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Prostate cancer overview

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Prostate cancer HAI

About

What is covered

This pathway covers the care of men referred to secondary care with suspected or diagnosed prostate cancer, including follow-up in primary care for men with diagnosed prostate cancer. The pathway does not cover men with an abnormal PSA (prostate-specific antigen) level detected in primary care who have no symptoms and are not referred for subsequent investigation.
The pathway provides guidance on:
  • pre-biopsy imaging
  • management after an initial negative biopsy
  • imaging for T and N staging
  • groups for whom active surveillance is suitable and a protocol for active surveillance
  • the most effective radical prostatectomy method
  • the combination of external beam radiotherapy and brachytherapy in non-metastatic prostate cancer
  • management of radiation-induced enteropathy
  • the combination of hormones and external beam radiotherapy in non-metastatic prostate cancer
  • intermittent compared with continuous hormone therapy for men having long-term hormone therapy
  • management of side effects resulting from long-term androgen deprivation therapy.
Prostate cancer is the most common cancer in men and makes up 26% of all male cancer diagnoses in the UK. In 2008, 34,335 men were diagnosed with prostate cancer and there were 9,376 deaths from prostate cancer in England, Wales and Northern Ireland. This figure increased to 9,632 deaths in 2010.
Prostate cancer is predominantly a disease of older men (aged 65–79 years) but around 25% of cases occur in men younger than 65. There is also higher incidence of and mortality from prostate cancer in men of black African-Caribbean family origin compared with white Caucasian men.
Prostate cancer is usually diagnosed following a blood test in primary care showing elevated PSA levels. The introduction of PSA testing has significantly reduced the number of men presenting with metastatic cancer since the 1980s. Most prostate cancers are now either localised or locally advanced at diagnosis, with no evidence of spread beyond the pelvis.

Updates

Updates to this pathway

29 October 2014 Minor maintenance updates.
22 July 2014 Enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen (NICE technology appraisal guidance 316) added to the metastatic prostate cancer path.
23 January 2014 Minor maintenance updates
7 January 2014 Pathway redrawn to include new recommendations from updated prostate cancer guideline (CG175).
13 September 2013 Minor maintenance updates.
8 February 2013 Minor maintenance updates.
30 October 2012 Minor maintenance updates.
23 October 2012 Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours (NICE technology appraisal guidance 265) added to hormone-relapsed metastatic prostate cancer.
03 October 2012 Minor maintenance updates.
31 August 2012 Minor maintenance updates.
27 June 2012 Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen (NICE technology appraisal guidance 259) added to hormone-relapsed metastatic prostate cancer.
11 May 2012 Cabazitaxel for hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing regimen (NICE technology appraisal guidance 255) added to hormone-relapsed metastatic prostate cancer.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Short Text

Prostate cancer: diagnosis and treatment

What is covered

This pathway covers the care of men referred to secondary care with suspected or diagnosed prostate cancer, including follow-up in primary care for men with diagnosed prostate cancer. The pathway does not cover men with an abnormal PSA (prostate-specific antigen) level detected in primary care who have no symptoms and are not referred for subsequent investigation.
The pathway provides guidance on:
  • pre-biopsy imaging
  • management after an initial negative biopsy
  • imaging for T and N staging
  • groups for whom active surveillance is suitable and a protocol for active surveillance
  • the most effective radical prostatectomy method
  • the combination of external beam radiotherapy and brachytherapy in non-metastatic prostate cancer
  • management of radiation-induced enteropathy
  • the combination of hormones and external beam radiotherapy in non-metastatic prostate cancer
  • intermittent compared with continuous hormone therapy for men having long-term hormone therapy
  • management of side effects resulting from long-term androgen deprivation therapy.
Prostate cancer is the most common cancer in men and makes up 26% of all male cancer diagnoses in the UK. In 2008, 34,335 men were diagnosed with prostate cancer and there were 9,376 deaths from prostate cancer in England, Wales and Northern Ireland. This figure increased to 9,632 deaths in 2010.
Prostate cancer is predominantly a disease of older men (aged 65–79 years) but around 25% of cases occur in men younger than 65. There is also higher incidence of and mortality from prostate cancer in men of black African-Caribbean family origin compared with white Caucasian men.
Prostate cancer is usually diagnosed following a blood test in primary care showing elevated PSA levels. The introduction of PSA testing has significantly reduced the number of men presenting with metastatic cancer since the 1980s. Most prostate cancers are now either localised or locally advanced at diagnosis, with no evidence of spread beyond the pelvis.

Updates

Updates to this pathway

29 October 2014 Minor maintenance updates.
22 July 2014 Enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen (NICE technology appraisal guidance 316) added to the metastatic prostate cancer path.
23 January 2014 Minor maintenance updates
7 January 2014 Pathway redrawn to include new recommendations from updated prostate cancer guideline (CG175).
13 September 2013 Minor maintenance updates.
8 February 2013 Minor maintenance updates.
30 October 2012 Minor maintenance updates.
23 October 2012 Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours (NICE technology appraisal guidance 265) added to hormone-relapsed metastatic prostate cancer.
03 October 2012 Minor maintenance updates.
31 August 2012 Minor maintenance updates.
27 June 2012 Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen (NICE technology appraisal guidance 259) added to hormone-relapsed metastatic prostate cancer.
11 May 2012 Cabazitaxel for hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing regimen (NICE technology appraisal guidance 255) added to hormone-relapsed metastatic prostate cancer.

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Prostate cancer. NICE clinical guideline 175 (2014)
Focal therapy using cryoablation for localised prostate cancer. NICE interventional procedure guidance 423 (2012)
Transperineal template biopsy and mapping of the prostate. NICE interventional procedure guidance 364 (2010)
Laparoscopic radical prostatectomy. NICE interventional procedure guidance 193 (2006)
Cryotherapy as a primary treatment for prostate cancer. NICE interventional procedure guidance 145 (2005)
Low dose rate brachytherapy for localised prostate cancer. NICE interventional procedure guidance 132 (2005)
Cryotherapy for recurrent prostate cancer. NICE interventional procedure guidance 119 (2005)
High-intensity focused ultrasound for prostate cancer. NICE interventional procedure guidance 118 (2005)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Supporting information

Glossary

Androgen deprivation therapy
Atypical small acinar proliferation
Digital rectal examination
An internationally recognised grading system, based on examination of tissue obtained by prostate biopsy, in which a pathologist allocates an overall cell abnormality score that can help predict prostate tumour behaviour. A low Gleason score (6 or lower) indicates a relatively non-aggressive cancer; a high Gleason score (8 or higher) indicates a relatively aggressive cancer.
High-grade prostatic intra-epithelial neoplasia
Multidisciplinary team
Phosphodiesterase type 5
Prostate-specific antigen

Paths in this pathway

Pathway created: October 2011 Last updated: October 2014

© NICE 2014

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