Live in the UK and have advanced prostate cancer? If you do then be prepared to have economics over-ride your legitimate health concerns.

The U.K.’s National Institute for Health and Care Excellence (NICE) makes no bones about what is more important, money or men’s health. NICE initially did not approve Zytiga, however when Johnson & Johnson offered to sell it at an additional discount they changed their tune and agreed that it was a good treatment for men who had castrate resistant prostate cancer.

Now, Zytiga’s rival, a much more costly drug, Xtandi has been the subject of a NICE change of heart. Initially they indicated that they would pay for Xtandi, but now they have reversed their decision.

Last Monday NICE issued a second draft guidance recommending Xtandi (enzalutamide) be covered in cases where hormone-relapsed metastatic prostate cancer has progressed after failing chemotherapy with docetaxel. However, the man must have been treated with Zytiga (abiraterone). This is a revision on prior guidance, which recommended that the National Health Service cover the drug in patients whose disease has progressed during or after one docetaxel-containing chemo regimen.

“Today’s announcement from NICE represents a major setback for many prostate cancer patients who would otherwise be eligible for treatment with enzalutamide according to the original draft guidance and licensed indication,” said Astellas UK Medical Director Dr. Alan McDougall.

So why has Nice had a the sudden change of heart?

NICE claims the change is due to a dearth of data. Xtandi trial data includes men whose disease progressed during or after docetaxel treatment, but none of those men’s had received Zytiga–a fact NICE felt it should highlight. “The Committee was not able to draw any conclusions about the effectiveness of enzalutamide after previous abiraterone treatment and considered it important to reflect this in its recommendations,” it said in a statement.

According to what I hear things aren’t yet set in stone. The public, healthcare professionals and Astellas itself will have a chance to say their piece before NICE issues a final guidance. The good news is that angry nonprofits got a jump-start on the process Monday night.

“NICE is playing fast and loose with men with prostate cancer in the advanced stages of the disease who may become resistant to other treatments,” said Owen Sharp, Chief Executive at Prostate Cancer UK.

If you are a reader of this blog you will notice that this issue is no different than the step therapy issue I’ve written about in prior posts. In the UK the problem seems to be NICE, in the United States it is the private insurance companies. The bottom line is that men with advanced prostate cancer will continue to suffer and not have their lives extended even though we have the ability, the science and the drugs. We seem to be lacking the willingness!

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