Quality Standards for Prostate Cancer

Tackle has been instrumental in drawing up quality standards to ensure all men with prostate cancer have a right to have the best possible care and support regardless of where they live.

Working with Prostate Cancer UK, Macmillan Cancer Support, patient representatives, urologists, oncologists, clinical nurse specialists, cancer commissioners, and Ipsen Ltd, a set of quality standards has been developed that best represents the quality of care for patients with prostate cancer with a particular focus on the quality and service requirements from the perspective of a patient.

Nine Quality Standards for prostate cancer care were identified and submitted to the National Institute for Health and Care Excellence (NICE) - for the full report, click here. In response, NICE published five Quality Standards in June 2015. The chart below compares what the working group submitted and what was finally approved by NICE.

A round-up of the whole process can be found in the September/October 2015 edition of Trends in Urology and Men’s Health.

Whilst the comparison chart (below) between the Nine and Five standards appears to show that NICE's standards fall rather short of our "gold" standards, Dr Jonathan Rees (who is a member of our Clinical Advisory Board but also a Specialist Member of the Quality Standards Advisory Committee for the NICE Prostate Cancer Quality Standard) writes that the standards are "complementary not competing" (and you can read that in the Trends in Urology and Men's Health article as well) and that they "can sit comfortably alongside each other".

Roger Wotton, Tackle Chairman, commented “We are pleased to see NICE include several improved quality standards in its latest guidelines.  However, we believe men deserve better guidance and support in other areas identified in our submission. We will continue to lobby for improvements to quality standards covering the whole prostate cancer pathway”.

Comparison between the Nine and Five Standards

  Stage Working Group Gold Standards NICE Standards
1 Risk assessment and referral Men over 50 or (or black men over 45) requesting a PSA test or presenting in primary care with symptoms suggesting prostate cancer are risk assessed, counselled and offered a PSA test. If considered appropriate they should be referred to a specialist centre.  
2 Diagnosis Men referred with suspected prostate cancer are offered the full range and access to the most up to date and clinically effective diagnostic technologies. Men with low-risk localised prostate cancer for whom radical prostatectomy or radical radiotherapy is suitable are also offered the option of active surveillance.

Men with intermediate‑ or high‑risk localised prostate cancer who are offered non-surgical radical treatment are offered radical radiotherapy and androgen deprivation therapy in combination.
3 Shared decision-making Men with prostate cancer have the opportunity to talk through all available treatment options and are provided with comprehensive information on the risks and benefits by members of their multi-disciplinary team (MDT) in order to make an informed decision. Men with prostate cancer have a discussion about treatment options and adverse effects with a named nurse specialist.
4 Access to treatment Men with prostate cancer (regardless of stage of disease) have access to their treatment of choice, including clinical trials if deemed clinically appropriate, regardless of geographical location. Men with hormone-relapsed metastatic prostate cancer have their treatment options discussed by the urological cancer multidisciplinary team.
5 Information and support Men with prostate cancer are provided with a written personalised care plan that is regularly reviewed by their assigned clinical nurse specialist. They are signposted or referred to support groups and specialist services that are appropriate to their stage of disease to manage their physical, emotional, psychological and sexual health.  
6 Access to other specialist care All men with prostate cancer (and where relevant their partner/carer) have access to specialists to support the prevention and management of their complications arising from their disease, whether physical, social, emotional or psychological, arising from the disease and its treatment. Men with adverse effects of prostate cancer treatment are referred to specialist services.
7 Supported self-management Men with prostate cancer receive guidance and a package of care to support self-management of the side effects from their treatment, if they wish to do so.  
8 Shared care Men living with prostate cancer benefit from an integrated and seamless approach to their care and wellbeing appropriate to their stage of disease for the rest of their lives. This will include clear accountability and responsibility across primary and secondary care.  
9 Non-curative care All men receive and benefit from non-curative care at the appropriate stage of their disease, which is not limited to end of life care or restricted to being associated with hospice care.