Quality standard
Quality statement 2: Treatment options
Quality statement 2: Treatment options
Quality statement
People with Cambridge Prognostic Group (CPG) 1 localised prostate cancer for whom radical treatment is suitable are offered active surveillance.
Rationale
People who are diagnosed with localised prostate cancer and assigned a risk category of CPG 1, for whom radical treatment is suitable, are offered active surveillance because it can reduce overtreatment and increase capacity for rapid treatment of high‑risk disease. It can also reduce the number of people unnecessarily having radical treatment and therefore experiencing adverse effects, and decrease the cost of treating and managing these adverse effects. By discussing the benefits and harms of active surveillance, people can make an informed decision. If active surveillance is not suitable or acceptable, radical prostatectomy or radical radiotherapy are alternative treatment options.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people with CPG 1 localised prostate cancer for whom radical treatment is suitable are offered active surveillance.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications or local protocols. The National Prostate Cancer Audit collects data on treatment options including radial treatments and active surveillance.
Process
Proportion of people with CPG 1 localised prostate cancer for whom radical treatment is suitable on active surveillance.
Numerator – the number in the denominator who are on active surveillance.
Denominator – the number of people with CPG 1 localised prostate cancer for whom radical treatment is suitable.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The National Prostate Cancer Audit collects data on treatment options including radial treatments and active surveillance.
What the quality statement means for different audiences
Service providers (such as hospitals, specialist urological cancer multidisciplinary teams and specialist prostate cancer services) ensure that systems are in place to offer active surveillance to people with CPG 1 localised prostate cancer for whom radical treatment is suitable.
Healthcare professionals ensure that they discuss the benefits and harms of active surveillance with, and offer it to, people with CPG 1 localised prostate cancer for whom radical treatment is suitable. If active surveillance is not suitable or acceptable, they consider radical prostatectomy or radical radiotherapy.
Commissioners (such as integrated care systems, clinical commissioning groups and NHS England) should monitor the treatment options offered to people with CPG 1 localised prostate cancer.
People whose cancer has not spread outside the prostate and has been assigned a risk category of CPG 1 discuss the benefits and harms of having regular tests but no treatment (known as active surveillance) and are offered this as a first option. If this is not suitable or acceptable, then surgery to remove the prostate (radical prostatectomy) or radiation treatment to destroy cancer cells (radiotherapy) may be alternative options.
Source guidance
Prostate cancer: diagnosis and management. NICE guideline NG131 (2021), recommendations 1.3.8, 1.3.13, 1.3.14 and 'active surveillance' as described in terms used in this guideline.
Definitions of terms used in this quality statement
Active surveillance
Part of a curative strategy for people with localised prostate cancer for whom radical treatments are suitable. It keeps these people within a 'window of curability' whereby only those whose tumours are showing signs of progressing or those with a preference for intervention are considered for radical treatment. Active surveillance may therefore avoid or delay the need for radiation or surgery. Active surveillance follows the protocol outlined in table 2 in NICE's guideline on prostate cancer. [NICE's guideline on prostate cancer, terms used in this guideline]
Cambridge Prognostic Group (CPG) 1
Gleason score 6 (grade score 1); and prostate-specific antigen (PSA) less than 10 microgram/litre; and stages T1–T2. [NICE's guideline on prostate cancer, table 1]
Localised prostate cancer
Cancer that has been staged as T1 or T2 (confined to the prostate gland). [NICE's guideline on prostate cancer, terms used in this guideline]
Equality and diversity considerations
People of black African or Caribbean family origin are more likely to develop prostate cancer than others. Despite this, awareness of prostate cancer is low among people in these groups. Similarly, older people are at higher risk of developing prostate cancer than younger people, but may be less likely to continue to engage with health services even after the initial contact with the service. For people in these groups for whom active surveillance is suitable, healthcare professionals should highlight its importance as a treatment option.
People who are gay, bisexual or transgender have a risk of developing prostate cancer. Healthcare professionals should be aware of their psychosexual needs, lifestyle and the impact of different treatment options.