Return to CG175 Overview

Prostate Cancer: diagnosis and treatment [CG175]

Measuring the use of this guidance

Recommendation: 1.1.2

Offer men with prostate cancer individualised information tailored to their own needs. This information should be given by a healthcare professional (for example, a consultant or specialist nurse) and may be supported by written and visual media (for example, slide sets or DVDs).

What was measured: Percentage of trusts in England that provide prostate cancer services that have clinical nurse specialists in Urology available
Data collection end: March 2014
97%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit

What was measured: Percentage of trusts in England that provide prostate cancer services that have clinical nurse specialists in oncology available
Data collection end: March 2014
46%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit

What was measured: Proportion of prostate cancer patients who reported that, when they were told they had cancer, they were given written information about the type of cancer they had and it was easy to understand.
Data collection end: June 2015
72.8%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Proportion of lung cancer patients who reported that the possible side effect(s) of treatments were explained to them in a way they could understand "completely".
Data collection end: June 2016
73.3%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Proportion of men who received radical prostatectomy that were given the name of a clinical nurse specialist.
Data collection end: April 2016
83%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit

What was measured: Proportion of men who received external beam radiation therapy that were given the name of a clinical nurse specialist.
Data collection end: April 2016
85%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.1.3

Offer men with prostate cancer advice on how to access information and support from websites, local and national cancer information services, and from cancer support groups. [2008]

What was measured: Proportion of prostate cancer patients who reported that hospital staff gave them information about support or self-help groups for people with cancer.
Data collection end: June 2015
62.3%
Data collection end: June 2016
63.4%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.


Recommendation: 1.1.10

Tell men: - about treatment options and their risks and benefits in an objective, unbiased manner and - that there is limited evidence for some treatment options.

What was measured: Proportion of prostate cancer patients who reported that, before their cancer treatment started, their treatment options were explained to them "completely" or there was only one type of treatment that was suitable for them.
Data collection end: June 2015
80.9%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Proportion of prostate cancer patients who reported that, before their cancer treatment started, their treatment options were explained to them "completely" or there was only one type of treatment that was suitable for them.
Data collection end: June 2016
76%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.


Recommendation: 1.1.12

Adequately inform men with prostate cancer and their partners or carers about the effects of prostate cancer and the treatment options on their sexual function, physical appearance, continence and other aspects of masculinity. Support men and their partners or carers in making treatment decisions, taking into account the effects on quality of life as well as survival.

What was measured: Proportion of prostate cancer patients who reported that the possible side effects of treatment(s) were explained to them in a way they could understand "completely".
Data collection end: June 2015
68.7%
Data collection end: June 2016
69.7%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.


Recommendation: 1.2.4

Carry out prostate biopsy following the procedure recommended by the Prostate Cancer Risk Management Programme in Undertaking a transrectal ultrasound guided biopsy of the prostate. [2008]

What was measured: Proportion of men with prostate cancer who had a biopsy who received a transrectal ultrasound biopsy before treatment.
Data collection end: May 2015
85%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit

What was measured: Proportion of men with prostate cancer who had a biopsy who received a transrectal ultrasound biopsy before treatment.
Data collection end: April 2016
84%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.2.6

Consider multiparametric MRI (using T2- and diffusion-weighted imaging) for men with a negative transrectal ultrasound 10–12 core biopsy to determine whether another biopsy is needed. [new 2014]

What was measured: Proportion of men with prostate cancer who received a multiparametric MRI.
Data collection end: May 2015
21%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.3.8

Consider using the protocol in table 2 for men who have chosen active surveillance. [new 2014]

What was measured: Proportion of urologists, clinical oncologists and urology nurse specialists who reported performing a repeat biopsy at 12 months
Data collection end: December 2013
40%
Area covered: Multiple Regional
Source: Philippou, Y., Raja, H. & Gnanapragasam, V. J. (2015) Active surveillance of prostate cancer: a questionnaire survey of urologists, clinical oncologists and urology nurse specialists across three cancer networks in the United Kingdom. BMC Urology, 15: 52

What was measured: Proportion of urologists, clinical oncologists and urology nurse specialists who reported using multiparametric MRI routinely as a tool for selecting patients suitable for active surveillance
Data collection end: December 2013
60%
Area covered: Multiple Regional
Source: Philippou, Y., Raja, H. & Gnanapragasam, V. J. (2015) Active surveillance of prostate cancer: a questionnaire survey of urologists, clinical oncologists and urology nurse specialists across three cancer networks in the United Kingdom. BMC Urology, 15: 52


Recommendation: 1.3.14

Offer radical prostatectomy or radical radiotherapy to men with high-risk localised prostate cancer when there is a realistic prospect of long-term disease control. [2008]

What was measured: Proportion of men with locally advanced prostate cancer who received external beam radiation therapy.
Data collection end: April 2016
42%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit

What was measured: Proportion of men with locally advanced prostate cancer who underwent radiacal prostatectomy.
Data collection end: April 2016
18%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.3.15

Commissioners of urology services should consider providing robotic surgery to treat localised prostate cancer. [new 2014]

What was measured: Proportion of men who received radical prostatectomy who had the procedure carried out by a robotic approach.
Data collection end: April 2016
70%
Number that met the criteria: 1888 / 2699
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.3.16

Commissioners should ensure that robotic systems for the surgical treatment of localised prostate cancer are cost effective by basing them in centres that are expected to perform at least 150 robot-assisted laparoscopic radical prostatectomies per year

What was measured: Percentage of trusts in England that provide prostate cancer services that carry out radical prostatectomy for prostate cancer who use robot-assisted laparoscopic prostatectomy
Data collection end: March 2014
43%
Number that met the criteria: 26 / 61
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit

What was measured: Proportion of specialist multidisciplinary team (MDT) hubs that have robotic-assisted laparoscopic prostatectomy available.
Data collection end: March 2014
67%
Area covered: England
Source: Aggarwal A, Nossiter J, Cathcart P, van der Meulen , J , Rashbass J, Clarke N, and Payne H. (2016). Organisation of Prostate Cancer Services in the English National Health Service. Clinical Oncology, 28(8), pp.482-489.


Recommendation: 1.3.17

Offer men undergoing radical external beam radiotherapy for localised prostate cancer a minimum dose of 74 Gy to the prostate at no more than 2 Gy per fraction.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
58%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.3.22

Consider high-dose rate brachytherapy in combination with external beam radiotherapy for men with intermediate- and high-risk localised prostate cancer. [new 2014]

What was measured: Proportion of specialist multidisciplinary team (MDT) hubs that have high dose rate brachytherapy available.
Data collection end: March 2014
44%
Area covered: England
Source: Aggarwal A, Nossiter J, Cathcart P, van der Meulen , J , Rashbass J, Clarke N, and Payne H. (2016). Organisation of Prostate Cancer Services in the English National Health Service. Clinical Oncology, 28(8), pp.482-489.


Recommendation: 1.3.24

Do not offer high-intensity focused ultrasound and cryotherapy to men with localised prostate cancer other than in the context of controlled clinical trials comparing their use with established interventions.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
75%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.3.26

Clinical oncologists should consider pelvic radiotherapy in men with locally advanced prostate cancer who have a higher than 15% risk of pelvic lymph node involvement and who are to receive neoadjuvant hormonal therapy and radical radiotherapy.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
14%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189

What was measured: Proportion of men identified as having a >15% risk of pelvic lymph node involvement who received pelvic radiotherapy.
Data collection end: April 2016
17%
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.3.31

Ensure that men have early and ongoing access to specialist erectile dysfunction services

What was measured: Percentage of trusts in England that provide prostate cancer services that have sexual function services available
Data collection end: March 2014
90%
Number that met the criteria: 129 / 143
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.3.34

Ensure that men with troublesome urinary symptoms after treatment have access to specialist continence services for assessment, diagnosis and conservative treatment. This may include coping strategies, along with pelvic floor muscle re-education, bladder retraining and pharmacotherapy

What was measured: Percentage of trusts in England that provide prostate cancer services that have specialist continence services available
Data collection end: March 2014
90%
Number that met the criteria: 129 / 143
Area covered: England and Wales
Source: Royal College of Surgeons National prostate cancer audit


Recommendation: 1.3.45

After at least 2 years, offer follow-up outside hospital (for example, in primary care) by telephone or secure electronic communications to men with a stable PSA who have had no significant treatment complications, unless they are taking part in a clinical trial that requires formal clinic-based follow-up. Direct access to the urological cancer MDT should be offered and explained.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
9%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.3.47

Do not offer biopsy of the prostatic bed to men with prostate cancer who have had a radical prostatectomy.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
76%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.3.49

For men with evidence of biochemical relapse following radical treatment and who are considering radical salvage therapy: • do not offer routine MRI scanning prior to salvage radiotherapy in men with prostate cancer • offer an isotope bone scan if symptoms or PSA trends are suggestive of metastases.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
35%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.4.12

Do not routinely offer bisphosphonates to prevent osteoporosis in men with prostate cancer having androgen deprivation therapy.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
59%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.4.16

For men starting long-term bicalutamide monotherapy (longer than 6 months), offer prophylactic radiotherapy to both breast buds within the first month of treatment. Choose a single fraction of 8 Gy using orthovoltage or electron beam radiotherapy.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
23%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.5.4

Hormonal therapy is not routinely recommended for men with prostate cancer who have a biochemical relapse unless they have: • symptomatic local disease progression, or • any proven metastases, or • a PSA doubling time of < 3 months

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
40%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.5.6

Offer bilateral orchidectomy to all men with metastatic prostate cancer as an alternative to continuous luteinising hormone-releasing hormone agonist therapy.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
7%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.5.7

Do not offer combined androgen blockade as a first-line treatment for men with metastatic prostate cancer.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
20%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.5.13

Repeat cycles of treatment with docetaxel are not recommended if the disease recurs after completion of the planned course of chemotherapy.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
25%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189


Recommendation: 1.5.17

Do not offer bisphosphonates to prevent or reduce the complications of bone metastases in men with hormone-relapsed prostate cancer.

What was measured: Oncologists who said this recommendation was followed in over 90% of their patients
Data collection end: December 2010
37%
Number that met the criteria: / 77
Area covered: National
Source: Payne H et al (2013). Nasty or Nice? Findings from a UK Survey to Evaluate the Impact of the National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines on the Management of Prostate Cancer. Clinical Oncology, Vol 25, pp 178-189



 Return to CG175 Overview