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

More documents

Recommendations

Info

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
Bisphosphonates • The benefits of zoledronic acid, in combination with hormone therapy have been investigated in a study by Saad in men with HRPC and bone metastases. 124 This was a multicentre, randomised, placebo-controlled trial evaluating the efficacy of zoledronic acid 4 mg administered every 3 weeks in 422 patients with HRPC for 15 months, with an option to continue for an additional 9 months. o At the 2-year analysis, treatment with zoledronic acid was found to significantly reduce the percentage of patients with at least one skeletal-related event (SRE; defined as radiation for bone pain or to prevent pathological fracture/spinal cord compression; pathological fracture; spinal cord compression; surgery to bone; change in antineoplastic therapy) compared with placebo (38% versus 49%; p=0.028). All SREs were delayed. o Zoledronic acid also significantly delayed the time to first SRE by around 6 months (median 488 versus 321 days; p=0.009). Furthermore, patients in the zoledronic acid group had consistently lower incidences of all types of SRE than the placebo group. Pain scores were consistently lower in patients taking zoledronic acid 4mg than placebo, and significantly at 3, 9, 18, 21 and 24 months (p
Page 1 and 2: MDT (Multi-disciplinary Team) Guida
Page 3 and 4: Integrated Care and the Multi-disci
Page 5 and 6: Figure 2: Treatment algorithm for l
Page 7 and 8: Figure 3: Treatment algorithm for l
Page 9 and 10: Integrated care and clinical govern
Page 11 and 12: Approach to the Patient Key points
Page 13 and 14: Assessment and Diagnosis Screening
Page 15 and 16: Prostate size - a benignly enlarged
Page 17 and 18: Key Questions for the MDT • TNM s
Page 19 and 20: Active surveillance Overview • Ac
Page 21 and 22: Watchful waiting Overview • Watch
Page 23 and 24: o Faced with these figures, some pa
Page 25 and 26: • Dearnaley and colleagues have r
Page 27 and 28: Low dose rate (LDR) brachytherapy O
Page 29 and 30: Novel therapies Cryotherapy/High-in
Page 31 and 32: The term locally advanced prostate
Page 33 and 34: Radiotherapy plus hormone therapy
Page 35 and 36: • Evidence of the benefits of dos
Page 37 and 38: Clinical evidence • Adjuvant andr
Page 39 and 40: Locally Advanced (Non-metastatic) D
Page 41 and 42: Clinical evidence • The EORTC 229
Page 43 and 44: Advanced Prostate Cancer (Metastati
Page 45 and 46: Table 6: Effect of immediate versus
Page 47: Chemotherapy, Strontium and Bisphos
Page 51 and 52: Ongoing Support The MDT team should
Page 53 and 54: 21. Tchetgen MB, Oesterling JE. The
Page 55 and 56: 57. Amer AM, Mott J, Mackay RI, et
Page 57 and 58: 92. Bolla M, Collette L, Van Tienho
Page 59: 126. Marx RE, Sawatari Y, Fortin M,

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?