Up to 5,000 men every year could avoid unnecessary treatment for prostate cancer if “outdated” guidelines reflected latest evidence, a charity has said.
Overtreatment of the disease can lead to side effects such as erectile dysfunction or incontinence, according to Prostate Cancer UK.
Experts suggest closely monitoring certain patients can be the “best” option for men whose cancer is unlikely to progress, although out-of-date guidance from the National Institute of Health and Care Excellence (Nice) on how this is implemented has created a “wild west”.
There are around 55,000 new cases of prostate cancer diagnosed in the UK every year.
However, in some cases, the cancer is slow-growing and unlikely to ever cause the patient harm.
These men benefit from being closely monitored with blood tests and scans, which is known as active surveillance.
Nice guidance on active surveillance is designed to advise specialists on how to implement monitoring and which men should be monitored.
However, it has not been updated since 2021, according to Prostate Cancer UK.
Freedom of information (FOI) request analysis by the charity found around one in four (24%) of hospitals rely on Nice guidance alone to implement active surveillance.
It also found 35 hospitals have created their own guidelines, which Prostate Cancer UK warned can lead to inconsistency and confusion among medics.
The charity is now repeating its call for Nice to update its guidance on active surveillance, claiming it could help up to 5,000 men a year avoid overtreatment.
It also claims the outdated guidance is hindering a screening programme for prostate cancer.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said: “To reduce the harm caused by prostate cancer and build the foundations for a screening programme, we need to both save lives and prevent unnecessary treatment but official guidelines still haven’t caught up with the clinical evidence.
“Concerns about overtreatment are a major reason the UK does not routinely screen for prostate cancer, despite it being the most common cancer in England.
“Acting on latest research that shows more men can safely opt for monitoring instead of treatment will reduce overtreatment and the harm it causes men.
“We asked Nice to update their active surveillance guidance two years ago, but our request was rejected. Now we have evidence this is potentially affecting thousands of men. Enough is enough.”
The NHS uses a prostate-specific antigen (PSA) blood test to check for prostate conditions including prostate cancer or an enlarged prostate.
Routine PSA testing is not currently offered on the NHS, but patients may be offered a PSA test if a GP suspects they have prostate cancer, while men over 50 can request a test from their GP even if they do not have symptoms.
However, there have been calls to roll the test out across the health service, although some argue widespread use could identify cases which may not have caused problems or needed treatment.
Vincent Gnanapragasam, a professor of urology at the University of Cambridge, said: “Active surveillance is the best treatment option for men whose cancer is unlikely to progress or cause them problems in their lifetime.
“But Nice’s outdated guidelines have created a deeply concerning wild west on how surveillance is implemented by different healthcare teams.
“This inconsistency is resulting in a lack of confidence from patients in surveillance, who may instead opt to have treatment they may not have ever needed, risking harmful side effects.
“Programmes for active surveillance that are standardised and individualised to a man’s risk factors have been tested and proven to work.”
The UK’s National Screening Committee is currently assessing whether a national screening programme for prostate cancer should be rolled out.
A Nice spokesperson said: “We are committed to ensuring our guidelines continue to reflect the best available evidence and give patients the best possible outcomes.
“They are developed by an independent committee, including NHS clinical experts, and are kept under review to ensure they remain current.
“We are updating our prostate cancer guideline, including a review of the recommendations around active surveillance, and will be assessing whether our suspected cancer guideline recommendations around age-related thresholds for PSA tests for prostate cancer for onwards referral from primary care require updating.”
