Inside Health – BBC Radio 4 discusses uncertainty in the diagnosis and treatment of prostate cancer

On Wednesday 4th & 11th January 2017, prostate cancer was the topic of discussion on BBC Radio 4’s Inside Health programme. Host Dr. Mark Porter chaired a panel discussion, which cast a spotlight on the uncertainty men, and their families, face during the diagnosis and treatment of prostate cancer.

A wide ranging and highly informative broadcast which is to be commended, the programme covered the benefits - and limitations - of screening options for prostate cancer, including PSA testing and MRI scanning. It also went on to cover a range of treatment options - from active surveillance, which is currently a recommendation under NICE guidelines, to so-called ‘radical treatments’ including surgery and external beam radiotherapy.

The programme covered two studies - PROMIS, a trial that aimed to tell us just how accurate MRI was at ruling in and ruling out prostate cancer - and ProtecT, a trial that monitored the progression of the disease under different treatment options. In both cases, the studies set out to ascertain the extent to which over-diagnosis of prostate cancer might lead to over-treatment.

The concept of over-diagnosis seems a strange one, yet there is a recognition that not all cases of prostate cancers detected will cause harm over a period of a lifetime. How does one then determine if these cases need radical intervention or not, was the question the ProtecT study set to answer.

The reason this is important is because, from the NHS’ perspective, radical intervention is a costly exercise. But perhaps more significant, from a patient’s viewpoint, unnecessary treatment can have - in many cases unnecessary short and long-term after effects.

Whilst on the whole a broadcast to be recommended and read, unfortunately, one treatment option that was not given airtime was brachytherapy, and in particular low dose rate (LDR) brachytherapy.

A study of our own - Ascende RT

The newly highlighted Ascende-RT study is the first of its kind. The randomised, controlled research study took place over a ten year period and enrolled 398 men with a median age of 68 - 69% of whom had high-risk disease. The study showed that over a ten year period there was a 50% decrease in biochemical relapse with the boost of low dose rate brachytherapy, meaning that more men remained disease free for longer. Moreover, LDR brachytherapy is proven to have fewer negative side-effects compared to other treatment options - from urinary function, sexual function, bowel function, quality of life, anxiety, depression and general health.

The results learned from this study are pivotal in ensuring that medical professionals inform men - and their families - of the full range of treatments available to them. Previously LDR brachytherapy was only considered to be an appropriate treatment option for patients with low risk prostate cancer (the very men that the ProtecT and PROMIS studies were trying to identify); however, Ascende-RT proves it’s an offer that can be made available to the majority of patient groups.

Collectively, studies like those mentioned will be invaluable in the medical and technological advancement in the accurate diagnosis and treatment of prostate cancer. However, it is also vital that the community at large pays heed to all relevant medically proven studies.