radiotherapy if a lower dose is applied to the whole prostate, if the standard dose is given in addition to the targeted higher doses of radiotherapy we might expect the side effects to stay the same. While we don’t have any information about the doses used in this particular pilot programme, we can note that it’s impossible to make general comments about side effects of radiotherapy immediately after a trial treatment, because while some side effects from radiotherapy develop during the treatment, other side effects can develop years later. You can read more about radiotherapy for localised, or locally advanced prostate cancer on our website.

How far has it got along the road to becoming a routine treatment?

Dr Isabel Syndikus, Consultant Clinical Oncologist at The Clatterbridge Cancer Centre said, ‘We have been offering this treatment in a pilot programme for three years, and a lot of our patients have done really well on it. We are now in a position to evaluate the best way to deliver this therapy in the context of a clinical trial. Research is currently being carried out in the UK at The Clatterbridge Cancer Centre, The Royal Marsden in London and in the Netherlands. Although it is too early to have definitive results, the indications thus far are highly encouraging.’

Clinicians at the Clatterbridge Cancer Centre are currently setting up a phase II trial of dose-painting radiotherapy – you can read the patient information here.  A similar phase II study at the Royal Marsden hospital in London will also be recruiting patients until October next year.

In general, the aim of phase II trials like these is to learn more about the potential side effects, and to see whether the treatment works well enough to be worth testing in larger trials called phase III trials, which check whether the new therapy works better than the best available standard treatment. Once there is enough information from clinical trials, there’s an approval process to go through before we find out whether a treatment will be routinely offered on the NHS. There is no ‘standard’ length of time for this process, because each step depends on the results of the previous one, and there’s no reference in the article to tell us why the journalist thinks it will only take two years for dose-painting radiotherapy to become available.

Sometimes individual hospitals or NHS trusts can start to introduce a treatment into standard practice before it’s routinely available on the NHS, although there are no hard and fast rules about this.

What can we take from this story?

Dr Iain Frame, Director of Research at Prostate Cancer UK summarises the important take-home message from this research:

‘Researchers are looking for men with prostate cancer that hasn’t spread to take part in a study to look at a potential new treatment. We would welcome any research that will add to our current armoury and this has the potential to become an additional treatment for some men while offering fewer side effects than other similar options. It is too early to tell whether the claims about increased survival rates are realistic but we will await the results of this study with great interest. We encourage all men who are offered the opportunity to take part in a study like this because by doing so they are helping make the advances we need to defeat this disease.’

You can find out more about taking part in a clinical trial and helping to bring promising new treatments into routine use on our website, and you can find out more about this particular trial from the patient information.


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