Introduction

Active surveillance has been shown to have the same 15-year survival benefits compared to both surgery and radiotherapy for men with low risk localised prostate cancer. Actively monitoring these cancers instead of treating them immediately, may give men the option to delay or avoid the potential side effects associated with surgery and radiotherapy. 

We want all eligible men in the UK to experience the highest standards of care when it comes to active surveillance. This includes –  

• Counselling men about the risks and benefits of each treatment option according to their prostate cancer diagnosis. 
• Information, and psychological support so men can confidently choose active surveillance and benefit as long as possible. 
• A care plan that empowers men to understand their follow up whilst on active surveillance and know when re-assessment for treatment is needed. 

To achieve this, we continue to work with health professionals, academics, and men with lived experience to develop a suite of resources to be used by health professionals, alongside NHS guidelines so that active surveillance is delivered to best practice. 

Evidence-base for active surveillance

In March 2023, the ProtecT study group reported on their 15-year outcomes analysis and concluded:

“prostate cancer-specific mortality was low regardless of the treatment assigned. Thus, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localised prostate cancer.”

Other active surveillance studies have arrived at similar conclusions. 

With improved understanding of how localised low- and intermediate-risk prostate cancers (CPG1 and CPG2, see Table 1 below) behave over time and improved diagnostic tools (mpMRI and targeted biopsy), more men could potentially benefit from active surveillance. However, we want to make sure that all men are given balanced and evidence-based information that supports them to make an informed choice about active surveillance. 

Hear more about active surveillance from Professor Caroline Moore and Professor Vincent J Gnanapragasam during our Spring 2023 Innovation Event.

Watch the Innovation Event

NICE Guidelines

• Following a review of evidence, including outcomes from a clinical consensus on the best practice approach to active surveillance led by Prostate Cancer UK, NICE guidelines changed in 2019.  
• The change meant that active surveillance became the primary recommendation for men diagnosed with localised, low-risk prostate cancer.  
• Men in this group can also consider radical prostatectomy or radical radiotherapy, if active surveillance is not suitable or acceptable to them. 

Criteria and treatment recommendations for men with localised and locally advanced prostate cancer
- Adapted from NICE guideline NG131, Prostate Cancer diagnosis and management, May 2019 (update Dec 2021).

NICE prostate cancer guideline

Decision making support

Decision making for cancer treatment has long been documented as a source of stress for patients diagnosed with prostate cancer. Any tools which can aid this process, and can be used in combination with clinical judgement, has the potential to alleviate at least some of the decision fatigue and associated anxiety which can be faced by patients in this position.  

You can signpost men to:  

• Our latest Active surveillance fact sheet  
• Our virtual Active surveillance support group.  

• A full list of patient information can be found in the ‘Resources for your patients’ section. 

Evidence suggests that using a validated tool can lead to a reduction in decision conflict and uncertainty and ‘shifts patient perception around prognosis to be more realistic. 

Studies also suggest that a tool such as Predict Prostate can support clinicians in providing ‘individualised and contextualised prognostic information which standardises the information patients receive'. 

Predict Prostate could be used as just one aspect of a multi-pronged approach to decision making for patients in this indication. We recommend patients discuss directly with their clinician any concerns or questions they may have when making a treatment decision. 

Important notes on Predict Prostate: 

• Predict Prostate is a tool intended for men with non-metastatic prostate cancer who are deciding between conservative and radical management regimes. 
• The tool is not for use in cases where prostate cancer has spread beyond the prostate. 
• The tool is also less well tested and likely to be less reliable in men with very high PSA, high grade group or high stage as very few men with these characteristics were managed with conservative management within the development or validation data. 
• Nothing can ever tell an individual man exactly what is going to happen to him in the future, but this tool will provide a realistic estimate or ‘best guess’ about the potential survival benefits of different treatment options. 
• Predict Prostate is not designed to give clinical advice and all decisions on treatment options must be made in consultation between the patient and a qualified doctor. 

Full FAQs, technical information and contact details can be found on the Predict Prostate website.

Predict Prostate