Today’s publication of new NICE guidance on how best to diagnose and treat prostate cancer may lead to some patient confusion or concern. While some men may feel reassured that treatment is unlikely to be necessary, others could feel anxious by the same news, and consultant oncologist, Dr Roberto Alonzi, explains what the changes in the guideline means to patients.
The updated guideline includes a number of new recommendations on the swift diagnosis and treatment of different stages of the disease and a new protocol for men who choose active surveillance, which involves regular check-ups to see if and how the cancer is developing, rather than undergo immediate radical treatment.
Dr Alonzi, who treats patients at Mount Vernon Cancer Centre, Spire Bushey Hospital and Elstree Cancer Centre in Hertfordshire explains: “The new guidelines are very welcome and clarify the options available to men with various stages of the disease. The recommendations have not suggested any dramatic changes for men diagnosed with prostate cancer, but have highlighted the need for better use of modern diagnostic and treatment technology.
“Also, evidence has strengthened the view that some men with low risk, non-aggressive prostate cancer may never need treatment, and can safely undergo active surveillance with regular review and biopsies. While the new guidelines put more emphasis on the use of active surveillance for those with low and intermediate-risk localised disease, each patient will still be advised and treated according to their specific oncological risk and individual situation.”
Dr Alonzi is also part of The Prostate Practice, a Hertfordshire-based team of specialists leading the way in prostate care. He pointed out that surveillance is not ideal for all men, including some of those with low-risk disease. It can be emotionally draining, and lead to psychological side effects which cause men to switch over to a radical treatment option.
“By working with patients we are able to ensure they make the most appropriate choice to suit their specific needs, both clinically and related to their quality of life. In cases where radical treatment such as surgery or radiotherapy are considered the best option, patients can be reassured that the chance of severe side effects are low. While all treatments have the potential to cause side effects, the risk of these being serious have been reduced with developments including robotic surgery and advanced radiotherapy treatments such as image guided and intensity modulated radiotherapy.”
Dr Alonzi has recently started a two-year research programme on behalf of GenesisCare, into the use of image guided radiotherapy and its ability to better target prostate cancer treatment. He adds: “Its early days, but the preliminary data is very positive showing a significant decrease in radiation of normal tissue when daily image guidance is used.”
Prof Karol Sikora is chief medical officer with GenesisCare, which routinely provides advanced, highly targeted radiotherapy from a network of specialist centres across the UK. An advocate for improved provision of universal cancer care, Prof Sikora says: “By using the latest advancements in external beam radiotherapy technology we can target tumours with a very high degree of accuracy.”
GenesisCare combines the use of intensity modulated radiotherapy (IMRT) and daily image guided radiotherapy (IGRT). IMRT uses a higher number of beams enabling the radiotherapy dose to be shaped to match the tumour precisely, while daily IGRT takes scans before and during every single treatment to ensure the radiotherapy is delivered exactly on target.
Prof Sikora adds: “This combination of treatment is extremely effective, and undoubtedly improves outcomes for patients, and reduces the risk of side effects by avoiding damage to surrounding healthy tissue and organs. This is particularly beneficial for treatment of the prostate which is in close proximity to critical structures which if damaged can lead to urinary incontinence or erectile dysfunction.”
Each year over 37,000 men are diagnosed with prostate cancer in England and Wales.
Dr Alonzi concludes: “The disease usually occurs in older men, but it isn’t uncommon in those under 65 so all men should be aware of the symptoms which include feeling the sudden need to or difficulty passing urine, or doing so more often than usual, especially at night. The vast majority of those with these symptoms are diagnosed with non-cancerous prostate conditions so men shouldn’t feel unduly alarmed, but get themselves checked by their GP.”