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Changing the story of cancer: Improving lives by not over-treating prostate cancer

3 min read

Each year more than 50,000 men in the UK are newly diagnosed with prostate cancer. This is expected to rise to 85,000 by 2040.

Many men are then treated with various interventions that can have serious, life-changing, and longlasting side effects. Research shows active monitoring in newly diagnosed cases where the cancer has not spread leads to the same survival rates without the side effects.

Cambridge University Hospitals (CUH) is leading the way in tackling the widespread problem of over-treatment of prostate cancer. Through the development of NHS tools, endorsed by NICE, CUH is refining risk stratification and personalising cancer care, enabling patients and their clinicians to balance risk and quality of life.

Predict Prostate, an NHS tool developed by CUH and the University of Cambridge, is helping men to make those personal choices. Data analysis shows the use of Predict Prostate, along with improved risk stratification, reduced over-treatment from 23% in 2016 to 4% in 2019/20.

Wider use of Predict Prostate nationally is needed to change the story of cancer for patients, consistent with the vision of the planned Cambridge Cancer Research Hospital, to bring together clinical and research expertise in a new world-class hospital designed in partnership with patients.

Non-urgent advice: Prostate cancer key facts

Important: Did you know?

Prostate cancer is more prevalent in men over 50, men with a strong family history of the disease, and those of Afro-Caribbean descent

  • Advances in detection for prostate cancer are resulting in more diagnoses of men at earlier stages of the disease
  • Active surveillance can have the same high survival rates after 15 years as either surgery or radiotherapy, but without the side effects
  • The lifetime risk of being diagnosed with prostate cancer in the UK is about 1 in 8
  • The risk of dying of prostate cancer in the UK is 1 in 23
Predict Prostate

Predict Prostate is a free web-based tool endorsed by NICE. It combines an individual’s clinical diagnosis with characteristics and other medical factors specific to them, to estimate how likely the cancer is to affect their natural life expectancy and what benefit treatment may be in their personal context. It also shows the potential side effects from different options over a 15-year period in a simple easy-to-understand format that can be used in any clinic or healthcare setting.

If the estimate shows the cancer is not likely to be their cause of death, it may be better for that individual to opt for active surveillance rather than risk side effects from a treatment without any actual benefit to them.

Predict Prostate was developed using observational data over a long period from thousands of men diagnosed with non-metastatic prostate cancer from the East of England. The model has also been tested among men diagnosed with prostate cancer in Singapore, Sweden, and the USA. Altogether the model has now been evaluated and tested in more than 350,000 men globally. It has been checked to ensure the estimates it provides are as accurate as possible given current knowledge.

The model was developed by a partnership between the Department of Surgery, Department of Cancer Epidemiology, and the Winton Centre for Risk Communication at the University of Cambridge in collaboration with the National Cancer Registration and Analysis Service at Public Health England.

It was supported by funding from The Urology Foundation and the Evelyn Trust.

Conclusion

Changes in healthcare are often the result of several small but significant steps that change the course of medicine. The wider adoption of Predict Prostate is one of those steps.

It does not take any more money, time, or resources.

It does require a change in national approach to reduce overtreatment of prostate cancer, giving men more choice in their cancer care.

Reducing over-treatment means better access to treatments when this is the best option, and releases resources to treat other more lethal cancers. This supports our vision for the new Cambridge Cancer Research Hospital to detect cancer earlier, treat it more precisely, and save more lives.

Photo of Vincent Gnanapragasam

“Using these tools, we have dramatically reduced over-treatment, saving many men from unnecessary treatment. Getting checked for prostate cancer is vital, but a diagnosis should not mean inevitable treatment. Predict Prostate is a major step forward in personalised healthcare.”

Professor Vincent Gnanapragasam, Professor of Urology and Hon Consultant Urologist