After a great deal of confusion and what turned out to be an error on my part I wish to let you know that the NICE (The U.K.’s National Institute for Health and Care Excellence) Guidance I shared on the blog on January 28, 2014 ( ) about enzalutamide (Xtandi) was not accurate.

In my post I indicated that NICE had decided that Xtandi could not be used until a man had failed Zytiga, this was incorrect. The guidance in fact was that Xtandi shouldn’t be given to a man if he has had abiraterone (Zytiga), a different guidance and probably even more devastating to men with advanced prostate cancer.

You can read the full Guidance at: NICE Guidance

The good news is that this is not yet a permanent guidance. NICE is still soliciting opinions and I urge you to reply to this guidance by going to REPLY TO NICE. There is no evidence that Xtandi does not work after Zytiga has failed. Men with advanced prostate cancer should not have a proven medications withheld from them for what seems to be economic reasons.

NICE’s decision to withhold Xtandi after Zytiga failure is not evidence based. If the lack of studies is to be considered evidence then on the same logic NICE should not permit men to have Jevtana (cabazitaxel) after Zytiga or chemotherapy after Zytiga because there is no evidence that this protocol is effective. Clearly, these restrictions make no sense, neither does this horrific possible guidance of no Xtandi after Zytiga.

So, where is the difference? What is really going on?

Joel T. Nowak, M.A., M.S.W.