A report for ecancermedicalscience by freelance journalist Stephen Pinn:

NICE launches new guideline to encourage best practice in the management of prostate cancer

New recommendations have been published for the diagnosis and management of prostate cancer, 35,000 new cases of which are identified each year in the UK alone. The guideline has been developed by the National Institute for Health and Clinical Excellence (NICE) - and, as is often the case with NICE guidance, it is not without controversy.

Dr John Graham, Lead Clinician on the Guideline Development Group (GDG) and Consultant Lead Clinical Oncologist, Taunton and Somerset NHS Trust, commented: "One of our major challenges is to identify and treat aggressive cancers that may be life-threatening, while avoiding over-treatment of slow-growing cancers that may not need treating for many years.

He added: "We are recommending that all men with localised prostate cancer should be categorised by specialist teams as low, intermediate or high risk - and that this classification should dictate the investigation and management that may be appropriate for each patient."

Explaining the conservative approach being recommended for the management of localised prostate cancer, Professor Mark Baker, GDG Chair and Lead Clinician Cancer Clinician at Leeds Teaching Hospital, said: "In this guidance, we hope to avoid the over-treatment of men who are unlikely to be troubled by prostate cancer during their natural life-span.

Mr David Gillatt, GDG member and Consultant Urologist, Southmead Hospital, Bristol: commented: "The potential side-effects of radical treatments such as surgery or radiotherapy can be serious, and include urinary incontinence and erectile dysfunction. Where appropriate, these recommendations can help some men to avoid or postpone undergoing these treatments."

The NICE guideline recommends the following management strategies:

1. Localised prostate cancer:

• - active surveillance for low-risk patients
• - prostatectomy and conformal radiotherapy for intermediate- and high-risk patients

2. Locally advanced prostate cancer:

• - offer neoadjuvant and concurrent luteinising hormone-releasing hormone agonist (LHRHa) therapy for 3-6 months to men receiving radiotherapy
• - adjuvant hormonal therapy for a minimum of 2 years to men receiving radiotherapy who have a Gleason score of >8

3. Metastatic prostate cancer:

• - bilateral orchidectomy as an alternative to continuous LHRHa therapy
• - monotherapy with bicalutamide in men wishing to maintain sexual function
• - androgen withdrawal in place of bicalutamide if that agent has been unsuccessful in maintaining sexual function

4. Hormone-refractory prostate cancer:

• - docetaxel, but only if Karnofsky score is ³60%
• - a corticosteroid as third-line therapy after androgen withdrawal and anti-androgen therapy

More controversially, the guideline specifically advises clinicians not to offer:

• - radical treatments such as cryosurgical ablation and high-intensity focused ultrasound (HIFU) for men with localised prostate cancer
• - adjuvant hormonal treatment in addition to prostatectomy, bisphosphonates, routine immediate post-prostatectomy radiotherapy, cryotherapy or HIFU for men with locally-advanced prostate cancer
• - combined androgen blockade as a first-line treatment in men with metastatic prostate cancer
• - routine spinal magnetic resonance imaging (MRI) to men with known bone met