NICE clarification boosts UK treatment options for prostate cancer
5 July 2008
The UK's National Institute of Clinical Excellence (NICE) has opened
the way for National Health Service patients with prostate cancer to
have continued access to cryotherapy — which was threatened by
earlier NICE guidance published in February.
A session of the British Association of Urological Surgeons' (BAUS)
annual meeting at the end of June discussed the NICE Clinical Guideline on Prostate
Cancer. Urologists reiterated their concern that earlier NICE
recommendations will harm survival rates. In the UK, prostate cancer
survival rates are below the European average.
The NICE Guideline advocates greater reliance on active surveillance
and recommended that newer treatments such as cryotherapy and high
intensity focused ultrasound (HIFU) should only be used in the context
of clinical trials. Given the ethical difficulty of establishing such
trials, clinicians and patients feared that PCTs would withdraw funding.
In contrast, last year the European Association of Urology (EAU)
recognised the important role of cryotherapy in treating prostate cancer
by including it in its prostate cancer guidelines. More recently, the
American Urological Association (AUA) announced best practice statements
citing cryotherapy as a treatment option for both primary and recurrent
localised prostate cancer.
Professor Damian Greene, Consultant Urologist at Sunderland Royal
Hospital in the UK, considers cryotherapy a valuable option in the
treatment of primary and recurrent prostate cancer. Prof. Greene
commented: "Cryotherapy is a significant alternative to traditional
treatments for prostate cancer, such as radical prostatectomy and
external beam radiation treatment. Patient satisfaction with
cryoablation is high due to its minimally invasive approach, which allows
returning to active life quicker than with alternative treatments."
Since publication of the Guideline, NICE has been in discussion with
industry, BAUS and the Health Technology Assessment programme of the
National Institute for Health Research to identify a way forward.
Discussions are progressing with BAUS to establish national data
collection. In the meantime, NICE has clarified that surgeons collecting
local data available for national analysis will satisfy the
recommendation on use of cryotherapy, enabling PCTs to continue funding.
Professor Greene comments: "This is excellent news, as prostate
cancer is a challenging condition. Clinicians need cryotherapy as a
treatment option and it's great that patients can now continue to
benefit from it within the NHS."
Source: Galil Medical