Quality statement 3: Combination therapy

Quality statement

People with intermediate‑ or high‑risk localised prostate cancer who are offered non‑surgical radical treatment are offered radical radiotherapy and androgen deprivation therapy in combination.

Rationale

Androgen deprivation therapy and radiotherapy are 2 of the treatment options available for people with intermediate‑ or high‑risk localised prostate cancer. Combining androgen deprivation therapy with radical radiotherapy can increase the effectiveness of treatment and the chances of survival compared with either androgen deprivation therapy or radical radiotherapy alone.

Quality measures

Structure

Evidence of local arrangements to ensure that people with intermediate‑ or high‑risk localised prostate cancer who are offered non‑surgical radical treatment are offered radical radiotherapy and androgen deprivation therapy in combination.

Data source: Local data collection.

Process

Proportion of people with intermediate‑ or high‑risk localised prostate cancer receiving non‑surgical radical treatment, who receive radical radiotherapy and androgen deprivation therapy in combination.

Numerator – the number in the denominator who received radical radiotherapy and androgen deprivation therapy in combination.

Denominator – the number of people with intermediate‑ or high‑risk localised prostate cancer receiving non‑surgical radical treatment.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as hospitals, specialised urological cancer multidisciplinary teams and specialised prostate cancer services) ensure that healthcare professionals know that radical radiotherapy and androgen deprivation therapy should be used only in combination for people with intermediate‑ or high‑risk localised prostate cancer.

Healthcare professionals ensure that people with intermediate‑ or high‑risk localised prostate cancer who are offered non‑surgical radical treatment receive radical radiotherapy and androgen deprivation therapy in combination.

Commissioners (such as clinical commissioning groups and NHS England area teams) monitor whether people with intermediate‑ or high‑risk localised prostate cancer offered non‑surgical radical treatment are offered radical radiotherapy and androgen deprivation therapy in combination. Commissioners may wish to ask providers for evidence of practice.

People whose cancer has not spread outside the prostate and whose future risk from the cancer is medium or high are offered treatment of combined radiation treatment to destroy the cancer cells (called radiotherapy) and a drug that blocks the production of androgen, a hormone that helps cancer cells to grow, (called androgen deprivation therapy). Having radiotherapy together with androgen deprivation therapy usually works better than having just one of these treatments on its own.

Source guidance

Prostate cancer: diagnosis and management (2019) NICE guideline NG131, recommendation 1.3.19

Definitions of terms used in this quality statement

Androgen deprivation therapy

Treatment with a luteinising hormone‑releasing hormone agonist such as goserelin to lower testosterone levels.

[Adapted from NICE's guideline on prostate cancer, 2014 full guideline]

High‑risk localised prostate cancer

Prostate‑specific antigen (PSA) greater than 20 ng/ml, Gleason score 8–10 or clinical stage T2C or greater.

[NICE's guideline on prostate cancer]

Intermediate‑risk localised prostate cancer

PSA 10–20 ng/ml, Gleason score 7 or clinical stage T2B.

[NICE's guideline on prostate cancer]

Radical radiotherapy

Radiation, usually X‑rays or gamma rays, used to destroy tumour cells by external beam radiotherapy or brachytherapy.

[NICE's guideline on prostate cancer, 2014 full guideline]

Equality and diversity considerations

Some older people may have previously been offered androgen deprivation therapy alone. Focusing on the benefits of combination therapy for older people with intermediate‑ or high‑risk localised prostate cancer should help to reduce such inequalities.

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.