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The National Cancer Control Programme recently published an updated version of the National Clinical Guideline (diagnosis and staging) for patients with prostate cancer.
The National Cancer Control Programme (NCCP) recently launched an update to a module of the National Clinical Guideline – Diagnosis and Staging of Patients with Prostate Cancer, which was developed in collaboration with clinicians, patient representatives, and key stakeholders.
This evidence-based guideline replaces recommendations within the original guideline – Diagnosis, Staging and Treatment of Patients with Prostate Cancer (published in 2015).
The guideline is intended for all healthcare professionals involved in diagnosing, staging, and treating patients with prostate cancer. It is also relevant to those involved in clinical governance, in both primary and secondary care, to help ensure that arrangements are in place to deliver appropriate care for the population covered by this guideline. This guideline is also of interest to patients undergoing investigations for prostate cancer and their families and carers.
The guideline was co-chaired by Mr David Galvin, Consultant Urologist, Mater Hospital and St Vincent’s University Hospital, Dublin; and Dr Eve O’Toole, Head of the Evidence and Quality Hub, NCCP.
Figure 1: Diagnosis and staging algorithm for patients with suspected prostate cancer referred from a urologist (NCCP guideline)
Speaking about the update, Dr O’Toole explains: “We have decided to take a phased approach to updating our National Clinical Guidelines to ensure they are based upon the latest evidence. This guideline integrates the best current research evidence with clinical expertise and patient values. It aims to reduce variation in practice and to improve the quality of care delivered to patients.”
According to Mr Galvin: “The updated guideline ensures a comprehensive review of current radiological and diagnostic strategies for patients with prostate cancer. It provides doctors and nurses with the necessary information to achieve excellence in care for these patients. The contributions from patients, nurses and a variety of medical specialists greatly enriched the process and the output from it. Over the last 10-to-15 years the diagnostic, staging and treatments in Ireland have evolved enormously and represent some of the latest advances in prostate cancer care.”
Clinical knowledge and judgment should be used in applying the principles and recommendations contained in this guideline.
As shown by National Cancer Registry Ireland (NCRI) data, the average number of newly-diagnosed cases of prostate cancer in Ireland between 2017 and 2019 was 3,869 cases per year (NCRI, 2021). This represents 30 per cent of all invasive cancers for men (excluding non-melanoma skin cancer), making prostate cancer the most commonly-diagnosed invasive cancer in men in Ireland. Prostate cancer incidence in Ireland is currently the highest in Europe (GLOBOCAN, 2020).
The number of deaths from prostate cancer in Ireland was 554 per year, during the period 2016-2018. This represents 20.2 deaths per 100,000 population attributing to 12 per cent of male cancer deaths (NCRI, 2021). Prostate cancer is the joint second (with colorectal cancer) most common cause of cancer death among males.
Prostate cancer is, however, a very treatable disease, which is reflected in the increase in survival rates over the last number of decades. Five-year net survival has improved from 61 per cent from 1994-1999 to 94 per cent from 2014-2018 (NCRI, 2021), while 10-year survival is currently approximately 89 per cent. The increase in survival is most likely due to improvements in diagnosis and treatment.
Risk factors
Increasing age is the most important risk factor for prostate cancer. In Ireland, the majority of cases are detected in men aged 65- to-74 years, with 41 per cent detected in men <65 years of age. Family history is associated with an increased risk of developing prostate cancer: Men with a father or a brother diagnosed with prostate cancer at age 50 years have an approximately two-fold increased risk of prostate cancer. Asian men are less likely to develop prostate cancer, whereas black men have the highest incidence of prostate cancer of any group (231.9 per 100,000). Obesity has been associated with higher-grade prostate cancers, possibly as a result of altered hormone levels
Treatment
Current management of prostate cancer involves a multidisciplinary approach, with input from primary care, radiology, pathology, urology, radiation oncology, and medical oncology. Management depends on the presentation of prostate cancer: Early/localised cancer, locally-advanced cancer, biochemical failure (rising PSA in the absence of metastatic disease), hormone-sensitive metastatic disease, and hormone-refractory metastatic disease.
Treatment options for patients with prostate cancer include active monitoring, radical prostatectomy, external beam radiotherapy and brachytherapy. Hormone therapy (androgen deprivation or anti-androgens) is the primary treatment for metastatic prostate cancer, but is also increasingly being used for patients with locally-advanced, non-metastatic disease. In patients with localised prostate cancer, the choice of treatment is guided by whether the disease is considered low-, intermediate-, or high-risk.
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