Prostate Cancer Over-Treatment: New Charity Findings
active Monitoring for Low-risk Prostate Cancer: A Growing Trend and Calls for Screening Expansion
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Prostate cancer is the most common cancer in men in the UK, but increasingly, doctors are opting for a ‘watchful waiting’ approach – active monitoring – for those diagnosed with lower-risk forms of the disease. This strategy avoids immediate treatment, rather relying on regular tests to track the cancer’s progress. However, uptake of this approach varies across the country, and a leading charity is calling for wider adoption to strengthen the case for a national prostate cancer screening program.
What is active Monitoring and Who is it For?
Active monitoring,also known as active surveillance,isn’t simply ignoring the cancer. It involves regular blood tests (specifically, Prostate Specific Antigen or PSA levels) and scans – typically MRI – to closely track the cancer’s growth. This approach is currently recommended by the National Institute for Health and Care Excellence (NICE) for men with the lowest risk prostate cancer, where studies show nine in ten will have no signs of the cancer spreading within five years.
However, recent research suggests active monitoring could safely be extended to the next lowest risk group, where eight in ten men experience no cancer spread within the same timeframe. This potential expansion is gaining momentum,with Prostate Cancer UK reporting that many hospitals are already implementing this wider approach.
Uneven Access to Active monitoring Across the UK
Despite the growing evidence supporting active monitoring, access remains inconsistent. Prostate Cancer UK’s analysis reveals a significant disparity in care across the UK:
24% of eligible patients in some English hospitals are still receiving immediate treatment instead of being offered active monitoring.
On average, 8% of men across the UK who could benefit from active monitoring are unnecessarily treated, equating to approximately 5,000 men annually.
While patient choice plays a role - men are frequently enough given the option of immediate treatment even with low-risk diagnoses – the charity argues that proactive offering of active monitoring by the NHS is crucial.
Why Expanding Active monitoring Matters: The Screening Debate
Prostate Cancer UK believes wider adoption of active monitoring isn’t just about improving individual patient care; it’s also vital for building a stronger argument for a national prostate cancer screening programme. Currently, there is no national screening programme for prostate cancer.
A key argument against widespread screening has been the unreliability of the PSA test - a blood test that measures levels of prostate-specific antigen. Critics argue that the PSA test can produce false positives, leading to needless anxiety and potentially harmful overtreatment. However, if more low-risk patients are appropriately managed with active monitoring, it could demonstrate that a screening programme, coupled with careful risk assessment, wouldn’t lead to a surge in unnecessary interventions.”To reduce the harm caused by prostate cancer and build the foundations for a screening programme, we need to both save lives and prevent unnecessary treatment,” explains Amy Rylance of Prostate Cancer UK.
Patient Experience: The Benefits of ‘Watchful Waiting’
Michael Lewis, 63, from the West Midlands, is a testament to the benefits of active monitoring. diagnosed with low-risk prostate cancer in 2020, he chose to delay treatment and opt for regular monitoring. four years later,tests indicated the cancer was progressing,and he underwent a prostatectomy.
“Delaying treatment was so valuable,” Lewis shares.”I was able to continue my everyday life with no side effects.” His experience highlights how active monitoring can allow men to avoid the potential side effects of immediate treatment – such as incontinence and erectile dysfunction – while still ensuring timely intervention if the cancer becomes more aggressive.
NICE Review and the future of Prostate Cancer Care
Recognizing the evolving evidence,NICE is currently reviewing its guidelines on prostate cancer management. A spokesperson stated, “We are committed to ensuring our guidelines continue to reflect the best available evidence and give patients the best possible outcomes.”
This review is expected to consider the potential expansion of active monitoring to a wider group of patients and its implications for the future of prostate cancer screening in the UK. As awareness grows – fueled in part by high-profile diagnoses like that of Olympic cyclist Sir Chris Hoy – the conversation around prostate cancer is shifting, with a growing demand for proactive and personalized care.