Oncology Central

Rethinking treatment pathways for prostate cancer


Alastair Henderson, Consultant Urologist at Maidstone & Tunbridge Wells NHS Trust (Kent, UK) and Saheed Rashid, Managing Director, BXTAccelyon (Slough, UK), explain why it is time to reconsider prostate cancer treatment pathways.

Patient choice

Given the recent reinforcement of NICE guidelines for prostate cancer treatment it would be easy to assume that patients are routinely being offered the full range of options [1]. Yet in reality, in prostate cancer, as in any common disease, it is far too easy to fall into standard patterns of treatment that fail to reflect either recent developments or the latest study findings. Too many patients are being offered radical prostatectomy without also being advised on the alternatives, including low-dose rate brachytherapy (LDR-B) which has both a high success rate and offers better long term outcomes in both sexual function and continence.

Closed thinking

Currently, the default position for low-risk cancer is active surveillance and when it comes to prostate cancer treatment, the vast majority of younger patients now receive radical prostatectomy – and in 75% of cases this is now via robotic surgery in the UK; with older patients receiving dose-escalating external beam radiotherapy (DE-EBRT). However, while there is an understandable perception that robotic surgery is significantly more advanced than open surgery, patient outcomes are very similar. While the robotic approach is less invasive and should reduce in-patient time, as well as the risk of a blood transfusion [2], the actual operation is still the standard radical prostatectomy that has been offered for decades.

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