Abiraterone made available on NHS Scotland for low-risk hormone sensitive metastatic prostate cancer patients

28 July 2023

Prostate Scotland welcomes NCMAG acceptance of Abiraterone for low-risk hormone sensitive metastatic prostate cancer patients on NHS Scotland who are not suitable for currently accessible on-label alternatives.

Prostate Scotland, Scotland’s prostate disease charity, very much welcomes the decision of the National Cancer Medicines Advisory Group to approve Abiraterone to be available on the NHS in Scotland for the treatment of low-risk hormone sensitive metastatic prostate cancer for patients who are not suitable for currently accessible on-label alternatives.

‘This is a very positive and welcome decision and will potentially make a real difference for those men with prostate cancer where their cancer has spread but is low-risk and still sensitive to hormone treatment, but where they are not suitable for currently available alternative  treatments.  The availability of abiraterone for men with low-risk hormone sensitive metastatic Prostate cancer, who are not suitable for alternatives, could improve the quality of their lives and the chances of progression free survival or delay the progression of their cancer’.

‘Men with hormone sensitive metastatic prostate cancer can face an uncertain future as to whether their cancer will continue to respond to hormone treatment, or progress to becoming hormone resistant. Being able to maintain quality of life through keeping the period of hormone sensitivity as long as possible is very important. The decision by the NCMAG to approve the availability of abiraterone on the NHS in Scotland for low-risk hormone sensitive metastatic prostate cancer where patients are not suitable for the currently available alternative medicines is therefore very helpful and very much to be welcomed’.

Research evidence from the STAMPEDE trial suggests that abiraterone for low-risk hormone sensitive metastatic prostate cancer can have benefits. In the study men with low-risk disease receiving hormone therapy (androgen deprivation therapy) and abiraterone and prednisolone had significantly improved overall survival and Failure Free Survival compared to men receiving hormone therapy alone[i]

Men with prostate cancer in Scotland that we consulted felt strongly that the availability of abiraterone for men with low-risk metastatic hormone sensitive prostate cancer in Scotland would be helpful and it should be made available on the NHS in Scotland.

Prostate cancer is an important issue in Scotland; it is the most common cancer in men in Scotland, with a lifetime risk of one in ten. We are pleased that there have been advances in treatment over the past few years, but there is still a need for further progress.

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Notes to Editors
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. Men where the cancer has spread will usually 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. More recently many men may also be offered novel hormone therapies. 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.

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. 1066 men died from prostate cancer in 2021[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] See Hoyle A et al European Urology Volume 76, Issue 6, December 2019, Pages 719-728 also Jayazeri et al and Hormonal Intensification Should Start at the Low-risk Stage in Metastatic Prostate Cancer – European Urology Open Science Volume 45, November 2022, Pages 38-40 European Urology Open Science . Also K. Fizazi, N. Tran, L. Fein, et al. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer N Engl J Med, 377 (2017), pp. 352-360

The STAMPEDE Trial found that men with low-risk disease receiving hormone therapy (androgen deprivation therapy) and abiraterone and prednisolone had significantly improved overall survival compared to men receiving hormone therapy alone (83% for those on abiraterone and ADT over 3 years compared with 78% on ADT alone) and Failure Free Survival (44% improvement of abiraterone and ADT as compared with ADT alone over a 3 year period).

[ii] See Cancer Incidence in Scotland 2018 Public Health Scotland April 2020 pp21

[iii] See Cancer Incidence in Scotland 2018 Public Health Scotland April 2020, Cancer mortality in Scotland 2018 Public Health Scotland October 2019

[iv] See Cancer in Scotland Public Health Scotland April 2020 and Scottish cancer registry Cancer mortality in Scotland 2018 Public Health Scotland October 2019 p8 and ISD Cancer in Scotland April 2019 Information Services Division, NHS National Services Scotland and PHS Scotland April 2020 and 20221 and Cancer Mortality in Scotland 2021 -PHS Scotland 2022

[v] Cancer in Scotland: ISD, NHS National Services Scotland, October 2018 pp 16-2

[vi] See Scottish Cancer Registry May 2016 and Cancer Incidence in Scotland (2014), and Information Services Division NHS National Services Scotland November 2015