A NICE clinical guideline on the diagnosis and treatment of prostate cancer was issued in February 2008. The guideline emphasises the importance of taking into account individual patient needs and preferences. Good communication is essential, supported by evidence based information, to allow patients (and their partners, families and carer’s if they agree) to make informed decisions about their treatment and care.
The NICE guideline contains detailed recommendations for specialised services on the diagnosis and treatment of prostate cancer according to its stage (localised, locally advanced or metastatic), and also covers follow up, management of relapse and side effects of treatment. Healthcare professionals in primary care have an important role to play in the detection and referral of patients with suspected prostate cancer, and in the continued support of patients following diagnosis and treatment.
Before referral to specialist care, men with suspected prostate cancer should have been offered a digital rectal examination (DRE) and prostate specific antigen (PSA) test as set out in NICE ‘Referral guidelines for suspected cancer’. To help men decide whether to have a prostate biopsy, healthcare professionals should discuss with them their PSA level, DRE findings (including an estimate of prostate size) and comorbidities, together with their risk factors (including increasing age and black African or black Caribbean ethnicity) and any history of a previous negative prostate biopsy. The serum PSA level alone should not automatically lead to a prostate biopsy.
Action: Primary care clinicians and healthcare professional involved in the diagnosis and management of people with prostate cancer should be familiar with this guideline.