Surveillance decision

Surveillance decision

We will plan an update of the following sections of the guideline:

  • Scheduling of docetaxel added to standard treatment for the treatment of hormone sensitive metastatic prostate cancer

  • Scheduling of docetaxel added to standard treatment for the treatment of hormone sensitive locally advanced prostate cancer

  • Multiparametric/functional MRI before TRUS biopsy in men with suspected prostate cancer

  • Optimal dose and fractionation schedule for men with localised prostate cancer (T1b – T3a N0 M0) who are treated with radical radiotherapy

Reason for the decision

Docetaxel

The NICE Evidence Summary on docetaxel for hormone-sensitive metastatic prostate cancer suggests that docetaxel could have a role in the treatment of hormone-sensitive metastatic prostate cancer. The evidence presented in the summary was considered against the current recommendations in the guideline to determine the need to update the guideline. Feedback was sought from the Guideline Development Centre Director acting Chair who indicated that the current recommendations on treating hormone-sensitive metastatic prostate cancer should be updated.

The acting Chair suggested that the recommendations for hormone-sensitive locally advanced prostate cancer also need to be considered. In addition to the 3 RCTs included in ESUOM50 – STAMPEDE, CHAARTED and GETUG-15 – the acting Chair highlighted a meta-analysis by Vale 2016 for evidence on for hormone-sensitive locally advanced prostate cancer which included all three trials. The meta-analysis suggests that docetaxel may be effective in the treatment of treating hormone-sensitive locally advanced prostate cancer. The acting Chair also advised that NHS England had already issued guidance because some centres had restricted use of docetaxel.

The evidence summary and meta-analysis suggest that docetaxel could have a role in the treatment of both hormone-sensitive metastatic and locally advanced prostate cancer. As such, the current guideline recommendations on treating hormone-sensitive metastatic and locally advanced prostate cancer should be revisited. A detailed view on the impact of the evidence on the guideline recommendations can be found in appendix 1.

Imaging

The evidence around imaging at initial diagnosis, imaging based assessment and treatment for advanced disease was discussed with the acting Chair. The acting Chair advised the PROMIS trial which is currently being undertaken and expected to publish in March 2017 would impact on current guideline recommendations on MRI. The acting Chair advised that there was not a lot of significant new evidence in diagnostics other than PROMIS.

Radiotherapy

The acting Chair advised the CHHiP trial published in June 2016 which considered the effectiveness of radiotherapy for men with localised prostate cancer. The acting Chair advised that NHS England had already written to radiotherapy centres and changed commissioning as a result of the trial and the results of the trial would impact on current guideline recommendations.

The acting Chair advised all other treatments for advanced disease were covered by NICE Technology Appraisals and therefore would not impact the guideline.

Additional areas

In addition during the exceptional review NICE was made aware of on-going research in the areas of risk stratification and treatment for localised prostate cancer (ProtecT trial) which may impact on current recommendations. During the scoping of the update these areas should be checked to assess if an update is required.

Decision: The following review questions should be updated:

  • What is the most clinically and cost effective scheduling of docetaxel added to standard treatment for the treatment of hormone sensitive metastatic prostate cancer?

  • What is the most clinically and cost effective scheduling of docetaxel added to standard treatment for the treatment of hormone sensitive locally advanced prostate cancer?

  • Does multiparametric/functional MRI before TRUS biopsy increase diagnostic yield of initial biopsy in men with suspected prostate cancer?

  • What is the optimal dose and fractionation schedule for men with localised prostate cancer (T1b – T3a N0 M0) who are treated with radical radiotherapy?

  • This update will require scoping due to the exceptional surveillance review identifying additional areas of treatment for localised prostate cancer and risk stratification requiring updating, there may be further areas not identified during the exceptional surveillance review which require update.

Other clinical areas

This exceptional surveillance review was carried out to allow us to consider the impact of the areas described above on the guideline recommendations. We did not search for new evidence relating to other clinical areas in the guideline as part of this focused surveillance.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the new evidence and views of topic experts, we decided that a partial update is necessary for this guideline.

See how we made the decision for further information.


This page was last updated: 27 October 2016