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

Palliative Care
Overview
• Radiotherapy has been a mainstay in the palliation of painful metastatic bone lesions. Palliative
radiotherapy can also aid other complications of metastatic disease, such as compression of the
spinal cord or a nerve root, haematuria, ureteric obstruction, perineal discomfort caused by the
local progression of prostate cancer, and symptomatic metastatic lymphadenopathy.
Clinical evidence
• Good evidence for the role of radiotherapy in palliation comes from McQuay et al. This systematic
review covered 20 trials, which reported on 43 different radiotherapy fractionation schedules, and
eight studies of radioisotopes. 128
o Radiotherapy produced complete pain relief at 1 month in 395 out of 1580 (25%) patients,
and at least 50% relief in 788 out of 1933 (41%) patients at some time during the trials.
o In the largest trial, which included 759 patients, 52% achieved complete pain relief within
4 weeks and the median duration of complete relief was 12 weeks.
o The study found no difference between the use of radioisotopes (such as strontium) and
EBRT for generalised disease, a finding supported by the work of Quilty et al.
o In this latter study, 284 patients with prostate cancer and painful bone metastases were
treated with local or hemi-body radiotherapy or strontium. Median survival was nonsignificantly
different between groups (33 weeks with strontium versus 28 weeks with
radiotherapy; p=0.1). 129
o Both radiotherapy and strontium provided effective pain relief that was sustained for
3 months in 63.6% of patients after hemi-body radiotherapy compared with 66.1% of
patients after strontium, and in 61% of patients after local radiotherapy compared with
65.9% of patients in the comparable strontium group.
o Fewer patients reported new pain sites after strontium than after local or hemi-body
radiotherapy (p