Incorporating the NICE Cambridge Prognostic Groups and Predict Prostate into a structured informed-decision making clinic reduces over-treatment rates of early prostate cancer.

Abstract

Abstract Introduction Over-treatment is a major burden in early prostate cancer management. We previously developed prognostic tools that provide unbiased estimates of survival and treatment benefit: (i) NICE Cambridge Prognostic Groups (CPG) and (ii) the Predict Prostate (PP) individualised prognostic webtool. Here we report the implementation impact of these assets on treatment choices by men with an early cancer diagnosis. Patients & Methods Multi-disciplinary team (MDT) discussions were updated in 2021 to incorporate CPG and with PP survival estimates calculated for CPG1&2 (early) cancers (Figure 1). MDT recommendations based on these were used in a structured counselling process in a dedicated new diagnosis clinic to counsel men. To measure impact, we compared treatment vs active surveillance selection by CPG1&2 men in post-implementation years 2023 and 2024 vs a cohort from 2018. Results Data from 205 men in 2018 (baseline), 161 in 2023 & 145 in 2024 were analysed. In 2018, 12.1% of CPG1 men selected treatment; in comparison this rate was 3.0% in 2023 and 5.9% in 2024 (Relative Risk Reductions [RRR] of 75.2% and 51.2% respectively). In 2018, 54.3% of CPG2 men opted for treatment vs 36.4% in 2023 and 35.5% in 2024 (RRR of 32.9% and 34.6% and 34.6 respectively). Conclusion A standardised counselling protocol incorporating unbiased, personalised prognostic and treatment benefit information significantly reduces rates of over-treatment in early prostate cancer.