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Palliative Treatment Of Advanced Prostate Cancer

Where Will I Be Cared For

What is Palliative Care An Introduction for Patients and their Families

You may have thought about where you would prefer to be cared for towards the end of your life and where youd prefer to die. This might change over time. For example, you may prefer to be cared for at home and then go to a hospice in your final days when you need more support.

Places you can be cared for may include:

  • a hospital
  • a family member or friends home
  • a nursing home
  • a residential home.

When deciding where you would prefer to be cared for, you should try to think about whats important to you. You might want to think about:

  • your physical and personal needs
  • how any pain can be managed
  • whether a family member or friend could help look after you
  • who can help you during the day, in the evenings and at weekends
  • how easy it is for your loved ones to visit and when they can visit
  • being in a calm and peaceful environment
  • the needs and preferences of your family and friends.

You might not be able to choose where youre cared for or where youll die. This can be upsetting for you and your family. But certain physical and personal needs can be managed better in some places than in others. For example, some men need medicines or care that cant be given at home. And some men die in hospital before theyre able to go home. It might also depend on the services available in your area. If you or your loved one live in a nursing home you may need to ask what services they provide as this can vary to help you work out if your needs can be met.

Getting help at home

Hospice care

Metastatic Spinal Cord Compression

Metastatic spinal cord compression is a potentially debilitating consequence of cancer that affects approximately 10% of patients. It is most often due to vertebral column metastases invading the epidural space. With prolonged compression, infarction of the cord can cause permanent paralysis, depending on the region of the cord involved. MSCC is more commonly seen in prostate cancer patients than in those who have cancer at other disease sites, as a result of the high percentage of prostate cancer bone metastases involving the vertebral column, purportedly from spread via the Batson plexus. For many years, the mainstays of treatment were the prompt initiation of corticosteroids, to reduce edema, and EBRT . However, in highly selected patients who were surgical candidates, surgery in addition to radiation improved the ability to walk, both for patients who were ambulatory prior to treatment and for patients who were non-ambulatory . Moreover, patients treated with upfront surgery had longer overall survival and improved continence.

Bone Protection In Patients Receiving Androgen Blockade

Two drugs, the bisphosphonate zoledronic acid and the RANKL inhibitor denosumab, have been approved to treat osteoporosis secondary to androgen deprivation. Zoledronic acid is administered as an intravenous infusion. Denosumab is administered subcutaneously. These drugs are given along with supplemental vitamin D and calcium. Patients should be monitored regularly for hypocalcemia. Both agents are associated with a low incidence of osteonecrosis of the jaw. Both drugs delay the risk of skeletally-related events by relieving bone pain, preventing fractures, decreasing the need for surgery and radiation to the bones, and lowering the risk of spinal cord compression.

A double-blind, placebo-controlled, multicenter study in men with primary or hypogonadism-associated osteoporosis found that over a 14-month period, treatment with zoledronic acid reduced the risk of vertebral fractures by 67%. New morphometric vertebral fracture occurred in 1.6% of men taking zoledronic acid and in 4.9% taking placebo. Patients receiving zoledronic acid had significantly higher bone mineral density and lower bone-turnover markers. However, the rate of myocardial infarction was higher in the treatment group .

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Surgery In Metastatic Disease

Physicians have suggested that the benefits seen from radiation to the prostate point to the benefits of local therapy, raising the question of whether radical prostatectomy might have the same results. Trials are ongoing, and at present the use of surgery should be considered investigational and conducted only within the context of a trial. However, transurethral resection is sometimes needed in men who develop obstruction secondary to local tumor growth. Bilateral orchiectomy can be used to produce androgen deprivation in patients with widely advanced and metastatic prostate cancer.

Since the introduction of LHRH agonist and antagonist therapies, surgical intervention has been practiced less often. An indication for immediate bilateral orchiectomy is spinal cord compression, because it avoids the potential flare response that can occur during the first 3 weeks of treatment with an LHRH agonist.

How Prostate Cancer Is Treated

Explaining Radiation Therapy for Cancer Treatment

In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.

The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.

Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.

Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:

Also Check: Ways To Prevent Prostate Cancer

Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

What Can You Do About Fatigue

The first step in helping to manage fatigue is recognizing and controlling any symptoms that make it worse, like pain, nausea, neuropathy, or constipation. Another step is to try to prevent more fatigue by carefully balancing rest and activity. If you feel tired, stop and rest. Your health care team and your caregivers can help you find ways to manage the things that can make you feel more fatigued. Tell them how you feel, and try different things to see if they help you feel less tired.

Some medicines can make you feel tired, too. They may be needed, but you may want to talk with your health care team to find out if switching to new ones or taking them at different times may help. You might even be able to stop taking certain medicines that arent helping or arent needed any more.

Keep safe when youre active. If youre unsteady on your feet, make sure you have help when walking. You may feel safer if you have a walker or wheelchair. Your doctor or hospice team can help you get the equipment you need to be comfortable and safe. If youre shaky, dont use sharp utensils or other things that might cause injury. If youre able to drive, be careful to not drive when you are feeling fatigue.

Plan activities around the times you feel the best and have the most energy. Sit outside, listen to music, go for a ride in the car, spend time watching a meal being prepared distractions and stimulation of your senses may help ease fatigue.

You can learn more in Cancer-related Fatigue.

Also Check: Can Low Grade Prostate Cancer Become Aggressive

Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.

Early-stage prostate cancer

Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer

Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.

Treatments For Prostate Cancer

KNOW THE RIGHT WAY TO Evaluate & Treat Advanced Prostate Cancer-Dr. Girish Nelivigi| Doctors’ Circle

If you have prostate cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for prostate cancer, your healthcare team will consider:

  • the type and stage of the cancer
  • the grade or Gleason score
  • prostate-specific antigen levels
  • the risk group
  • possible side effects of treatments
  • your personal preferences
  • your overall health and any existing medical conditions
  • your age and life expectancy
  • whether you have symptoms

Prostate cancer treatments can seriously affect your quality of life and cause side effects such as erectile dysfunction and incontinence . Many prostate cancers grow slowly and cause no symptoms or problems.

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Thinking And Planning Ahead

You might be thinking about how and where you will be cared for as you approach the end of your life. This can make you feel more prepared and more confident about making decisions. And it can help you get the support you need. Planning ahead can also make things easier for your family and friends.

It can be difficult to think about these things. Some men prefer to focus on the time they have left and may not want to think about or plan for their death. Thinking about dying can make it seem more real. And it can be difficult to talk about these things. Some men worry about upsetting their family and friends. Everyone reacts differently and theres no right or wrong way to feel.

Making Decisions About My Future Care

You might need to make decisions about your medical and personal care. For example, you may need to decide how and where youd prefer to be cared for and whether there are any treatments you dont want to have. You, your loved ones, and your doctor or nurse will usually make these decisions together.

But some men become too unwell to make these decisions so you may want to think about the care youd like to receive if this happens. This is called advance care planning and it can help you to make sure you get the care you want. It can also take the pressure off your family or friends.

Writing down my wishes

Advance care planning can be written down in a document called an advance statement. An advance statement is a general statement about anything that is important to you in relation to your future health and wellbeing. It can include:

  • your preferences about the type of care you want
  • who you would like to make decisions about your care, if you are unable to make them yourself
  • where you would prefer to be cared for for example, at home, in a hospice or at hospital
  • where you would prefer to die.

Your doctor will take your advance statement into account when making any decisions about your care. But they don’t legally have to follow what your advance statement says, and your doctor might not always be able to follow your wishes.

You cant use an advance decision or advance directive to ask for a specific treatment or to ask for your life to be ended.

Read Also: Stage 4 Prostate Cancer Survival Rate Without Treatment

What Are Prostate Cancer Survival Rates By Stage

Staging evaluation is essential for the planning of treatment for prostate cancer.

  • A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
  • Further testing and calculations may be performed to best estimate a patients prognosis and help the doctor and patient decide upon treatment options.

Prognosis refers to the likelihood that cancer can be cured by treatment, and what the patients life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.

If cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival-based again on group statistics for people who have been in the same situation.

Nomograms are charts or computer-based tools that use complex math from the analysis of many patients treatment results.

The prognosis for prostate cancer varies widely and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and cancers responsiveness to treatment, among other factors.

The 5 and 10-year survival rate of prostate cancer chart

Stage and 5-Year Survival

What Care Will I Receive

Contemporary role of palliative cystoprostatectomy or pelvic ...

What is palliative care?

If you have advanced prostate cancer, you may hear the term palliative care. It’s sometimes called supportive care. Palliative care aims to manage pain and other symptoms. It aims to provide emotional, physical, practical and spiritual support. It also provides support for your family and for people looking after you.

Palliative care can be provided at any stage of advanced prostate cancer. It isnt just for men in their final weeks and days, although it does include end of life care. Men with advanced prostate cancer might receive palliative care for many months or years.

Palliative care may include:

  • treating and managing pain and other symptoms
  • talking about how youre feeling and finding ways to cope
  • relaxation services, such as massage or aromatherapy
  • social groups to help you enjoy life and not feel isolated
  • help getting the financial and practical support you need
  • support for your family and other people looking after you.

You might get this care in a hospice, hospital, care home, or your own home. Where you get this care will depend on what you need, what you prefer, and the services in your local area.

Even if you dont need any support at the moment, it can help to know what support is available. Speak to your GP to find out what support might be suitable or available for you, now or in the future.

At the end of life

Getting access to care

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What Symptoms Might I Get With Advanced Prostate Cancer

Depending on where the cancer has traveled to, the symptoms you may have will vary. If you dont have many symptoms you will have more once the cancer begins to spread again. You may not experience this at all as not everyones cancer creates symptoms that affect you on a day-to-day basis. Here are some symptoms you may experience when you have advanced prostate cancer.

External Beam Radiation Therapy For Osseous Metastases

The predilection of prostate cancer for spreading to bone in the form of osteoblastic metastases is well known. Approximately two-thirds of prostate cancer patients have osseous metastases at autopsy, and over 90% of patients with metastatic castration-resistant disease have evidence of osseous metastases. Recent advances in systemic therapies have resulted in a reduction of prostate cancer skeletal events, but painful skeletal metastases remain common.

A meta-analysis of 16 randomized trials, involving almost 5,000 patients undergoing palliative radiation for painful osseous metastases, confirms similar rates of pain control for single-fraction vs multi-fraction schedules. Data from this analysis indicate near identical overall responses and complete responses in both large and small trials. Of the eight trials reporting progression to pathologic fracture or the five studies reporting progression to cord compression, there was no significant difference between single- and multiple-fraction treatment regimens. Consistent with radiobiological principles, two trials showed an increase in acute toxicity with prolonged treatments compared with single treatments.

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