Diagnosis     Back to top

Men find out that they have prostate cancer in a wide variety of ways. Following a diagnosis of prostate cancer your General Practitioner (GP) and specialist hospital team can provide you with more information about prostate cancer treatment options.

Family Doctor/GP referrals

Men concerned about the risk of prostate cancer because of their age, race and family history of prostate cancer sometimes decide for themselves that they want to have a prostate specific antigen (PSA) blood test and rectal examination in order to find out if they have prostate problems (see Prostate Cancer Risk Management programme www.cancerscreening.nhs.uk/prostate/pcrm-aim.html). Sometimes a doctor may suggest these tests based on a man reporting certain symptoms. If your family doctor (GP) identifies a potential prostate problem because PSA test results are higher than expected or the rectal examination shows the prostate gland is enlarged they will typically refer you to a hospital specialist team (urologist, oncologist and specialist nurse) for further tests.

The specialist team will usually want to obtain prostate biopsies. This is because a definite diagnosis of prostate cancer can only be made by taking cells from the prostate gland and then looking at them under a microscope. Small amounts of the tissue that makes up the prostate gland are taken from any suspicious areas. Some tissue will be removed from different parts of the prostate to make sure they don't miss any areas of cancer. The result of the biopsies will help confirm the type, grade (Gleason Score) and stage (T1-T4) of the cancer, all of which are important to know before deciding how to treat the cancer.

If your disease is low risk then you may also be offered 'active surveillance' or 'watchful waiting', which means that you will be tested regularly and monitored to see if your cancer starts to grow, or grow more quickly.

Depending on the type, grade and stage of the cancer, the specialist team will discuss with you when to treat it, and if so, the best options for treatment. If your cancer is localised and is of low to intermediate risk the treatment options include radical prostatectomy (surgery), external beam radiation and LDR brachytherapy (seed implantation) (Click here to view the treatment selector chart). While studies have shown that each of these treatments is equally effective at curing the cancer, they do have important differences with regard to their impact on quality of life and disruption of normal routine that should be carefully considered Your doctor and specialist nurse should be able to answer your questions (also see Is LDR brachytherapy right for me). You can also contact other groups such as the Prostate Cancer Charity which has a nurse helpline (0800 074 8383) and the Prostate Brachytherapy Advisory Group.

If you decide that LDR brachytherapy is the right choice for you, then you should ask your GP and/or specialist team to refer you to a hospital which performs this procedure. Brachytherapy can only be done in a hospital which has a Radiotherapy Department because it requires special equipment and the hospital must be able to handle radioactive material. There are approximately 25-30 radiotherapy centres that carry out the procedure throughout the UK and a varying numbers of centres in other countries. Please click on the attached link to find the centre in the UK closest to you and to access more information on LDR brachytherapy provided by the centre itself.

Referral     Back to top

Referral to a radiotherapy centre performing LDR brachytherapy

At each centre in the UK you will be able to be treated as an NHS or private patient.

NHS Care

Through the NHS ‘Choose and Book’ service you have the right to decide which hospital you would like to be treated at even if this is in a different area of the country. You should discuss this fully with your GP. Please see the attached link for more information and commonly asked questions and how to use the ‘Choose and Book’ system to make an appointment with the hospital of your choice.

http://www.chooseandbook.nhs.uk/patients/choose

Although the NHS 'Choose and Book' service helps patients make appointments, it is the 152 Primary Care Trusts (PCTs) covering all parts of England that are responsible for delivering health care to their local areas. Similar groups exist in Wales, Scotland, Northern Ireland and Éire.

PCTs receive budgets directly from the government (Department of Health) and then make decisions about which types of treatment they want to fund. You may have seen reports in the newspaper and on television about instances where patients in a certain area have been denied access to a particular treatment because of lack of PCT funding; the so called 'postcode lottery'.

PCTs typically follow the direction of the government with regard to funding decisions, for example, guidelines will often come from the Department of Health (DoH) and the National Institute of Health and Clinical Excellence (NICE). The DoH and NICE have both published advice and guidance in support of LDR brachytherapy for the treatment of men with low and intermediate risk prostate cancer. To view the DoH and NICE documents, visit the Brachytherapy Guidance and Guidelines section, in the PCT section of the main site

The majority of the PCTs in the UK have made the decision to fund LDR brachytherapy based on the significant evidence that exists and they are often happy to pay travel-related expenses for patients to attend a radiotherapy centre that is not close to their home.

There are a smaller number of instances where funding decisions are made on a case by case basis. A few PCTs claim they do not fund the procedure. When the referral request to an LDR brachytherapy centre is submitted by your GP or hospital specialist team, issues about funding may come to light. See below about what to do if your PCT denies funding for your procedure.

Private Care

If you want to be treated privately you should contact your private health insurance company, e.g. BUPA, and follow their procedure for referral to an LDR brachytherapy centre for treatment. Again, you will have a good amount of choice as to which centre you can attend. It is unlikely that you will experience any LDR brachytherapy funding issues with private insurers.

Funding     Back to top

What to do if your PCT denies funding for LDR

If your local PCT decides that it will not pay for your LDR brachytherapy it will inform your GP or specialist hospital team. When you are advised of the PCT decision you should discuss with your GP or hospital team what your next step should be. It is often possible to ask the PCT to reconsider their refusal.

PCTs sometimes issue 'blanket' refusals for certain treatments and wait for a case to be re-submitted before considering funding on an individual basis. Typically the best way to get your PCT to reconsider is for your GP or a hospital specialist to put your case again for treatment based on your individual needs.

GPs and hospital specialists are very used to this submission process and they will be able to guide the collecting together of all the relevant information (and answer any questions) the PCT will require to grant approval. Often this re-submission from the doctor involved will be successful.

If your PCT continues to refuse payment you should first ask them why they are refusing funding. All PCTs must have a clear policy on funding decisions and also have an appeals process in place, this can be requested from the PCT and they have a duty to provide it.

This information is available to you under the Freedom of Information Act 2000. Information about where to contact your local PCT can be found through the NHS website (http://www.nhs.uk/ServiceDirectories/Pages/AcuteTrustListing.aspx). You then have several options open to you:

1. Discuss the matter with your local MP and ask them to intervene with the PCT directly
2. Contact the local media as the 'postcode lottery' is a very newsworthy topic and this may cause the PCT to change its mind
3. Consider having LDR brachytherapy carried out privately

Irrespective of the route you choose the Prostate Brachytherapy Advisory Group welcomes hearing from you and will provide support in any way it can. Contact us.