Update in palliative management of hormone refractory cancer of prostate

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Abstract

Hormone refractory prostate cancer (HRPC) is an incurable disease and as in the pressure sensitive adhesive era the median survival of patients is increasing, these men increasingly develop symptomatic problems as a result of advanced local and or metastatic disease during their progression to death. Recently, it has been shown that it is possible to improve survival in this group of patients with use of chemotherapy which reinforces the need of better options in palliative care. We discus the various clinical problems (Part I) and treatment options of palliative care (Part II) and try to formulate an action plan in this review.

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The significance of skeletal-related events for the health-related quality of life of patients with metastatic prostate cancer.

K.P. Weinfurt, Y. Li, L.D. Castel … (2005)

We examined the clinical relevance of skeletal-related events (SREs) for health state preferences, pain and health-related quality of life in patients with advanced prostate cancer and a history of bone metastases. Data were from a clinical trial of zoledronic acid versus placebo in the treatment of SREs associated with advanced prostate cancer metastatic to bone. Patients (n=248) were included if they experienced an SRE during the study. Outcome measures were assessed at fixed intervals. We used mixed-effects models to estimate changes in outcomes after each patient's first SRE. There were clinically meaningful and statistically significant declines in physical well-being after: radiation and pathologic fractures; functional well-being after radiation; and emotional well-being after radiation and pathologic fractures. There also were meaningful and significant declines in preference and utility scores after radiation and fracture. Pain intensity declined after radiation, but not after other SREs; no other pain measure changed substantively. SREs have important and significant effects on measures of health-related quality of life in men with prostate cancer. Treatments that prevent SREs may not demonstrate corresponding effects on outcomes if the effects of SREs occur between scheduled outcome assessments. Implications for trial design are discussed.

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The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group.

John R. Hendrickson, John Gillick, D Tong (1982)

Different dose fractionation irradiation schedules have been evaluated in a randomized Radiation Therapy Oncology Group (RTOG) study to determine their palliative effectiveness in patients with osseous metastases. The frequency, promptness and duration of pain relief were utilized as measures of response. Ninety percent of patients experienced some relief of pain and 54% achieved eventual complete pain relief. Important prognosticators included the initial pain score and the site of the primary lesions. Administration of steroid or chemotherapy during the one-month on-study period did not influence the frequency of pain relief. The low-dose, short-course schedules were as effective as the high-dose protracted programs.

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Murine models of inflammatory, neuropathic and cancer pain each generates a unique set of neurochemical changes in the spinal cord and sensory neurons.

P Honore, D R Clohisy, Selina M Luger … (1999)

The aim of this investigation was to determine whether murine models of inflammatory, neuropathic and cancer pain are each characterized by a unique set of neurochemical changes in the spinal cord and sensory neurons. All models were generated in C3H/HeJ mice and hyperalgesia and allodynia behaviorally characterized. A variety of neurochemical markers that have been implicated in the generation and maintenance of chronic pain were then examined in spinal cord and primary afferent neurons.Three days after injection of complete Freund's adjuvant into the hindpaw (a model of persistent inflammatory pain) increases in substance P, calcitonin gene-related peptide, protein kinase C gamma, and substance P receptor were observed in the spinal cord. Following sciatic nerve transection or L5 spinal nerve ligation (a model of persistent neuropathic pain) significant decreases in substance P and calcitonin gene-related peptide and increases in galanin and neuropeptide Y were observed in both primary afferent neurons and the spinal cord. In contrast, in a model of cancer pain induced by injection of osteolytic sarcoma cells into the femur, there were no detectable changes in any of these markers in either primary afferent neurons or the spinal cord. However, in this cancer-pain model, changes including massive astrocyte hypertrophy without neuronal loss, increase in the neuronal expression of c-Fos, and increase in the number of dynorphin-immunoreactive neurons were observed in the spinal cord, ipsilateral to the limb with cancer. These results indicate that a unique set of neurochemical changes occur with inflammatory, neuropathic and cancer pain in C3H/HeJ mice and further suggest that cancer induces a unique persistent pain state. Determining whether these neurochemical changes are involved in the generation and maintenance of each type of persistent pain may provide insight into the mechanisms that underlie each of these pain states.

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Journal

Journal ID (nlm-ta): Indian J Urol

Journal ID (publisher-id): IJU

Title: Indian Journal of Urology : IJU : Journal of the Urological Society of India

Publisher: Medknow Publications (India )

ISSN (Print): 0970-1591

ISSN (Electronic): 1998-3824

Publication date (Print): Jan-Mar 2007

Volume: 23

Issue: 1

Pages: 43-50

Affiliations

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Author notes

For correspondence: Aneesh Srivastava, Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. E-mail: anees@ 123456sgpgi.ac.in

Article

Publisher ID: IJU-23-43

DOI: 10.4103/0970-1591.30266

PMC ID: 2721495

PubMed ID: 19675762

SO-VID: 3ea9c2dc-0582-451c-9c01-c96469670355

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review
Authors: R Sood, M. Mancinetti, D. Betticher …

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Update in palliative management of hormone refractory cancer of prostate

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Most cited references 59

The significance of skeletal-related events for the health-related quality of life of patients with metastatic prostate cancer.

The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group.

Murine models of inflammatory, neuropathic and cancer pain each generates a unique set of neurochemical changes in the spinal cord and sensory neurons.

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