Prostate cancer remains the most common cancer in men in the UK, with more than 40,000 new cases diagnosed here each year. Treatment options vary, depending on how early the disease is diagnosed and how far it has spread. These range from a simple ‘watching and waiting’ approach to see how and when the disease spreads to more definitive treatment such as radiotherapy or surgery to remove the affected tissue.
Although the NHS treats around 16,000 men a year with radiotherapy, the treatment is associated with potential serious side-effects including bladder and bowel incontinence and sexual dysfunction such as impotence and sterility. These are some of the main causes of disability among prostate cancer survivors.
Until now, the optimum radiotherapy has involved treatment five days a week for over seven weeks. This is a drain both on patients and financially on the NHS, with prostate cancer treatment accounting for over a quarter of the work of radiotherapy departments in the UK.
The Institute of Cancer Research and the Royal Marsden Hospital has now published new research suggesting that 10,000 patients a year could benefit from fewer hospital appointments over a shorter period of time. The research follows a 10-year study into thousands of prostate cancer patients who were treated with intensity modulated radiotherapy (IMRT).
The research concludes that treating patients with fewer, higher doses of radiotherapy is as effective as current best practice of 37 doses for five days a week over two months. The higher dose caused no increase in side effects and very few of the patients involved in the study experienced serious bladder or bowel problems. Lowering the IMRT dose reduced the risk of side effects but also slightly reduced its efficacy in treating the cancer. This trade-off might be attractive to some patients, for example, those who are frail.
Andrew Clayton of Penningtons Manches' clinical negligence team comments: "The potential benefits here are clear. A shorter course of higher dose radiotherapy would reduce the number of trips to hospital, which itself can be an ordeal for cancer sufferers both physically and emotionally. There may also be lower risks of serious side effects of radiotherapy treatment for a shorter period and the risks of the serious side effects may be lower as a result. The NHS also gains from the reduced number of appointments, in turn enabling it to increase capacity, reduce waiting times and make potential cost savings.
"The higher dose treatments over shorter time periods do need to be precisely controlled and the researchers highlight that many NHS units may need to invest in new equipment. NHS England is understood to be looking at changing the standard of care in line with this research and expected to implement new guidance later this year.
“Cancer Research reports that most hospitals involved in the study have already changed to the higher dose, shorter course IMRT. For others, the short-term investment cost clearly has the potential to deliver benefits, both to patients and the NHS."