NICE Guidelines & Prostate Cancer

July 2015

WILL THE NEW NICE GUIDELINES FOR GPs HELP IDENTIFY MEN WITH EARLY, CURABLE PROSTATE CANCER?

UK cancer death rates are worse than most western countries, particularly for men, who have higher cancer death rates than women. One possible cause for this is delayed diagnosis due to late referral from GPs. Consequently new guidelines concentrating on cancer symptoms have been issued by the National Institute for Health & Care Excellence (NICE) with recommendations on urgent referral for specialist investigation. It is estimated that following the guidelines will save 5,000 lives every year.

But how will this guidance impact upon our commonest men's cancer, Prostate Cancer (PCa) which is newly diagnosed in 42,000 UK men each year and kills nearly 11,000, second only to lung cancer as a killer. The answer is "hardly at all". Why? Because by the time PCa causes symptoms, it will usually have spread beyond the prostate gland and such cancers are not usually curable. To catch the cancer whilst it is still inside the prostate gland means looking for it before it has produced any symptoms. In other words, "screening" using the simple blood test PSA (Prostate Specific Antigen).

Extensive European trials on PSA screening for men aged 50-74 now show a reduction in PCa mortality of up to 40%, though at the risk of unnecessary overtreatment of some men whose cancers would never cause any problems. Historically this risk of overtreatment and the inaccuracy of PSA in detecting some cancers have been used as arguments against its use for UK population screening. Instead, emphasis has been put upon raising awareness of the risk of PCa and on offering PSA testing to men at risk, namely black African and African-Caribbean men and men with a family history of PCa.

Three things should now change this limited view. Firstly, the European trials showing the benefit of lives saved now outweighs the risk of harm. Secondly, in the UK, improved diagnostic pathways using second-line markers such as hK2 and MRI prostate scanning are reducing the number of unnecessary biopsies and allowing much better visualisation of cancers that do need treatment. Thirdly, our multi-disciplinary cancer teams and careful discussion of treatment options with the patients is greatly reducing the risk of overtreatment of non-aggressive cancers.

In conclusion, the new NICE guidelines will be of little help. Therefore, it is up to men themselves from their 40's onwards to be aware of their prostate gland, consider the option of a PSA test - it is their NHS right to have a test once counselled - and, if at risk, insist.