Prostate Scotland expresses disappointment regarding NCMAG decision on Abiraterone for non-metastatic hormone sensitive prostate cancer
Prostate Scotland, Scotland’s prostate disease charity, expressed its disappointment and surprise at the National Cancer Medicines Advisory Council’s decision not to approve Abiraterone to be available on the NHS in Scotland for the treatment of high risk non-metastatic hormone sensitive prostate cancer.
‘We are disappointed and surprised by this decision given the research evidence showing abiraterone’s benefits for men in this situation, which has been shown to have significantly longer metastasis free survival over standard care, as well as longer overall survival. This was accepted by the Council – who were satisfied that the case for the clinical effectiveness of abiraterone for this indication had been made.
It is also disappointing and surprising in that the European Association of Urology Guidelines[i] recommend its use for this indication. Whilst we appreciate the need to consider the economic case – the decision seems particularly surprising in view of abiraterone being available on the NHS in Scotland for several other prostate cancer indications. In view of this, we urge NCMAG to review the position as soon as possible and not wait until a later date – so that the benefits of this medicine for men with non-metastatic hormone sensitive prostate cancer can be made available on the NHS in Scotland for eligible men and they do not have to wait to access this medicine which may help slow the progression of their cancer and potentially make a difference for men where their cancer has not spread.
‘Men with non-metastatic hormone sensitive metastatic prostate cancer can face an uncertain future – as to whether or when their cancer could spread. Being able to delay the spread of their cancer for as long as possible is very important. Research has shown that treatment with abiraterone for men with non-metastatic prostate cancer which is sensitive to hormone treatment can lead to a delay in metastasis and potentially lead to an improvement in overall survival by comparison to standard hormone therapy alone. The availability of abiraterone for men with non-metastatic hormone sensitive prostate cancer offers a potential delay in the progression of their cancer’.
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For further information please contact Prostate Scotland at info@prostatescotland.org.uk or 0131 603 8660
In many cases where the prostate cancer has not spread, men will be offered surgery or radiotherapy treatments, with a curative intent. Where the cancer has not yet spread and is locally advanced and still sensitive to hormone treatment it is called non-metastatic hormone sensitive prostate cancer and men will usually be offered hormone treatment/ Androgen Deprivation Treatment (ADT) and radiotherapy to halt the growth of the cancer cells and to try to slow/ halt the cancer from spreading. Men, where the cancer has spread will usually also be offered hormone treatment/ Androgen Deprivation Treatment (ADT) to halt the growth of the cancer cells. Where the prostate cancer is still sensitive to hormone treatment it is known as mHSPC. Often men at this stage will be offered abiraterone with prednisone (where they are at high risk of progression), or chemotherapy or Enzalutamide, in addition to ADT. The aim of treatment at this point is to continue to stop the cancer progressing to becoming hormone/castrate resistant. In some men after a period of time the cancer cells may adapt to or get used to lower levels of androgen, which fuels the cancer and start to grow again – this is known as castrate resistant prostate cancer.
The recent STAMPEDE trial results showed that when Abiraterone is prescribed earlier to those men with hormone sensitive, non-metastatic prostate cancer there is a reduced risk of them developing metastasis and an increased survival rate when compared with being on hormone therapy alone. 6-year metastasis-free survival was 82% in those receiving Abiraterone and androgen deprivation therapy (ADT) and 69% in the group receiving ADT alone. In terms of overall survival 6-year survival improved from 77% for those receiving ADT to 86% those receiving in the combination-therapy[i]
Prostate cancer is the most common cancer amongst men in Scotland, with a lifetime chance of one in ten men developing it[[ii]]. There were over 37,009 new registrations of men with prostate cancer between 2008 and 2018 and 9,782 deaths of men in Scotland from prostate cancer during that period.[iii]. The most recent figures for Scotland prior to the pandemic show that 4066 men in Scotland were diagnosed with prostate cancer in 2019 and in 2020 3394 were diagnosed. 1038 men died from prostate cancer in 2020 [[iv]]. Survival rates amongst men with prostate cancer have encouragingly doubled over the past two decades with 84% of men with prostate cancer now surviving it[[v]]. Projections by the NHS show that the diagnosis of men with prostate cancer is likely to rise by up to 35% over the decade to 2027[[vi]].
Prostate Scotland is a registered Scottish charity no SC037494. It was set up in 2006 as a Scottish charity to develop awareness of prostate disease, to support men and their families/ partners with the disease through providing advice and information and to advance treatment and research into prostate disease. Its aim is to reach out across Scotland to create greater awareness amongst men and their families/partners about prostate disease and to advance treatment. It has established an award winning website www.prostatescotland.org.uk providing a wide range of information about prostate disease and treatments, as well as providing information and advice about prostate disease to men and their families across Scotland. In 2010 the charity won a national award for its impact on community health and in 2013 and 2015 was commended in the British Medical Association Patient information Awards, and in 2017 was awarded Scottish health charity of the year.
[i] Mottet N, van den Bergh RC, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79(2):243-62. And also https://uroweb.org/guidelines/prostate-cancer