MDT (multi-disciplinary team) guidance for managing prostate cancer

Side-effects
• Side-effects of chemotherapy depend on the treatment, but usually include fatigue, nausea and
vomiting, diarrhoea, hair loss and increased susceptibility to infection. Specific therapies to handle
these side-effects may be necessary to improve the patient’s quality of life.
Strontium
• Metastatic pain can be palliated effectively with systemic radionuclide therapy with strontium
chloride.
• Relief of bone pain starts within 2 weeks. Possible initial bone pain flare may occur within 2 days,
lasting 2−4 days.
o Pain relief lasts 4−15 months.
o 75−80% of patients experience significant palliation of pain.
• A Canadian collaborative study showed significant improvement in quality of life, increased time
to further metastases, significant reduction in the amount of additional radiotherapy needed,
and significant falls in PSA and alkaline phosphatase. 120
• Strontium is not associated with improvements in OS. 121
• Four randomised clinical trials have reviewed the use of strontium. 122
o One trial reported significant improvement in pain control, two trials reported fewer new
sites of pain.
o One trial showed no significant difference in pain control compared to a placebo but an
improved 2-year survival rate.
• A randomised clinical trial examining strontium versus placebo found a significant increase in
median time to progression, but no significant effects on median OS or clinical response. 123
Side-effects
• The most notable side-effect of strontium is mild haematological suppression with a fall in
circulating platelet and leukocyte counts recognised in most patients.
o With usual therapeutic doses, platelets typically fall by 30% and leucocytes by 20%.
o Clinically significant toxicity is rare, but its use is not recommended in patients with severely
compromised bone marrow, platelet count