Abiraterone shown to cut deaths in high‑risk prostate cancer faces funding barrier in England

NHS England has not approved routine funding for abiraterone to treat men with high‑risk prostate cancer that has not yet spread, even though clinical trials and independent health systems in Scotland and Wales support its use for this group. Campaigners and clinicians say the decision is leaving eligible patients in England to pay privately or miss out on a treatment shown to cut deaths significantly.

Patients directly affected say they have faced heavy personal costs to obtain the drug. Giles Turner, 65, a retired banker from Sussex, said he was advised by his consultant that abiraterone was not available on the NHS in England for his locally advanced, high‑risk prostate cancer. Turner paid about £20,000 for the medication, monitoring and tests after starting treatment in July 2023; an MRI in May 2025 showed no sign of cancer.

Abiraterone works by blocking production of male hormones not only in the testicles but also in the adrenal glands and within the tumour itself. Trials led by teams at the Institute of Cancer Research and The Royal Marsden Hospital, including the long‑running Stampede study, found that adding two years of abiraterone to standard hormone therapy and radiotherapy for men with high‑risk, non‑metastatic disease can reduce the risk of death by just over 40 percent. New research presented at the American Society of Clinical Oncology in May also reported that artificial intelligence can identify the subgroup most likely to benefit: for about one in four men with high‑risk disease, the five‑year risk of death fell from 17 percent to 9 percent when abiraterone was added.

Abiraterone is already routinely funded in England for several forms of advanced (stage 4) prostate cancer in line with NICE guidance, an NHS England spokesman said. But he told Good Health that expanding access for high‑risk non‑metastatic disease was identified as a top priority after a clinically led review in May 2024 and that the treatment can be offered only once the necessary recurrent funding is available. "This is being kept under active review," the spokesman added.

Prostate Cancer UK, among the charities pressing for immediate action, said the delay in widening access has already cost lives. The charity estimates more than 1,300 deaths since 2023 and projects that, without a change in policy, about 13 more men will die each week. "A blockage is costing hundreds of lives every year — this situation cannot continue," Amy Rylance, assistant director of health improvement at Prostate Cancer UK, told Good Health.

The funding impasse is not primarily a price argument, campaigners say. When abiraterone was under patent, a two‑year course cost about £68,000 and was rejected by NICE on cost grounds. The drug went off patent in 2022 and generic versions have driven the price down substantially: NHS list figures show a pack price around £66, bringing a two‑year course to under £2,000. However, because no company now owns the branded product, there is no commercial sponsor to request a new appraisal from the National Institute for Health and Care Excellence (NICE). That has left responsibility for funding the drug in these earlier cases to NHS England's clinical priorities process, which has not yet identified a sustainable recurrent budget.

The Clinical Priorities Advisory Group, which advises NHS England, ranked abiraterone among treatments that offer the greatest health gains for the lowest cost to the NHS. Nevertheless, its report said it was "not possible to identify the necessary recurrent headroom in revenue budgets." NHS England has estimated that widening the criteria could benefit another 8,400 men a year, according to correspondence seen by campaigners.

Clinicians argue that earlier treatment with abiraterone could also reduce later costs. "We could stop men ever needing palliative treatment for metastatic disease if we gave abiraterone at the right time," said Professor Nick James, a clinical oncologist at The Royal Marsden Hospital and a lead on the Stampede trial. He said it was "one of the most effective interventions we've ever had in prostate cancer" and called the delay between evidence and routine NHS commissioning "mystifying."

The different approaches across the UK have created what clinicians describe as a postcode lottery. Scotland and Wales moved quickly to extend routine access once the drug became generic, deciding that the clinical and cost effectiveness justified offering abiraterone to men whose cancer had not yet spread. In England, patients who can afford to do so may obtain the drug through private care or by self‑funding a private prescription, but costs and access vary widely.

Tony Collier, 68, of Cheshire, was diagnosed with metastatic prostate cancer in 2017 and received abiraterone under NHS funding for stage 4 disease, which he credits with putting him into long‑term remission. By contrast, Keith ter Braak, 82, of Somerset, who developed locally advanced disease after initial NHS treatment, moved to private care and says he has spent about £88,000 to access abiraterone because of what he described as high private provider fees. A spokesman for the private provider Lloyds Clinical said their fee covers the British National Formulary list price and other costs such as monitoring, clinic time and delivery, and said a lower‑cost package was close to finalisation.

Professor James and others also warn of clinical disadvantages to private, piecemeal access. NHS England guidance can bar patients from receiving the same class of drug again on the NHS if they received it previously privately, potentially leaving men who relapse without access to a proven therapy when it might be most needed.

There have been signs of movement. Karin Smyth, minister for secondary care, told MPs in June that NHS England's advisers support routine commissioning in principle and that financial modelling was being reviewed with Prostate Cancer UK. But campaigners, clinicians and patients say the timeline for a final decision and the allocation of recurrent funding remain unclear.

The impasse exposes tensions between clinical evidence, regulatory pathways and funding mechanisms for off‑patent medicines. As the debate continues, clinicians stress the time‑sensitive nature of the decision: men with high‑risk, non‑metastatic prostate cancer are in a narrow window where treatment can avert progression to incurable disease. Delays in commissioning, they say, risk converting potentially curable cases into life‑limiting disease and shifting future costs to palliative care.

NHS England and the Department of Health did not provide further detail on when recurrent funding might be identified. Prostate Cancer UK has called for an immediate allocation to allow routine access in line with the clinical evidence and the practice in Scotland and Wales. Clinicians said that, until a policy change is enacted, men across England face unequal access to an intervention that trials and experts describe as capable of substantially improving survival in high‑risk prostate cancer.