Professor Vincent Gnanapragasam, the East of England Regional Clinical Lead for Urology sparked a great amount of interest at the East of England Urology Network Cancer Meeting with his 'Eliminating variations in under and over-treatment of prostate cancer in the East of England: Tools for standardising patient counselling' presentation, which aligns with a national recommendation to address treatment variation in men with prostate cancer as a priority.
The NHS Cancer Programme have undertaken a desk-based review of tumour sites associated with a high volume of late-stage diagnoses to identify further opportunities to improve earlier diagnosis and deliver the 75% ambition. The Prostate Tumour Site Review is available on the FutureNHS workspace for comment from the relevant tumour site leads within Cancer Alliances.
Professor Gnanapragasam discusses variation in the use of CPG (and PREDICT) to guide management decisions, which is now recommended best practice and is important for men to ensure that they are fully informed of all their management options and the risk vs benefits / long term effects. Also, there is a need to start protecting resources and reduce long waits to ensure that those men that most need radical treatment have timely access.
Professor Gnanapragasam's presentation slides are available at the following link:
To watch the recording of the Professor Gnanapragasam's webinar on 11 January 2024 please use the following link:
'Over-treatment'
There is concern that some patients traditionally classified as having low risk prostate cancer who can generally be safely monitored with active surveillance, are being offered radical treatment early and sometimes unnecessarily. Although patient choice and other circumstances will mean that some men in the lowest risk category will receive treatment, this potential 'over-treatment' can result in avoidable long term side-effects such as reduced sexual function, or urinary and bowel problems.
The National Prostate Cancer Audit has monitored the degree of 'over treatment' of prostate cancer within England. The proportion of men with low-risk disease having radical treatment as opposed to active surveillance has reduced steadily over the last decade. This likely reflects studies that have recommended increased use of active surveillance such as PIVOT and Protect and a greater understanding of the risks of overtreatment of indolent prostate cancer. There has been a reduction in the proportion of overtreatment from 12% in 2014 to 5% in 2018-2019, although there remains a substantial variation between providers (0-27%).
Studies have shown the positive long-term outcomes of management with active surveillance for appropriate groups of men and that its use can reduce 'over-treatment'. Active surveillance has also been shown to be safe for men with what is currently classified as intermediate-risk disease, where this is judged to be 'favourable'.
To find out more about active surveillance please see our video available:
Active Surveillance for Early Prostate Cancer - an information video for patients
Recommendations:
- To analyse if there are trusts which are outliers for 'over-treatment' which may benefit from a root cause analysis.
- To encourage active surveillance in low risk CPG 1 and 2 without inappropriately curtailing patient choice for treatment of low risk prostate cancers.
- To encourage the patient use of Predict to empower patients with standardised advice about their treatment options based on risk profiles and staging.
More information is available on our 'Knowing Your Options' Prostate Management Tool
