For three years Rob Paterson put up with the symptoms of an enlarged prostate — with trips to the loo up to five times a night, leaving him exhausted during the day.
Medication didn’t really work and the 71-year-old former engineer from Cornwall was reluctant to undergo surgery to remove the enlarged prostate tissue as he worried about the potential side-effects, which can include impotence and incontinence.
This was, however, the only surgical option his GP mentioned.
But then he stumbled upon an article in the Daily Mail in November 2016 about a new minimally invasive procedure called UroLift.
Rather than removing tissue from the prostate, surgeons move the enlarged prostate tissue aside. This relieves symptoms and, as nearby tissue and nerves aren’t damaged, the procedure doesn’t carry the same potential for side-effects as traditional surgery.
A new £2 million Government initiative — the Accelerated Access Collaborative (AAC) — has been launched to speed up access to the most promising treatments and diagnostic tools that would benefit patients and save the NHS money
Rob, who lives with his wife Jillian, paid around £5,000 to have UroLift done privately in 2017 because it wasn’t available in his local hospital. He is delighted with the results.
‘I still need the loo twice a night but there are no ill-effects,’ he says. ‘I am out on the tractor, cutting logs, walking the dog and do 25,000 steps a day and feel great. More men should have access to this treatment.’
UroLift has been recommended by the National Institute for Health and Care Excellence (NICE), has been available on the NHS since 2014, and as many as a third of men with an enlarged prostate (or benign prostatic hyperplasia) needing surgery could benefit.
However, says Neil Barber, a consultant urologist at Frimley Park Hospital in Surrey, just 5 per cent of patients with an enlarged prostate who could benefit from UroLift, currently receive it.
In fact, UroLift is one of dozens of new treatments approved for use on the NHS yet still not being widely used. Cost, doctors’ reluctance to use new products, and a lack of awareness of the availability of the latest advances are all to blame.
But a new £2 million Government initiative — the Accelerated Access Collaborative (AAC) — has been launched to speed up access to the most promising treatments and diagnostic tools that would benefit patients and save the NHS money.
For example, while UroLift costs a similar amount to the standard surgery, it saves the NHS money because it can be done as a day case and has fewer complications.
The AAC also plans to educate doctors and make the referral and prescribing of new treatments easier by removing unnecessary red tape and financial barriers
Along with UroLift, other treatments that the AAC has highlighted include two new cholesterol-lowering drugs and advanced blood tests to look for signs of heart attack and bowel cancer. Together, they could improve the lives of 436,000 patients a year and save the NHS £30 million annually in England alone, it is claimed.
‘It takes far too long for novel techniques such as UroLift to spread throughout the NHS,’ says Lord Darzi of Denham, a surgeon and director of the Institute of Global Health Innovation at Imperial College London, who is chair of the AAC.
He is urging patients to ask their doctors about these new treatments: ‘Often patients hear about them first from newspaper articles, for example, so an important way to boost uptake is to make patients aware of the benefits so that they can ask their doctors if they are suitable candidates.’
The AAC also plans to educate doctors and make the referral and prescribing of new treatments easier by removing unnecessary red tape and financial barriers.
Here, we look at the seven treatments highlighted by the AAC as needing a greater take up by doctors and patients — all of them are innovations available on the NHS.
Experts assess the pros and cons — so you can decide whether new really is better.
ENLARGED PROSTATE
ASK ABOUT: uroLift
For an enlarged prostate, an extremely common condition that occurs with age, the standard last resort is surgery called transurethral resection of the prostate (TURP) to relieve symptoms such as problems passing urine.
While very effective, this operation can damage nerves and surrounding tissue, which may result in side-effects such as impotence and incontinence.
UroLift is a 25-minute technique that involves moving the enlarged prostate tissue aside rather than removing it. This tissue is anchored in position with tiny permanent implants to relieve pressure on the urethra and bladder.
The procedure has many benefits: a reduced hospital stay (patients can go home the same day compared with a two-night stay in hospital with traditional surgery), quicker recovery (one week compared with six) and fewer post-op complications, which the AAC calculates will save the NHS around £2 million a year in England alone.
However, ‘it is not an equivalent procedure to TURP and many urologists are not keen on it’, says Mr Barber. ‘With TURP, there is a 100 per cent improvement in urine flow and a 70 per cent improvement in symptom scores; compared with 50 per cent for both with UroLift.
‘But TURP comes with possible side-effects including sexual dysfunction. It’s a balance between the level of improvement you are likely to get and protection against side-effects.
‘But men need to be informed that there is another option.’
HEART ATTACK
ASK ABOUT: High sensitivity troponin tests
When patients arrive in A&E with chest pain, they are given a blood test to check for a protein called troponin that is released when the heart is damaged, such as following a heart attack.
However, the traditional test doesn’t give a reliable result until 12 hours after symptoms start, which ‘means patients have to be admitted to hospital, often unnecessarily’, says Steve Goodacre, a professor of emergency medicine in Sheffield. Two new high sensitivity troponin tests can rule out a suspected heart attack in two hours.
Dr Andrew Chapman, a clinical lecturer in cardiology at the University of Edinburgh, says: ‘This is exciting technology as the tests are inexpensive, can reduce patient anxiety by giving fast results, and reduce the length of time a patient is in hospital.
‘In future, they may be used as a screening test as every slight increase is predictive of a patient’s risk of future heart attack.’
But pick up has been slow, partly down to concerns about the tests.
‘Because they are so sensitive, they may over-diagnose heart disease and ignore other causes of chest pain such as infections or heart rhythm problems,’ says Professor Goodacre.
‘Diagnosing a heart attack requires experience. High sensitivity troponin tests help the professional but can’t replace them.’
BOWEL SYMPTOMS
ASK ABOUT: Faecal Immunochemical tests
For patients who go to their GP with vague symptoms that could indicate bowel cancer, such as abdominal pain, a faecal immunochemical test (FIT) should be used, says NICE.
There are three versions of these tests available — known as the OC Sensor, HM-JACKarc or FOB Gold test — and each uses special proteins to detect minute amounts of blood in a stool sample.
These tests could help GPs decide whether a patient should be referred for more urgent hospital tests such as a colonoscopy.
Before the introduction of FITs, patients who did not meet the criteria for an urgent referral often saw their GP multiple times before being sent for tests.
Yet a similar number of bowel cancer cases are diagnosed in this low-risk group as there are among high-risk patients, says Deborah Alsina, chief executive of the charity Bowel Cancer UK, and ‘this can lead to a delayed diagnosis and more advanced disease’.
The FIT tests are between 89 and 100 per cent accurate at detecting colorectal cancer and, according to BMC Medicine in 2017, using them can avoid colonoscopies.
The tests cost between £2 and £6 each and could save the NHS up to £9 million a year in England by identifying bowel cancer earlier when it is easier to treat.
Deborah Alsina adds: ‘As bowel cancer symptoms can be common and non-specific [for example, unexplained weight loss and abdominal pain without bleeding], they can be attributed to less serious conditions. There is an urgent need to better detect the disease and so the consistent use of FITs is important.’
However, a concern is that not all patients with colorectal cancer will have an abnormal FIT result.
BLOCKED ARTERIES
ASK ABOUT: HeartFlow
Narrowing of the arteries due to heart disease can lead to reduced blood flow to the heart — but not always.
Traditionally, this is determined during an angiogram, where a catheter (tube) is fed through to one of the arteries of the heart to examine it for narrowings — and then another wire is placed in the artery to measure the pressure within the vessel.
A doctor uses this result to decide whether surgery to insert metal tubes (called stents) to widen the arteries is needed. This diagnostic procedure is invasive and can damage the blood vessel.
However, a new computer program called HeartFlow can determine the severity of the blockage using CT scans of the heart. Patients are given a scan to determine where the blockages are, and these images are sent through a computer program that calculates how each blockage impacts blood flow to the heart. The doctor uses this information to determine what treatment a patient needs.
HeartFlow isn’t suitable for everyone; for example those who have stents or pacemakers as these can reduce the quality of a CT scan.
Adopting this technology could save the NHS in England £9 million by 2022 by avoiding invasive and unnecessary treatment with stents, according to NICE, which approved its use in 2017.
Dr Chapman says: ‘This non-invasive test could be used to identify patients who need a stent procedure to improve blood flow.
‘If an ongoing trial demonstrates this improves patient outcomes we could safely reduce the number of patients who have invasive procedures,’ he says.
PRE-ECLAMPSIA
ASK ABOUT: Placental growth factor test
Around one in 20 pregnancies is affected by pre-eclampsia, a problem with the development of the placenta that means a foetus may not be growing normally. If untreated, it can be fatal for both the mother and baby.
Diagnosing the condition can be difficult as signs such as high blood pressure and protein in the urine are common in pregnancy; while some cases are missed, other women with suspected pre-eclampsia may be unnecessarily admitted to hospital.
Two new simple blood tests can identify with 99 per cent accuracy which women are going to develop pre-eclampsia — even before they get symptoms. The tests measure placental growth factor — a protein involved in the development of new blood vessels in the placenta, which can be abnormally low in pre-eclampsia.
This can reassure most women that they’re not going to develop the condition and help avoid unnecessary tests, and allow greater monitoring of those who do. According to NICE, using it could save the NHS £7.3 million a year by 2021.
Andrew Shennan, a professor of obstetrics at King’s College London, says: ‘Sadly, this test is only being used by about half a dozen hospitals as many are reluctant to drop the old tests even though they are not as good. It costs around £70 but we have proved it saves the health service money. These savings may prove substantial in the future as it will prevent serious harm to babies.’
MULTIPLE SCLEROSIS
ASK ABOUT: Cladribine
Cladribine (brand name Mavenclad) can manage symptoms of multiple sclerosis (MS) — a neurological condition that causes blurred vision and movement problems.
Known as a disease-modifying therapy, cladribine is used to treat adults with a severe type of MS called highly active relapsing-remitting MS; it works by killing white blood cells made by the immune system, which in MS attack the nerves.
A treatment course costs up to £80,000 and involves patients taking the pill daily for a week, over two months; then again a year later. Research found relapses dropped by 58 per cent with cladribine compared with a dummy pill, reported the New England Journal of Medicine in 2010.
However, it can weaken the immune system as it attacks white blood cells.
It is estimated that it would save the NHS £3.2 million a year, according to the AAC.
Genevieve Edwards, director of external affairs at the charity MS Society, says: ‘Because it’s taken as a tablet, some people find this treatment easier to take than other disease-modifying therapies. However, it can have side-effects and won’t work for everyone.’