Prostate cancer: summary of updated NICE guidanceBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7524 (Published 08 January 2014) Cite this as: BMJ 2014;348:f7524
- John Graham, director and consultant in clinical oncology1,
- Peter Kirkbride, consultant in clinical oncology2,
- Kimberley Cann, researcher1,
- Elise Hasler, information specialist1,
- Matthew Prettyjohns, health economist1
- 1National Collaborating Centre for Cancer, Cardiff CF10 3AF, UK
- 2Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral CH63 4JY, UK
- Correspondence to: J Graham
Prostate cancer poses a major health problem in many countries and is the commonest cancer in men in the UK.1 Its incidence and mortality rate are higher in men of African-Caribbean origin. Since publication of the original NICE guideline in 2008,2 there have been several changes in diagnosis and management of prostate cancer. Great improvements in the treatment of hormone relapsed metastatic disease with the introduction of several new treatments (cabazitaxel, abiraterone, enzalutamide, and radium-223) have been assessed by NICE’s Technology Appraisal Programme3 4 and are not covered by this guidance.
This article summarises recently updated recommendations from the National Institute for Health and Care Excellence (NICE) on the diagnosis and care of men with prostate cancer.5 Many recommendations have not been updated from the previous guidance and can be found in a previous BMJ summary.6
NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
Information and support for patients
Discuss all relevant management options recommended in the guideline with men with prostate cancer, and their partners or carers, irrespective of whether they are available through local services and use a validated, up to date decision aid.7 [Based on the experience and opinion of the Guideline Development Group (GDG)]
Initial assessment and diagnosis
To help men decide whether to have a prostate biopsy, discuss with them their prostate specific antigen (PSA) level, digital rectal examination findings, age, black ethnicity (associated with an increased risk of prostate cancer), and comorbidities (which may affect the decision to offer curative treatment), together with any previous negative prostate biopsy. [Based on evidence …