Prostate cancer is the most commonly diagnosed cancer in the UK. In their lifetime 1 in 6 men will be diagnosed.
This report highlights progress made by the health and care system in implementing NICE guidance on prostate cancer.
Published November 2020
Why focus on prostate cancer?
- 57,000 new UK diagnoses in 2018 - more than breast, lung and bowel cancer
- 33% increase in hospital admissions between 2014 to 2015 and 2018 to 2019
- 1 in 6 men will be diagnosed in their lifetime
- 400,000 people living with or after the disease
What we've published on this topic
Key findings from the report
This page provides a summary of the findings from the report. It includes insight from Dr John Graham, consultant oncologist and cancer lead clinician at Taunton and Somerset NHS Foundation Trust, about NICE's role in improving outcomes for people with prostate cancer.
This report looks at the impact of our guidance using data mostly collected before the COVID-19 pandemic. It highlights where new COVID-19 resources have been developed to help the NHS take action.
There have been substantial improvements in the diagnosis and treatment of prostate cancer over the last 20 years and NICE guidance has been key to many of these.
Recognition and diagnosis of prostate cancer
Key points
- Prostate cancer has a 5 year survival rate of over 95% when diagnosed at stage 1 to 3 compared with other cancers. Although, for the 1 in 5 people diagnosed with stage 4 prostate cancer (metastatic), the 5 year survival rate drops to just 49%.
- Awareness has been raised by national campaigns. NHS Be clear on cancer has raised awareness. as has coverage of diagnoses. Media coverage of Stephen Fry and Bill Turnbull's cases resulted in a 250% increase in visits to the NHS prostate cancer advice webpage.
- In April 2020, the number of people referred for investigations for any suspected cancer fell by more than half. This was due to the first COVID-19 lockdown. Numbers have since recovered and by August 2020, 88% had their first consultant appointment within 2 weeks. Despite the pandemic, the number of urgent GP referrals had returned to almost previous levels.
- Testing is important to determine the stage of prostate cancer and to make sure the appropriate treatment is offered. Our guideline on prostate cancer says to offer multi-parametric MRI (mpMRI) first for people with suspected clinically localised prostate cancer. The proportion of mpMRIs performed before biopsy is increasing year on year. In 2017 only 37% were performed. This increased to 46% in 2018 and 87% in 2019.
Insight from Dr John Graham
"Identifying significant prostate cancer remains the principal challenge. Many localised cancers may never impact on life expectancy, but it is essential that high risk cancers are identified at an early stage.
Although the treatments for incurable prostate cancer continue to improve, it is imperative that we reduce the number of people being diagnosed with stage 4 of the disease.
The impact of COVID-19 remains to be quantified, but it's encouraging to see referrals for cancer diagnostics improving following the initial reduction. However, the second wave of COVID-19 may impact on this."
Treatment
Key points
- A range of prostate cancer treatment options are available depending on the stage of cancer. The Predict Prostate patient decision aid is endorsed by us and supports our guideline on prostate cancer. Produced by the University of Cambridge Academic Urology Group, it compares the potential outcomes of different treatment options for people with non-metastatic prostate cancer.
- The robotic approach to surgery is increasing. In 2019, the proportion of prostatectomies performed robotically rose from 74% in 2017 to 85% in 2019. The benefits of robotic surgery include less blood loss, reduced pain and shorter hospital stays.
- For people with metastatic hormone-relapsed prostate cancer, we recommended both abiraterone or enzalutamide before chemotherapy and following androgen deprivation therapy. The overall use of these drugs has increased since they were first recommended by us. The use of abiraterone and enzalutamide is measured in defined daily doses (DDDs). DDDs have risen from 350,000 in 2015 to almost 600,000 in 2020.
- We published the COVID-19 rapid guideline: delivery of systemic anticancer treatments in line with advice from NHS England and NHS Improvement. This prioritises radiotherapy treatments if services become limited because of the COVID-19 pandemic. It maximises patient safety and makes the best use of resources while protecting staff from infection.
Insight from Dr John Graham
"The steady increase in robotic radical prostatectomy is welcome and the 2014 NICE guidance was a key driver of this change in practice.
The COVID-19 measures for newly diagnosed prostate cancer are welcome. However, I remain concerned that due to COVID-19 the incremental improvements seen in the management of advanced prostate cancer over the last 20 years may be undermined by clinicians' and patients' reluctance to consider chemotherapy.
Even pre-COVID there were substantial variations in chemotherapy rates across the UK."
Managing adverse effects of treatment
Key points
- Side effects after treatment for prostate cancer are common. After radiotherapy, 10% of people develop gastrointestinal complications, and after prostatectomy, 9% developed genitourinary complications. Both require further investigation or treatment 2 years after radical treatments.
- After treatment for prostate cancer, most people will have an assessment for some of the key adverse events. These assessments allow decisions on further treatment. Our guideline on prostate cancer says that people with adverse effects should be offered care from an expert team of professionals and have access to specialist services for assessment, diagnosis and conservative treatment.
Insight from Dr John Graham
"While the earlier use of novel hormone therapies has many advantages, there is a continuing need for improved investigation and management of the toxicities associated with long term androgen deprivation therapy."
People’s experience of care
Key points
- People should discuss their treatment options and possible adverse effects with a named nurse specialist. In 2019, 88% of people with prostate cancer in England were given the name of a nurse specialist to support them through their treatment. The support given helps people feel reassured that they are well informed and involved in decisions about their care.
- Urology has the highest number of new cases per cancer nurse specialist. There are 145 urological cancer patients for every nurse, compared to 108 for lung cancer and 84 for breast cancer patients.
- There is a substantial variation between cancer alliances in the ratio of urology specialist cancer nurses to newly diagnosed patients in their care. For every urology cancer nurse, there are 251 new patients. The fewest new patients for a nurse is 87.
Insight from Dr John Graham
"The figures on cancer nurse specialists in urology compared to other cancers remain a concern. Prostate cancer treatment is complex and often extends over many years.
NICE guidance has highlighted the need for additional nurse specialists for people with prostate cancer but a lot more needs to be done."
More information
This report highlights progress made by the health and care system in implementing NICE guidance. We recognise that change can sometimes be challenging and may require pathway reconfiguration. It may also require additional resources such as training and new equipment.
We work with partners including NHS England and NHS Improvement, Public Health England and other relevant organisations to support changes. We also look for opportunities to make savings by reducing ineffective practice.