Quality standard
Quality statement 3: Combination therapy
Quality statement 3: Combination therapy
Quality statement
People with Cambridge Prognostic Group (CPG) 2, 3, 4 and 5 localised or locally advanced prostate cancer who are offered non‑surgical radical treatment are offered radical radiotherapy and androgen deprivation therapy in combination.
Rationale
Androgen deprivation therapy and radiotherapy are 2 of the treatment options available for people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer. Combining androgen deprivation therapy with radical radiotherapy can increase the effectiveness of treatment and the chances of survival compared with either androgen deprivation therapy or radical radiotherapy alone.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer who are offered non‑surgical radical treatment are offered radical radiotherapy and androgen deprivation therapy in combination.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records or service protocols.
Process
Proportion of people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer receiving non‑surgical radical treatment, who receive radical radiotherapy and androgen deprivation therapy in combination.
Numerator – the number in the denominator who received radical radiotherapy and androgen deprivation therapy in combination.
Denominator – the number of people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer receiving non‑surgical radical treatment.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (such as hospitals, specialised urological cancer multidisciplinary teams and specialised prostate cancer services) ensure that healthcare professionals know that radical radiotherapy and androgen deprivation therapy should be used in combination for people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer.
Healthcare professionals ensure that people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer who are offered non‑surgical radical treatment receive radical radiotherapy and androgen deprivation therapy in combination.
Commissioners (such as integrated care systems, clinical commissioning groups and NHS England) monitor whether people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer offered non‑surgical radical treatment are offered radical radiotherapy and androgen deprivation therapy in combination. Commissioners may wish to ask providers for evidence of practice.
People whose cancer has not spread outside the prostate, or has spread just outside the prostate, and has been assigned a risk category of CPG 2, 3, 4 or 5 are offered radiation treatment to destroy the cancer cells (called radiotherapy) combined with a drug that blocks the production of androgen, a hormone that helps cancer cells to grow, (called androgen deprivation therapy). Having radiotherapy together with androgen deprivation therapy usually works better than having just one of these treatments on its own.
Source guidance
Prostate cancer: diagnosis and management. NICE guideline NG131 (2021), recommendation 1.3.21
Definitions of terms used in this quality statement
Androgen deprivation therapy
Treatment with a luteinising hormone‑releasing hormone agonist such as goserelin to lower testosterone levels. [Adapted from NICE's 2014 full guideline on prostate cancer]
Cambridge Prognostic Group (CPG) 2 to 5
|
CPG |
Criteria |
|---|---|
|
2 |
Gleason score 3 + 4 = 7 (grade group 2) or PSA 10 microgram/litre to 20 microgram/litre and Stages T1–T2 |
|
3 |
Gleason score 3 + 4 = 7 (grade group 2) and PSA 10 microgram/litre to 20 microgram/litre and Stages T1–T2 or Gleason 4 + 3 = 7 (grade group 3) and Stages T1–T2 |
|
4 |
One of: Gleason score 8 (grade group 4), PSA more than 20 microgram/litre, Stage T3 |
|
5 |
Two or more of: Gleason score 8 (grade group 4), PSA more than 20 microgram/litre, Stage T3 or Gleason score 9 to 10 (grade group 5) or Stage T4 |
[NICE's guideline on prostate cancer, table 1]
Locally advanced prostate cancer
For the purposes of this quality standard, this includes T3 and T4 prostate cancer. [NICE's guideline on prostate cancer, terms used in this guideline]
Localised prostate cancer
Cancer that has been staged as T1 or T2 (confined to the prostate gland). [NICE's guideline on prostate cancer, terms used in this guideline]
Radical radiotherapy
Radiation, usually X‑rays or gamma rays, used to destroy tumour cells by external beam radiotherapy or brachytherapy. [NICE's 2014 full guideline on prostate cancer]
Equality and diversity considerations
Some older people may have previously been offered androgen deprivation therapy alone. Focusing on the benefits of combination therapy for older people with CPG 2, 3, 4 and 5 localised or locally advanced prostate cancer should help to reduce such inequalities.
People who are gay, bisexual or transgender have a risk of developing prostate cancer. Healthcare professionals should be aware of their psychosexual needs, lifestyle and the impact of different treatment options.