Thousands of men with prostate cancer could avoid invasive treatment and side-effects after scientists developed a personalised tool to give them a prognosis.
Every year more than 47 000 men in the UK are diagnosed with the disease.
But in many cases, it is not clear how fast-growing the cancer is.
Currently, around half of patients are classed as low or intermediate risk — and left to decide if they should opt for treatment such as surgery and radiotherapy, or could safely opt to be monitored.
Treatment can carry significant side-effects, including urinary incontinence and erectile dysfunction.
Rates of treatment for cases classed as low-risk vary more than ten-fold between different hospitals, national data shows.
Scientists from Cambridge University said their new method could give individual patients a personalised survival estimate, allowing patients and doctors to make a far more informed choice.
The web-based tool, which will be offered to hospital consultants, also shows how survival for the next 10 to 15 years could change, depending on different treatment options.
It also spells out the risks of different side-effects, depending on which steps are taken.
Researchers said they had developed the first personalised tool to provide such information.
Following the study, published in PLOS medicine, researchers found that doctors without access to the algorithm over-estimated the risk of death, and were far more likely to say treatment was needed, compared with those using the web programme.
The model was developed using data from more than 10 000 prostate cancer sufferers in the East of England. One in five cases had opted for “watchful waiting” with the remainder opting for surgery, radiotherapy and hormone therapy.
Lead researcher, Dr Vincent Gnanapragasam, University Lecturer and Honorary Consultant at Cambridge University Hospital NHS foundation trust, said: “We believe this tool could significantly reduce the number of unnecessary — and potentially harmful — treatments that patients receive and save the NHS millions every year.”
He said the tool would help patients and doctors to make decisions based on evidence.
“In some cases, treatment will be the right option, but in many others, patients will want to weigh up the treatment benefits versus the risks of side effects. It will also show men who do need treatment a realistic estimate of their survival after treatment,” he said.
Fellow researcher Dr David Thurtle, Academic Clinical Fellow in Urology at the University of Cambridge and Addenbrooke’s Hospital, said: “As far as we are aware, this is the first personalised tool to give an overall survival estimate for men following a prostate cancer diagnosis.”
“PREDICT Prostate is designed for men who are considering whether to choose to monitor or to opt for treatment. This is the choice that faces nearly half of all men who are diagnosed with prostate cancer.”
Data from the National Prostate Cancer Audit shows that rates of treatment for low-risk prostate cancer ranges from between two and 25 percent, depending on the hospital.
Researchers said the tool could also save the NHS significant sums, with operations such as surgery or radiotherapy costing on average around £7 000 per patient.
Heather Blake, from Prostate Cancer UK said that if validated in a larger group, a simple affordable tool could help to inform crucial decision-making. But she said more robust validation of the tool was needed before the charity could be confident about its use.
She said: “We urgently need to find methods to more reliably predict just how aggressive a man’s prostate cancer is, not only to help ensure more harmful cancers are urgently treated, but also to allow more men with low-risk localised cancer to avoid unnecessary radical treatment by confidently opting for active surveillance. ”
The tool developed by Cambridge University uses routinely available clinical information which is taken before a diagnosis of prostate cancer.
This includes the PSA blood test — which indicates an increased risk of disease — as well as the cancer grade and stage, based on a biopsy, if available, and other details from a patient’s medical record, including their age and other illnesses, or results of genetic tests, if known.
The tool stratifies patients into risk groups, before providing individuals with their overall survival chances at 10 and 15 years.
It means any individual can be told their chance of surviving this long, if they have radical treatment — such as surgery or radiotherapy — or opt for regular monitoring.
Researchers found that the predictions, which work by stratifying patients into five groups, can achieve accuracy levels of more than 80 per cent — far better than the rates of 60 to 70 percent achieved under standard NHS practices. — The Telegraph.