The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on high dose rate brachytherapy in combination with external-beam radiotherapy for localised prostate cancer in May 2006.
Further recommendations have been made as part of the clinical guideline on prostate cancer published in February 2008, as follows:
Brachytherapy is not recommended for men with high-risk localised prostate cancer.
Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. More information is available from NICE guideline CG58. The IP guidance on high dose rate brachytherapy in combination with external-beam radiotherapy for localised prostate cancer remains current, and should be read in conjunction with the clinical guideline.
Prostate cancer is one of the most common cancers in men. It tends to affect older men, with the risk rising with age. It is not a single disease entity but may be indicated from an incidental biopsy finding to presentation with metastatic prostate cancer, which may or may not cause any symptoms or shorten life. Symptoms when they occur include urinary outflow obstruction and features of metastases, such as bone pain. Prognosis with prostate cancer is variable and depends on the grade of the tumour and stage of the diagnosed cancer. Treatment options depend on the stage of the cancer.
Brachytherapy is a form of radiotherapy in which delivery of radiation is targeted directly to the prostate gland through the implantation of small radioactive pellets. Needles are inserted through the skin of the perineum, these needles deliver the seeds which are left in place. In high dose rate brachytherapy thin plastic catheters are inserted through a template, through the perineal skin, and into the prostate gland. They enter the skin below the scrotum and above the rectum. Radioactive seeds are then inserted into each catheter. The catheters are then pulled out, leaving no radioactive material in the prostate gland. Brachytherapy may be used in combination with external beam radiation (EBRT) in high dose therapy.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.