The recent news of Theresa May’s announcement of £75m plans to drive prostate cancer research is a huge step forward in the diagnosis of Prostate Cancer. At present, patients are in danger of being diagnosed at too late a stage and subsequently are then not being fully educated on the variety of treatments available to them.
This newly pledged funding could allow alternative biopsy procedures to be offered more widely, such as free hand transperineal biopsy of the prostate under Local Anaesthetic. The transperineal biopsy path allows clinicians to more thoroughly sample all regions of the prostate including those difficult to access with the traditional transrectal approach. In addition, the potential for infection is significantly reduced, since passage of the biopsy needle avoids the rectal wall contaminants entirely. Equally importantly, biopsies can be performed under local anaesthesia rather than general, which saves significant NHS resources and costs and dramatically improves the overall patient experience. Such an approach can also facilitate the rapid access diagnostic clinics that are emerging as an effective way of diagnosing the most significant prostate disease requiring treatment.
Further down the line, this funding could also work to broaden the reach of other, more effective prostate cancer treatments such as, Low Dose Rate Brachytherapy (LDR-B). This has been approved by NICE to be an effective treatment for localised prostate cancer. The recent Ascende-RT study from Canada analysed the outcomes of patients with intermediate- and high-risk prostate cancer (typically the domain of radical prostatectomy) over a ten-year period, and found that LDR-B in conjunction with hormones and whole pelvis radiotherapy offered highly favourable outcomes. LDR-B is a well evidenced treatment option that can offer an important alternative to radical prostatectomy, and effective alternative to less proven focal therapies like HIFU and Cryotherapy not only improving patient experience by reducing operating theatre time, lowering the use of general anaesthetic but ensuring good curative outcomes and minimal side effects of treatment compared with the alternatives.
A recent survey conducted by BXTaccelyon revealed that only 61% were given either one or two treatment options out of the five listed in the survey, with surgery – otherwise known as radical prostatectomy – the most widely recommended. Furthermore, only 11% of patients surveyed received advice on three or more of the available options. The data from this study reveals that too many patients are being offered radical prostatectomy, a serious operation to completely remove the prostate gland and surrounding tissue; this treatment is highly invasive and has the greatest impairment of sexual function and urinary continence. If we were to make a comparison with breast cancer, it’s the equivalent of women being steered towards radical mastectomy.
Prostate cancer is highly intimate, so it’s perfectly understandable that some patients might feel embarrassed and why some are less inclined to visit GPs sooner than they have. Patient choice is key – and that demands accurate, informed discussions about the pros and cons of every treatment, from outcomes to process. Pledges of funding for prostate cancer research, like this, will hopefully result in earlier detection and a complete education of the wide variety of treatment options available that will improve overall patient experience, deliver the best possible health outcomes and will ultimately lead to reduced mortality rates and ultimately a better use of NHS resources.