The National Prostate Cancer Audit (NPCA) published results from a prospective audit of men newly diagnosed with prostate cancer earlier this year. Men diagnosed with prostate cancer in England and Wales between 1st April 2016 and 31st March 2017 were included in the audit.
Recommendations from the findings included increased use of transperineal prostate biopsy. The report noted that the use of transperineal biopsies had remained static over the period, despite the procedure being associated with more precise diagnoses. Transperineal biopsies - typically conducted under GA - accounted for just 12% of biopsies carried out in England over the period, while the other 88% were transrectal ultrasound (TRUS). However, a wave of change is in the air which could be attributed to innovations such as the PrecisionPoint device and the subsequent capability for clinicians and nurse specialists to now perform the procedure under local anaesthetic.
The results show evidence to support the increased use of LA TP biopsy to reduce the risk of post-biopsy sepsis and to maximise diagnostic accuracy and risk stratification. The report’s recommendations to commissioners also suggest a positive indication towards the adoption of the LA TP method.
Alongside findings and recommendations around prostate biopsy, the report also highlighted interesting findings on side effects of prostate cancer treatments.
Key findings from the report show that while there has been no significant increase in the number of men reporting genitourinary complications following radical prostatectomy, one in ten men experience at least one severe genitourinary complication within two years of their prostatectomy or a severe gastrointestinal complication after external beam radiation. Of 5,000 men who underwent a radical prostatectomy at 57 Trusts during 2015, overall 11% experienced at least one severe treatment-related genitourinary complication within two years following surgery.
On the other hand, brachytherapy looks to be greatly under-prescribed. Of the 4% of men diagnosed with low-risk localised cancer who underwent radical prostate cancer therapy within 12 months of diagnosis, only 0.1% received brachytherapy. While 67% of men diagnosed with locally advanced prostate cancer were found to have undergone some form of radical therapy within 12 months of diagnosis, only 0.1% received brachytherapy. With excellent oncological outcomes and increasingly strong evidence to support LDR Brachytherapy as a safe and effective treatment option, why aren’t more men made aware of it?
The report recommends that data on the prevalence of side effects, including the prevalence of genitourinary complications, should be used to ensure all patients are offered appropriate counselling and management. Given this and the reduced risk of genitourinary complications, low-dose rate (LDR) brachytherapy should be highlighted as a viable treatment option.
Other notable findings include positive news for patient care and engagement building, with 83% of men diagnosed with prostate cancer being given the name of their Clinical Nurse Specialist, and feeling involved in and overall happy with their care.