We’re working with health professionals, men and other key stakeholders to develop a best practice active surveillance protocol. We also aim to understand more about the information and support needs of men who face difficult treatment decisions when they have been diagnosed with localised prostate cancer.

What is active surveillance?

Active surveillance is a way of monitoring prostate cancer that hasn’t spread outside the prostate (localised prostate cancer), rather than treating it straight away. You might hear it called active monitoring.

If you decide to go on active surveillance, you’ll have regular tests to check on the cancer. You won’t have any treatment unless these tests show that your cancer may be growing, or you decide you want treatment – so you’ll avoid or delay the side effects of treatment. If there are signs your cancer may be growing, you’ll be offered treatment that aims to cure your cancer.

Find out more about active surveillance.

NICE guidelines

Current NICE guidelines already include recommendations for health professional on the management of men with low and intermediate-risk, localised prostate cancer:

  • Offer active surveillance (in line with the NICE recommended protocol) as an option to men with low-risk localised prostate cancer for whom radical prostatectomy or radical radiotherapy is suitable
  • Consider active surveillance (in line with the NICE recommended protocol) for men with intermediate-risk localised prostate cancer who do not wish to have immediate radical prostatectomy or radical radiotherapy

ProtecT

A recently released clinical trial, called the Prostate testing for cancer and Treatment (ProtecT) trial has shown that men with localised prostate cancer who go on active surveillance have the same chances of living for 10 years or more as men who choose surgery or radiotherapy.

The trial, which is run by the University of Oxford and funded by the National Institute for Health Research, began in June 2001 and randomly allocated men to one of three groups: active monitoring (also called active surveillance), radiotherapy or surgery. Over the next ten years, only half of the men who were on active surveillance went on to receive either radiotherapy or surgery. Across all groups, 99 per cent of the men survived over ten years regardless of their initial treatment decision.

Why is this project important?

Even though the ProtecT trial showed there was no survival benefit for men with low-risk localised prostate cancer, too many men are still receiving radical treatment (‘over-treatment’) and living with the unpleasant side-effects associated with these treatments, including: bowel symptoms, erectile dysfunction, and urinary problems. Active surveillance by contrast does not produce these side-effects. The ProtecT study did highlight that men on active surveillance could delay or avoid treatment within a 10 year period.

Active surveillance can however cause some men stress and anxiety because they are living with a cancer. Additionally, it cannot mitigate the effects of prostate cancer or the normal changes to a man’s body as he ages. But as it provides a survival outcome that is the same as radical treatment, it means that men’s treatment choice is now about whether to experience the side-effects associated with radical treatment or not.

Since the ProtecT clinical trial we have seen a dramatic innovation in the way prostate cancer is diagnosed through the use of multi-parametric (mp)MRI. These innovations allow health professionals to achieve greater accuracy in the diagnosis and treatment of prostate cancer and therefore provide men with more certainty about the individual risks and benefits of different treatment options.

With active surveillance, some men diagnosed with localised prostate cancer can safely delay or avoid treatment and subsequently avoid those side-effects for up to 10 years.

What are we doing?

In July 2017, a freedom of information (FOI) request was sent out to NHS Trusts in England, Health Boards in Wales and Scotland and Health & Social Care Trusts in Northern Ireland. This will help us understand current practice across the UK, including which men are being offered active surveillance, what active surveillance protocols are in use and whether these vary across the UK.

Throughout August and September 2017 we surveyed men with experience of localised prostate cancer. We wanted to know what the main issues were that influenced decision-making and views of men when it came to being offered active surveillance. Through this research, we'll be able to better understand:

  • What drives men to choose one treatment over another (i.e. the trade-off between side-effects from curative treatment against the risk of a man's cancer progressing whilst on active surveillance);
  • What information and support men require in making treatment decisions; and
  • What support men feel is important whilst being on active surveillance

By bringing together the best available academic research, clinical expertise and our own research we’ll be developing a consensus survey that will be sent out to a large number of health professionals across the UK. The purpose of this survey will be to determine the current best practice approach to active surveillance.

Supporting us throughout this project are an expert group of health professionals and men with experience of prostate cancer. Our Expert Reference Group (ERG) will ultimately come together to discuss and reach a final consensus on the best practice approach to active surveillance for men with localised prostate cancer so that all men are empowered to make an informed choice and have access to the highest standard of care no matter where they are in the UK.

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