Up to 5,000 men in the UK could avoid unnecessary prostate cancer treatment each year if NHS guidance was updated to reflect the latest clinical evidence, according to Prostate Cancer UK. In fact it may be that if the prostate cancer is slow growing and the patient elderly, the cancer may not in fact be the cause of death. There are concerns of ‘over treatment’ with this type of cancer. A balance will have to be addressed and indeed treatment in such situations may not be the best outcome even if there is a delay in prostate diagnosis.
The charity says outdated advice from the National Institute for Health and Care Excellence (NICE) on “active surveillance” is leading to overtreatment with surgery or radiotherapy — treatments that can cause life-changing side-effects such as erectile dysfunction and incontinence.
Active surveillance is recommended for men diagnosed with slow-growing prostate cancer at an early stage, allowing doctors to monitor the disease closely without immediate intervention. This approach can help patients avoid the risks of unnecessary treatment. However, NICE’s guidelines have not been updated since 2021, despite advances in diagnostics that can better identify men at low risk.
Prostate Cancer UK’s analysis found that 24% of hospitals rely solely on the outdated NICE guidance, while 35 hospitals have created their own protocols — a “Wild West” approach that risks inconsistency and confusion.
The charity argues that updating the guidelines could prevent overtreatment, improve patient confidence in active surveillance, and help pave the way for a national screening programme.
Professor Vincent Gnanapragasam of the University of Cambridge said: “Active surveillance is the best option for men whose cancer is unlikely to cause harm. NICE’s outdated guidelines have created inconsistency, leading some men to opt for treatment they may never have needed.”
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