Men spared from surgery as NHS adopts ‘active surveillance’ for prostate cancer patients

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Thousands of men with prostate cancer may be spared aggressive treatment as health bosses have backed a new treatment method.

In a landmark decision, NHS rationing watchdog NICE has now included active surveillance in its official guidance.

The treatment allows the killer disease to be monitored every couple of months, through blood tests and scans.

It offers patients the option of avoiding or delaying radical treatments, which can cause a host of unwanted side effects.

Prostate Cancer UK has welcomed the move. Each year 47,000 men in the UK are diagnosed with the disease.

Heather Blake, a director at the charity, said: ‘It’s great news that the NICE guidelines now reflect the latest evidence.

‘What is crucial now is that active surveillance is consistently delivered to a high standard across the UK.’

She also urged that personalised information and support need to be given to men to encourage men to choose the approach.

Radiotherapy, while effective, is known to cause nausea, fatigue, erectile dysfunction and incontinence.

Only patients whose cancer is contained within the prostate and not considered harmful will benefit from active surveillance.  

This type of the disease, which grows slowly and has a low risk of spreading, is known as low risk localised prostate cancer. 

The NICE guidelines acknowledge that active surveillance has the same 10-year survival benefit as radiotherapy and surgery.

Dr Sam Merriel, a GP based in Bristol, said: ‘Choosing active surveillance over radical treatment is not necessarily an easy decision.

He added that it ‘goes against the natural instinct of wanting to get rid of the cancer immediately’. 

Vincent Gnanapragasam, a consultant urologist at the University of Cambridge, said: ‘Clinicians do not want to be seen to be telling people not to have treatment.’

Patients, meanwhile, will often demand action when they hear the word ‘cancer’.

Daniel Beecroft, 45, from Epping in Essex, was diagnosed with low-risk localised prostate cancer in July 2018.  

The father- said he was initially advised to have surgery, but after talking it through with other clinicians he was put on active surveillance. 

He added: ‘In the end it was a no-brainer for me to choose to keep an eye on things for now. I was told my cancer was small and not aggressive.’

Mr Beercroft watched his father’s health deteriorate after surgery to remove his prostate following a diagnosis in 2012.

He added: ‘I had seen the side effects my father had to deal with after surgery – such as incontinence.

‘So felt I would prefer to delay going down that route for as long as possible. I’m pleased that I got a second opinion – it was definitely the right decision for me.’

Two in every 100 men who opt for active surveillance will die from prostate cancer in a decade, compared to one in 100 for surgery and radiotherapy. The chance of the cancer spreading is higher with active surveillance – meaning some men end up having to be treated eventually. 

Professor Freddie Hamdy, of the University of Oxford, who led a decade-long study into active surveillance published in 2016, said: ‘It gives the patients choice and options which are based on evidence.

‘The moment patients hear the word cancer they want it treated, and they can pay the price of that treatment in side effects. This is quite remarkable and could really go some way to reducing the risk of overtreatment.’

Prostate Cancer UK said the guidance was an ‘endorsement’ of active surveillance. Heather Blake, director of support at the charity, said: ‘This could potentially provide thousands of men with the opportunity to safely delay or avoid radical treatment and its associated side effects.

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