Annex 1
Case Study
THE DETECTION AND TREATMENT OF PROSTATE CANCER
1. Prostate cancer is the second most prevalent
form of cancer in men. Around one in 12 men in the UK will develop
the disease which, like many cancers, will have high survival
rates if the disease is detected and treated at an early stage.
Regrettably, in the UK, detection is often not until the later
stages and, accordingly, some 10,000 deaths per annum are attributed
to prostate cancer.
2. In countries such as the USA and Canada,
where there is more emphasis upon the early detection of prostate
cancer, the morbidity rate is proportionately substantially less.
Both countries have more prevalent screening for the cancer which
is by means of regular testing of the at risk population. A relatively
simple blood test is conducted which, over a period of time, monitors
the amount of Prostate Specific Antigen in the blood. Growing
levels of PSA are a good indication of the onset of prostate cancer
and when detected, urologists can conduct further examinations
to determine the presence and extent of cancer and take appropriate
action. This is usually in the earlier stage of the disease's
development when treatment success rates can be as high as 85
per cent of patients surviving disease free for at least ten years.
3. There are a number of treatment options
available for the cancer. The current "gold standard"
is radical prostectomy—the surgical removal of the gland.
Radiation treatment by external beam therapy is also common. Both
techniques carry the risk of undesirable side effects—incontinence,
impotence and discomfort for the patient which clearly lowers
the patient's quality of life and costs healthcare providers more
money to treat over a prolonged period. Both options also involve
extensive time in hospital either for surgery, taking up bed space,
or with repeated visits to radiology departments over several
weeks for external beam therapy.
4. A further option is that of brachytherapy.
This involves the implant of radioactivity directly into the prostate
gland which irradiates the cancer from within. This technique
has several advantages over other methods, notably it has much
less incidence of side-effects and can be performed with only
a one night hospital stay or even on an out-patient basis as the
technique does not involve surgery. Instead, 80 to 100 tiny seeds
of radioactive material are placed, under local anaesthetic, into
the gland using a needle-like device. Once implanted into the
prostate the radioactivity, which is tailored precisely to the
amount required to treat the individual patient's cancer, irradiates
the cancer from within over a period of months. The seeds are
not removed from the patient and they cause no problem to him.
5. Nycomed Amersham has been amongst the
pioneers of providing this technique across the globe. Around
30 per cent of all prostate cancers in the USA are now treated
by brachytherapy and of the 40,000 OncoSeedsTM produced each week
by the company in the UK, around 90 per cent are destined for
patients in North America. In the UK, only about 400 patients
in total have been treated with OncoSeedsTM in the past two years
and the technique is still not readily available.
6. With its inherent advantages over surgery,
it is right to query why so few patients have been treated with
brachytherapy in the UK. The first problem has been that the technique
is relatively new and requires considerable skill and training
for urologists or radiologists to conduct implants. Nycomed Amersham
has been helping to achieve this by inviting USA experts to Europe
to demonstrate the technique and train clinicians at key centres
in the UK. There are now about a dozen centres in the UK which
can offer brachytherapy and the next challenge is to increase
GPs awareness of the technique as a treatment option. This is
now occurring faster as patients become more aware of the technique
through prostate cancer charities and support groups which promote
their work using the internet.
7. The second important problem to overcome
is the poor record of early detection of prostate cancers in the
UK. By the time it is diagnosed, for many men the disease has
progressed beyond successful treatment by any method. This simply
is a preventable waste of life as routine PSA testing could identify
many cancers before they reach a life threatening stage. In the
UK, only 35 to 40 per cent of prostate cancers are detected at
an early stage, compared to 65 to 70 per cent in the USA. Trials
in Canada showed that screening resulted in a five fold reduction
in deaths from prostate cancer and that close to 100 per cent
of cancers diagnosed at an early stage were curable.
8. We would urge the Government to consider
the full benefits in terms of avoided treatment costs and increased
life expectancy from diagnosing prostate cancer earlier and treating
it using proven techniques, including brachytherapy. In the same
way, that the cost benefits of providing mass routing screening
for cervical cancer have been shown, the same case could be made
for PSA testing for prostate cancer.
9. Finally, as new technology emerges, it
is likely that within a few years there will be a genetic screening
test available for the predisposition of prostate cancer. This
will provide the ability to either treat the patient with new
genetically based drugs which could alter the relevant protein
structure which causes the cancer, or at least alert the patient
to be regularly screened in later life using conventional methods
to determine when the disease begins to take effect and at which
point treatment could be administered with excellent prospects
of success.
10. Nycomed Amersham would be pleased to
provide further information on its OncoSeedsTM radiopharmaceuticals
and RAPIDStrandTM delivery system for the Seeds to the Committee.
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