09 May 2020

Men must receive support for choosing active surveillance as new guidelines provide endorsement

We publish new best practice guidelines for doctors offering active surveillance to men, as NICE today recognise the procedure as being on a par with surgery and radiotherapy for men with low risk localised prostate cancer.

Today the National Institute for Health and Care Excellence (NICE) has updated their guidelines for prostate cancer in England and Wales, including recognition that active surveillance offers men with low risk localised prostate cancer the same survival benefit as radiotherapy and surgery.

Each year thousands of men are diagnosed with prostate cancer that is still contained within the prostate and is considered to have a low risk of causing harm. Active surveillance is a way of monitoring their cancer rather than treating it immediately, allowing men to avoid or delay the side effects of invasive treatment.

"It's great news that the NICE guidelines now reflect the latest evidence and recommend that active surveillance should be offered as a primary option for men with low risk localised prostate cancer. This could potentially provide thousands of men with the opportunity to delay or avoid radical treatment and its associated side effects," says Heather Blake, our Director of Support and Influencing, who also warned of the need for tailored support for men considering active surveillance.

"From our discussions with men we have discovered that the language used and information provided by clinicians about their individual cancer risk has a huge impact on their treatment decision. Regular, open communication with a trusted health professional and a personalised treatment plan are also crucial to ensuring men feel reassured and can maintain a good quality of life during their time on active surveillance."

To help health professionals give men the support they need, we have worked with experts to develop a suite of materials to be used alongside the NICE guidelines to make sure active surveillance is delivered to best effect. These best practice approaches are published in the BJU International journal and have been summarised in videos and an e-learning module.

Despite the potential benefits for men, choosing active surveillance over radical treatment is not necessarily an easy decision as it goes against the natural instinct of wanting to get rid of the cancer immediately.
Dr Sam Merriel GP and lead author of the work

Daniel Beecroft, 45, was diagnosed with low risk localised prostate cancer in July 2018, six years after his father had been diagnosed. "In my initial consultation, my doctor said I would need robotic surgery, however after being referred to another hospital, and talking it through with other clinicians, it was agreed that I would be a good candidate for active surveillance. 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. Active surveillance was definitely the right decision for me," he says.

There are a number of changes in the updated NICE guidelines, some of which have already started to be put into practice:

  • Men should be offered multiparametric MRI scans before biopsy if they are suspected to have localised prostate cancer. However, these scans are still not widely available in Wales. "This breakthrough diagnostic technique should now be made available in all parts of Wales in the near future, ending the current variation in access that has resulted in some men paying privately for scans," said Andrew Seggie, Change Delivery Manager at Prostate Cancer UK. "We’ll be doing everything we can to support Health Boards make this a reality."
  • Radiotherapy for localised prostate cancer will be given at a lower overall dose over a shorter period of time, which was proven in 2016 to provide equal benefit with fewer visits to the hospital.
  • Docetaxel chemotherapy will be given to men newly diagnosed with advanced prostate cancer, and considered for men with high-risk locally advanced disease, following the STAMPEDE trial's positive findings in 2015.
  • Men whose PSA is stable after prostate cancer treatment and have no complications should be offered a supported self-management programme – such as the one we've developed and been trialling through the TrueNTH initiative.