Androgens - CHOice of Intermittent vs Continual– Prostate Cancer (A CHOICe-PC)
Student: Nafees Din
Supervisor: Professor Clare Wilkinson
Location: Bangor University
Cancer type: Prostate
Start and end date: Oct 2015 – March 2019
Prostate cancer is common and increasing; 830,000 men will be living with prostate cancer in the UK by 2020. Androgen deprivation, which means stopping the male hormones, is something most men have at some point as a treatment.
Side effects are very common and troublesome. These include hot flushes (80% of men), sexual dysfunction (90%), fatigue (43%), anaemia (90%), thinning bones (20% increase in fracture), and increased chances of diabetes, heart disease, memory loss and depression.
Offers of treatment breaks are now recommended for about one in ten prostate cancer sufferers (defined by NICE in the UK). This allows men’s natural hormones to recover for a while; giving them better quality of life.
Extensive research has checked whether such treatment breaks increase the risk of the prostate cancer coming back (5 systematic reviews). A further detailed analysis of over 4000 men showed that taking treatment breaks with careful monitoring is as good at keeping cancer in check as continual treatment. Therefore, NICE recommends that men, for whom this is considered a safe option, should be given a choice of ‘intermittent’ hormone deprivation.
It appears that men may not yet be given this choice consistently; but even this is not known. Older men are reluctant to complain; oncologists and surgeons need to focus on reducing cancer risk, and more men are being followed up by their own GP practice, where more education is needed to support men well.
This PhD study will do three things:
- Summarise the broader literature on quality of life related to hormone deprivation breaks
- Find out more about whether men want and value a choice about treatment breaks
- Study the normal practices of the health professionals involved; and aim to gain UK consensus. These studies could underpin a trial of patient choice, possibly leading to a decision aid in the future.