NICE has issued new guidance on the diagnosis and management of prostate cancer (PCa).
Key recommendations include:
Do not routinely offer multiparametric MRI (mpMRI) to patients ineligible for radical treatment.
mpMRI is the first-line investigation for suspected clinically localised PCa, with results reported using a five‑point Likert scale.
Offer mpMRI-influenced prostate biopsy to people when Likert score is ≥3.
Consider omitting biopsy when Likert score is 1-2.
Do not offer mapping transperineal template biopsy at initial assessment.
For men with raised PSA and Likert score 1-2, who have not had a biopsy or had a negative biopsy, repeat PSA at 3-6. Discharge to primary care, advising follow-up PSA at six months and then every year, and referral if PSA reaches set targets ie, PSA density (0.15 ng/ml/ml) or velocity (0.75 ng/year).
PROGENSA PCA3 assay and the Prostate Health Index is not recommended in people having investigations for suspected prostate cancer who have had a negative or inconclusive prostate biopsy.
For active surveillance, consider PSA every 3-4 months in the first year, with digital rectal examination (DRE) at 12 months and mpMRI at 12-18 months. In subsequent years, PSA every six months and DRE every 12 months.
For people having docetaxel, start treatment within 12 weeks of starting androgen deprivation therapy (six 3‑weekly cycles at 75 mg/m2 with/without daily prednisolone).
Do not routinely offer DRE to people not on active surveillance with PSA increase.
Advice on treating metastatic hormone-relapsed prostate cancer previously treated with docetaxel, abiraterone, and enzalutamide can be used, as per previous recommendations.
Medroxyprogesterone, tamoxifen, and bicalutamide are not included as they do not currently have UK marketing authorisation for this indication.