Patients in England denied lifesaving prostate cancer drug as funding dispute continues

NHS England has not approved routine funding for abiraterone for men with high‑risk, locally advanced prostate cancer, leaving some patients to pay privately for a drug clinicians and charities say can substantially reduce the risk of death.

Doctors, campaigners and trial investigators say clinical evidence supports adding two years of abiraterone to standard hormone therapy and radiotherapy for men whose cancer has not yet spread. Prostate Cancer UK and other campaigners estimate the delay in England’s decision has already cost more than 1,300 lives since 2023 and predicts about 13 additional deaths each week until policy changes are made.

Clinicians say the drug works by blocking androgen production not only in the testicles but also in the adrenal glands and within the tumour itself, closing a pathway that can allow aggressive cancers to survive standard hormone suppression. Professor Nick James, a clinical oncologist at The Royal Marsden Hospital in London and lead investigator on the long‑running Stampede trial, said adding abiraterone to standard therapy can reduce the risk of death by just over 40 percent for men with high‑risk disease that has not yet metastasised.

The Stampede trial, conducted by teams at the Institute of Cancer Research and The Royal Marsden and published in The Lancet in 2022 and 2023, enrolled thousands of men and helped inform decisions in other parts of the UK. Scotland and Wales moved to fund abiraterone for non‑metastatic, high‑risk prostate cancer after generic versions entered the market in 2022 and prices fell. NHS England, however, says routine commissioning awaits identification of “recurrent headroom in revenue budgets.”

The funding gap is driven in part by the drug becoming generic. When abiraterone was under patent a company would typically sponsor a formal appraisal by the National Institute for Health and Care Excellence (NICE). With no single commercial sponsor, the appraisal route has not been triggered and responsibility for funding the review sits with NHS England’s clinical priorities process, which has not allocated a sustainable year‑on‑year budget to expand access.

An NHS England spokesman said expanding access to abiraterone was identified as a top priority after a clinically led review in May 2024 and that the treatment can only be offered once recurrent funding is available. The spokesman noted that abiraterone continues to be routinely funded in England for several forms of advanced prostate cancer in line with existing NICE guidance.

Patients and clinicians describe a patchwork of routes that have arisen in response: private commissioning, self‑funding via private prescriptions, and treatment in devolved nations where NHS provision has already widened. Giles Turner, 65, of Sussex, who was diagnosed with high‑risk locally advanced prostate cancer in March 2023, researched abiraterone, began a private two‑year course in July 2023 alongside hormone therapy and radiotherapy, and by May 2025 had MRI scans showing no sign of cancer. He said he had spent about £20,000 on the drug, monitoring and tests.

Other men have faced much higher costs. Keith ter Braak, 82, a retired retail director from Somerset, said he moved to private care in London after his cancer returned in 2022 and has paid about £88,000 to date for treatment including abiraterone under a private provider. A spokesman for the private clinic said fees covered the British National Formulary list price and clinic costs and that a lower‑cost package was being finalised.

Professor James and campaigners point to the shifting price as further evidence that lack of timely NHS action is not primarily a cost problem. When abiraterone was patented a two‑year course cost the NHS around £68,000; generic prices have reduced the cost of an equivalent course to under £2,000. NHS England has estimated that widening eligibility could benefit another 8,400 men a year.

Campaigners say procedural obstacles have led to patients in England being treated differently despite the same underlying evidence base. Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said the delay in England’s decision was “costing hundreds of lives every year.” The Clinical Priorities Advisory Group, which advises on treatments to fund, ranked abiraterone as a high priority because of the health gains and low cost, but its report said it had not been possible to identify the necessary recurrent budget.

Clinicians also warn of unintended penalties for men who self‑fund. NHS England policy can block access to the same drug class if it has been given previously, which may prevent some men who paid privately from receiving a similar therapy later if their cancer relapses.

Long‑term individual cases cited by clinicians illustrate potential benefit. Tony Collier, 68, of Cheshire, was treated with abiraterone after a 2017 diagnosis with metastatic prostate cancer and went into remission; eight years later he remains active and credits the drug with changing his prognosis.

New research presented to the American Society of Clinical Oncology in May 2025 strengthened arguments for earlier use by identifying biomarkers that predict which men with high‑risk disease benefit most. Researchers at the Institute of Cancer Research and University College London used artificial intelligence to analyse tissue samples and found roughly one in four men with high‑risk disease fall into a subgroup for whom abiraterone reduced five‑year mortality from 17 percent to 9 percent.

Prostate cancer is the most common male cancer in the UK and ranges from indolent tumours that may not require treatment to aggressive forms at high risk of spread. Abiraterone is not recommended for routine use in low‑risk stage 1 or 2 disease because the harms and side effects, including raised blood pressure and the need for concurrent steroids, outweigh benefits for men whose cancer is usually curable with surgery or radiotherapy alone.

Ministers have signalled movement. In June, Karin Smyth, minister for secondary care, told MPs that advisers to NHS England support routine commissioning in principle and that financial modelling was being reviewed with Prostate Cancer UK. For now, patients in England face a postcode divide: abiraterone is routinely available in Scotland and Wales for earlier, high‑risk disease, while most men in England who are eligible must either pay privately, obtain a private prescription at market rates, or wait until their cancer advances to the stage already covered by existing NHS funding.

Clinicians, researchers and charities say the evidence and falling costs support routine funding in England and warn that continued delay will result in preventable deaths and potentially higher long‑term costs to the health service if more men progress to incurable disease.