New NICE Interventional procedures guidance [IPG611] Prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia

Interventional procedures guidance [IPG611] Prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia
Published date: April 2018


Evidence-based recommendations on prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia in adults. This involves blocking the blood vessels supplying the prostate with tiny plastic particles.


for full guidance https://www.nice.org.uk/guidance/ipg611

A 3D deformable prostate model derived from orthogonal projections of radiotherapy CT data

Poster on a 3D deformable prostate model derived from orthogonal projections of radiotherapy CT data

Modern radiotherapy to the prostate uses daily imaging to track the prostate position and improve targeting accuracy. A 3D flexible model of prostate shape could be used to evaluate such techniques through simulation. Ideally such a model could shape variation during treatment and target definition errors from observer variability.

UHCW Research: J P Sage

NIHR Signal Men feel physically and psychologically ill-prepared for prostate cancer surgery.

Following prostate cancer surgery men often experience physical changes, such as urinary incontinence and erectile dysfunction, causing negative emotions and distress. This review found that men felt poorly prepared – psychologically and physically – for the changes they might experience after surgery. Surgery was often described as "life-changing", and men described worrying about their future.

From the NIHR Dissemination Centre

National Prostate Cancer Audit (NPCA) Annual Report 2017

Only 8% of men with low-risk prostate cancer received potentially unnecessary radical treatment aimed at curing the disease[1] in 2015-16 according to the fourth Annual Report of the National Prostate Cancer Audit (NPCA) published by the Royal College of Surgeons. This is an improvement on 2014-15 figures, when 12% of men treated by the NHS in England may have received unnecessary treatment for low risk disease. This reflects the international trend in this area of prostate cancer therapy.

Enzalutamide (Xtandi) for non-metastatic prostate cancer

Enzalutamide (Xtandi) is a drug which blocks the effect of the hormone testosterone on the prostate and so slows down the growth of the cancer. Enzalutamide is taken as four capsules once a day. If licenced in the UK, it could provide an additional treatment option for patients with non-metastatic prostate cancer


From the NIHR Innovation Observatory

Topsalysin for benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a medical term that is used to describe enlargement of the prostate gland. It is not a cancer and is usually not a serious threat to health if well-treated. Most males aged 50 years and above will develop BPH. As the prostate gets bigger, it can place pressure on the bladder and it may squeeze or partly block the tube that carries urine from the bladder out of the body. This often causes problems with passing urine and may also cause other complications such as recurrent urinary tract infections, blockage of the bladder outlet, and kidney failure.
Topsalysin is a new medicine that is under development for the treatment of BPH. It acts on a specific receptor on the cell surface of prostate cells leading to shrinkage of these cells. It is delivered through an injection directly into the prostate, precisely shrinking the enlarged prostate tissue without damaging neighbouring tissue and nerves. This is believed to diminish the risk of side effects. If licensed, topsalysin will offer a new treatment option for patients with BPH.


From the NIHR Innovation Observatory

High-precision radiotherapy for prostate cancer 'shows promise'

"Targeted radiotherapy 'cures' prostate cancer that kills thousands," reports The Times.

The news is based on a UK study of the use of high-precision radiotherapy to treat men with advanced localised prostate cancer.

Researchers wanted to see if they could safely target cancer cells that had spread outside the prostate to nearby lymph nodes without damaging nearby healthy cells, and reduce treatment side effects.

Prostate cancer is the most common cancer in men – more than 47,000 cases are diagnosed in the UK every year.

Some 447 men with locally advanced disease took part in the 10-year study, carried out by the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust.

The high-tech radiotherapy, called pelvic lymph node intensity modulated radiation therapy (PLN-IMRT), can modify the shape and strength of its beams to target cancerous cells more effectively.

The main aim of the study was to look at the side effects of the treatment, specifically on the bladder and bowels.

Five years after receiving treatment, up to 71% of patients were alive and disease-free. Only 8-16% of patients experienced bowel or bladder complications.

This is promising research that suggests PLN-IMRT should be studied further. Later-stage randomised controlled trials would be the best way of confirming the safety and potential benefit of this treatment for men with advanced localised prostate cancer and seeing how it compares with other treatment approaches.

Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer [IPG590]

New Evidence-based recommendations on biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer in adults. This involves using a liquid gel or a balloon to increase the distance between the prostate and the rectum to reduce the amount of radiation reaching the rectum.Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer

1 Recommendations

1.1 Current evidence on the safety and efficacy of insertion of a biodegradable spacer to reduce rectal toxicity during radiotherapy for prostate cancer is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

1.2 The procedure should only be done by clinicians with training in, and experience of, transperineal interventional procedures.

Collecting outcomes to promote value-based healthcare

This case study describes how the University Hospital of Coventry and Warwickshire NHS Trust (UHCW) has started to collect, measure and use health outcomes for patients receiving prostate cancer care. The project is part of a wider programme of work currently underway in the trust to promote value-based healthcare.

UHCW Research: Rachel Mayman and Catherine Mitchell

Blood test may lead to targeted therapy for prostate cancer

"A blood test has been developed that could help target treatment for men with advanced prostate cancer," BBC News reports. The test could help identify men unlikely to respond to drugs such as enzalutamide.

Enzalutamide and abiraterone are additional treatments for men for whom standard hormonal treatment has not worked, or has stopped working.

Treatment success varies; some men get little benefit, while others have responses that last many years. The new test – if confirmed – could help doctors know in advance who is likely to benefit.

Geographic patterns of cancer survival, England: 2015

Survival at 1 year and 5 years after diagnosis improved for the 8 cancers examined in this report (colon, breast, cervix,prostate, oesophagus, stomach, bladder, lung) among adults diagnosed in England between 2003 and 2010. Differences in net survival between the 4 NHS Regions are generally small, of the order 1% to 3%. Survival improved slightly but consistently in all 4 regions for 7 of the 8 cancers.

Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer

This updated NICE guideline covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer

NICE recommends anastrozole is offered for 5 years to postmenopausal women at high or moderate risk of breast cancer unless they have severe osteoporosis. And clinicians should consider offering it to women at moderate risk of breast cancer.

Women at high risk who have not been through the menopause should continue to be offered tamoxifen

MRI scan before biopsy could detect more prostate cancer

In men with a raised prostate specific antigen (PSA) blood test, which can be a sign of prostate cancer, MRI scanning before standard biopsy could allow more targeted biopsies and increase diagnosis of medium and high-risk prostate cancer.

From the NIHR Dissemination Centre

MRI scans could spare 25% of men from prostate biopsies

"Every man with suspected prostate cancer should have an MRI scan," The Guardian reports. That is the conclusion of a study looking at how well MRI scans compare with the current practice of biopsies; removing sections of prostate tissue for analysis.

Overall, this study provides good evidence that using an MP-MRI test before a biopsy can result in a much lower proportion of men undergoing unnecessary biopsy. The combination helps detect cancer and avoid unnecessary treatment.

However, the lower accuracy of predicting patients without the disease means that patients with a suspicious MP-MRI scan will still need a biopsy. That is because the current results suggest that in cases where the scan gives an "all-clear" there is around a 40% chance that this is actually an incorrect result.

See also Multi-parametric MRI scans prior to biopsyfor improving diagnosis of prostate cancer and the RCR's response to the study.

Irreversible electroporation for treating prostate cancer

New NICE interventional procedures guidance on irreversible electroporation for treating prostate cancer in adults. This involves using electrical pulses to destroy the cancer cells.

Bone-targeting drugs improve quality of life, but not survival in prostate cancer that has spread to bone

The drug zoledronic acid delayed the onset of bone complications by two months in men with prostate cancer that had spread to the bone. Though it did not increase overall survival, it improved quality of life by reducing important complications such as fractures and spinal cord compression.

From the NIHR Dissemination Centre

Belfast physios use prehab to improve quality of life for men with prostate cancer

Two band 7 physiotherapists, Thamra Ayton and Alison Robinson, are leading a service at Belfast City Hospital that has improved continence for patients and reduced the workload for consultants and a clinical nurse specialist.

Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases

New Technology Appraisal Guidance from NICE:

Evidence-based recommendations on radium‑233 dichloride (Xofigo) for treating hormone-relapsed prostate cancer with bone metastases in adults.

Large ten-year trial on treatment of localised prostate cancer will aid management decisions

New, long-term research indicates that active monitoring, with prompt treatment if needed, may be a better option than radical surgery or radiotherapy for many men who have prostate cancer if it’s confined to the prostate gland. In the ProtecT trial, after an average of ten years, few men died of prostate cancer and there was no difference in survival between men receiving active monitoring and those who had radical treatments (which caused unpleasant side effects). But active monitoring did increase the risk of cancer progressing or spreading to other parts of the body. Longer follow-up will help to fully understand the balance between treatments.


From the NIHR Dissemination Centre

NICE recommends Cancer Drugs Fund treatment for prostate cancer for routine NHS use

More prostate cancer patients will receive radium-223 after NICE approved it for routine NHS use. NICE had previously recommended it only for patients who had received initial treatment with another drug called docetaxel.

This meant that prostate cancer patients who had not received docetaxel had to access radium-223 through the Cancer Drugs Fund (CDF). The number of patients in England able to access this during 2014-15 was 601. This recommendation means that prostate cancer patients who have not already received docetaxel treatment can access radium-223 through the NHS and no longer need to access the CDF.