From the Guidelines
Management strategies for prostate cancer should prioritize a multidisciplinary approach, considering disease stage, patient age, comorbidities, and patient preferences, with a focus on balancing cancer control and quality of life. For localized prostate cancer, options include active surveillance for low-risk disease, radical prostatectomy, or radiation therapy (external beam or brachytherapy) 1. Active surveillance involves regular PSA testing, digital rectal exams, and periodic biopsies to monitor for disease progression. For intermediate or high-risk localized disease, treatment typically includes surgery or radiation, sometimes with adjuvant androgen deprivation therapy (ADT). Common ADT medications include LHRH agonists like leuprolide (Lupron) 7.5mg monthly or 22.5mg every 3 months, or LHRH antagonists like degarelix (Firmagon) 240mg initial dose followed by 80mg monthly 1.
Some key considerations in managing prostate cancer include:
- Monitoring and follow-up: Regular monitoring of PSA levels, digital rectal exams, and periodic biopsies are crucial for detecting disease progression 1.
- Symptom management: Patients with prostate cancer may experience symptoms such as urinary dysfunction, sexual dysfunction, and fatigue, which should be managed with supportive care measures 1.
- Psychosocial support: Patients and their families may benefit from psychosocial support, including counseling, support groups, and educational resources 1.
- Treatment decisions: Treatment decisions should be made in collaboration with the patient, considering their preferences, values, and quality of life goals 1.
For advanced or metastatic disease, ADT forms the backbone of treatment, often combined with newer agents like abiraterone (1000mg daily with prednisone 5mg daily), enzalutamide (160mg daily), or apalutamide (240mg daily) 1. Chemotherapy with docetaxel (75mg/m² every 3 weeks with prednisone) may be added for metastatic disease. For castration-resistant prostate cancer, additional options include sipuleucel-T immunotherapy, radium-223 for bone metastases, or PARP inhibitors like olaparib for those with specific genetic mutations 1.
It is essential to consider the potential side effects of therapies, including sexual dysfunction, hot flashes, fatigue, and metabolic changes, and to prioritize quality of life considerations in treatment decisions 1. By taking a comprehensive and patient-centered approach to prostate cancer management, healthcare providers can help patients achieve optimal outcomes and improve their overall quality of life.
From the Research
Management of Prostate Cancer
Prostate cancer is a condition where cells in the prostate gland grow uncontrollably, commonly affecting older men and potentially causing symptoms related to urination or other complications if left untreated.
Symptoms
The symptoms of prostate cancer include:
- Difficulty starting or stopping urination
- Weak or interrupted urine flow
- Frequent urination, especially at night
- Blood in urine or semen
- Pain or burning during urination
- Persistent pain in the lower back, hips, or pelvis
- Fatigue
Monitoring and Emergency Situations
It is essential to look for and call the RN on-call if any of the following are observed:
- Persistent or worsening pain in the back, hips, or pelvis
- Significant weight loss
- Swelling in the legs or pelvic area
- Difficulty urinating or inability to urinate
- Increased fatigue or weakness Call 911 and notify the RN on-call if any of the following are observed:
- Severe pain that does not improve with medication
- Blood in urine or stool that is heavy or persistent
- Sudden shortness of breath
- Confusion or loss of consciousness
- Chest pain or rapid heartbeat
- Inability to urinate with abdominal swelling or pain
Actions to Take
The following actions can be taken to manage prostate cancer:
- Monitor vital signs regularly
- Encourage a balanced diet and adequate hydration
- Assist with mobility to prevent falls or injury
- Manage pain and discomfort by administering prescribed pain medications as directed, using acetaminophen for mild pain, and avoiding NSAIDs unless approved by the physician due to potential bleeding risks 2
- Provide supportive care, including assisting with daily activities, encouraging rest periods to manage fatigue, promoting a calm and comfortable environment, and monitoring for side effects of treatments (e.g., radiation or chemotherapy) 3, 4
Exercise and Quality of Life
Exercise has been shown to improve physical function and mitigate urinary toxicity in men with prostate cancer undergoing radiation therapy 3. Active surveillance for prostate cancer does not appear to significantly harm patients' quality of life, with patients reporting good overall health-related quality of life scores and favorable anxiety and depression scores 5.
Pain Management
Pain management is crucial in patients with advanced prostate cancer, with options including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, palliative radiation, bisphosphonates, and radioisotopes 4.
Quality of Care
Assessing the quality of prostate cancer care is essential, with researchers developing tools to measure the quality of care and documenting room for improvement in prostate cancer quality of care in the US 6.