Surveillance decision

Risk stratification

We propose to update recommendation 1.2.16 on risk stratification in the NICE guideline on prostate cancer and to consider the impact of any changes to risk stratification on treatment recommendations. There is evidence that newer 5-tier risk stratification models, particularly those from the Cambridge Prognostic Group (CPG), perform better than the 3-tier model currently recommended in the NICE guideline, and that using the old model may result in harm to the patient because of over and under treatment. There is also new evidence that might inform treatment recommendations using the CPG risk stratification model.

Prostate cancer biopsy

We propose not to update the recommendations on prostate cancer biopsy. There was new evidence of prostate cancer biopsy showing a shift towards local anaesthetic transperineal biopsy and that transperineal biopsies may reduce rates of sepsis compared to transrectal biopsy, albeit possibly at the risk of increased urinary retention. However, following discussion with clinicians and the diagnostics assessment team within NICE it was decided that the diagnostics assessment process would be the most appropriate way to assess the clinical and cost-effectiveness of specific transperineal prostate cancer biopsy devices. As such, the topic will be considered for guidance development within the diagnostics assessment programme.

Related interventional procedures guidance

We propose to make an editorial amendment that will make reference to NICE's interventional procedures guidance on focal therapy using high-intensity focused ultrasound for localised prostate cancer and focal therapy using cryoablation for localised prostate cancer. This is in response to feedback from a clinician in August 2020 that the 2019 update of the NICE guideline made no reference to these 2 relevant procedures.

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