Prostate cancer: diagnosis and treatment.

http://publications.nice.org.uk/prostat … ment-cg175

Introduction

Prostate cancer is the most common cancer in men and makes up 26% of all male cancer diagnoses in the UK. In 2008, 34,335 men were diagnosed with prostate cancer and there were 9376 deaths from prostate cancer in England, Wales and Northern Ireland. This figure increased to 9632 deaths in 2010.

Prostate cancer is predominantly a disease of older men (aged 65–79 years) but around 25% of cases occur in men younger than 65. There is also higher incidence of and mortality from prostate cancer in men of black African-Caribbean family origin compared with white Caucasian men.

Prostate cancer is usually diagnosed after a blood test in primary care has shown elevated prostate-specific antigen (PSA) levels. The introduction of PSA testing has significantly reduced the number of men presenting with metastatic cancer since the 1980s.
Most prostate cancers are now either localised or locally advanced at diagnosis, with no evidence of spread beyond the pelvis.

A number of treatments are available for localised disease, including: active surveillance, radical prostatectomy, external beam radiotherapy and brachytherapy. Hormone therapy (androgen deprivation or anti-androgens) is the usual primary treatment for metastatic prostate cancer, but is also increasingly being used for men with locally advanced, non-metastatic disease.
This updated guidance includes several treatments that have been licensed for the management of hormone-relapsed metastatic prostate cancer . It also aims to reduce the uncertainty and variations in practice that remain in some areas of prostate cancer diagnosis and management. Updated recommendations are provided on:
• pre-biopsy imaging
• management after an initial negative biopsy
• imaging for T and N staging
• groups for whom active surveillance is suitable and a protocol for active surveillance
• the most effective radical prostatectomy method
• the combination of external beam radiotherapy and brachytherapy in non-metastatic prostate cancer
• management of radiation-induced enteropathy
• the combination of hormone therapy and external beam radiotherapy in non-metastatic prostate cancer
• intermittent compared with continuous hormone therapy for men having long-term hormone therapy
• management of side effects resulting from long-term androgen deprivation therapy.

This guideline covers the care of men referred to secondary care with suspected or diagnosed prostate cancer, including follow-up in primary care for men with diagnosed prostate cancer.
The guideline does not cover men with an abnormal PSA (prostate-specific antigen) level detected in primary care who have no symptoms and are not referred for subsequent investigation.

ACCESS – PATHWAY: http://pathways.nice.org.uk/pathways/prostate-cancer

G Mohan.