Excerpt

In April 2019, this guideline was updated by an expert committee. They reviewed the evidence on the assessment, diagnosis and staging, treatment and follow-up of prostate cancer.

The original Prostate Cancer: Diagnosis and Treatment Guideline published in 2008 was the first clinical guideline produced by the National Collaborating Centre for Cancer (NCC-C); accordingly this is now the first NCC-C clinical guideline to be reviewed and updated. Many areas of the original guideline are unchanged as there is little or no new evidence; other aspects have been completely rewritten. As ever there are still many topics where the research evidence is incomplete or conflicting, and so the Guideline Development Group (GDG) have been required to reach a consensus using the evidence available to them in several areas. In places where it was clear that further work needed to be done, new research recommendations have been made which we hope will be used as the basis for future research work.

Contents

• Foreword
• Key priorities for implementation
• Key research recommendations
• List of all recommendations
• List of all research recommendations
• Methodology
• Algorithms
• 1. Epidemiology
  • 1.1. Introduction
  • 1.2. Diagnosis and investigations
  • 1.3. Current treatment options
  • 1.4. References
• 2. Communication and support
  • 2.1. Introduction
  • 2.2. Communicating with men with prostate cancer, their partners and carers
  • 2.3. Decision support
  • 2.4. Specific problems
  • 2.5. References
• 3. Diagnosis and staging of prostate cancer
  • 3.1. When to biopsy
  • 3.2. Histological diagnosis
  • 3.3. Staging classification for prostate cancer
  • 3.4. Nomograms
  • 3.5. References
• 4. Localised prostate cancer
  • 4.1. Introduction
  • 4.2. Predictive factors and risk groups
  • 4.3. Treatment decision making
  • 4.4. Initial treatment options
  • 4.5. Managing adverse effects of treatment
  • 4.6. Follow-up
  • 4.7. References
• 5. Managing relapse after radical treatment
  • 5.1. Introduction
  • 5.2. Defining biochemical relapse
  • 5.3. Assessment of biochemical relapse
  • 5.4. Management of biochemical relapse
  • 5.5. References
• 6. Locally advanced prostate cancer
  • 6.1. Introduction
  • 6.2. Combined hormone and radiotherapy
  • 6.3. Systemic therapy alone
  • 6.4. References
• 7. Hormone therapy
  • 7.1. Introduction
  • 7.2. Neoadjuvant and adjuvant hormone therapy
  • 7.3. Hormone therapy in metastatic disease
  • 7.4. Managing the complications of hormone therapy
  • 7.5. References
• 8. Metastatic prostate cancer
  • 8.1. Introduction
  • 8.2. Hormonal therapy
  • 8.3. Androgen deprivation versus combined androgen blockade (CAB)
  • 8.4. Anti-androgen monotherapy
  • 8.5. Hormone-relapsed prostate cancer
  • 8.6. Imaging
  • 8.7. Bone targeted therapies
  • 8.8. Pelvic targeted therapies
  • 8.9. Palliative care
  • 8.10. References
• Appendices
  • Appendix A. Prostate Specific Antigen (PSA)
  • Appendix B. The cost-effectiveness of multiparametric magnetic resonance imaging (mpMRI) before trans-rectal ultrasound (TRUS) guided prostate biopsy in men with suspected prostate cancer
  • Appendix C. TNM Staging for Prostate Cancerkk
  • Appendix D. An Economic Evaluation of Radical Prostatectomy Versus Alternative Treatment Options for Clinically Localised Prostate Cancer
  • Appendix E. The cost-effectiveness of HDR brachytherapy in combination with external beam radiotherapy in comparison to external beam radiotherapy alone
  • Appendix F. Abbreviations
  • Appendix G. Glossary
  • Appendix H. Guideline scope
  • Appendix I. People and organisations involved in production of the guideline
  • Appendix J. Sections from NICE clinical guideline 58 (2008) that have been removed
  • Appendix K. Recommendations from NICE clinical guideline 58 (2008) that have been deleted or changed
  • Appendix L. Sections from NICE clinical guideline 58 (2008) Evidence Review that have been removed

This guidance updates and replaces NICE clinical guideline 58 (published February 2008). New and updated recommendations have been included on the diagnosis and treatment of men with prostate cancer.

Recommendations are marked to indicate the year of the last evidence review:

• [2008] if the evidence has not been reviewed since the original guideline.
• [2008], amended [2014] if the evidence has not been reviewed, but an essential change has been made that affects the meaning of the recommendation.
• [2014] if the evidence has been reviewed but no change has been made to the recommendation.
• [new 2014] if the evidence has been reviewed and the recommendation has been updated or added.

Appendix K contains recommendations from the 2008 guideline that have been deleted from this 2014 update. Details of any replacement recommendations are also included.

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.