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

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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
Ongoing Support The MDT team should ensure regular communication with the primary care team. This may mean: • Timely provision of detailed discharge or outpatient summaries • Explanation of why a treatment route has been decided upon • The patient’s response to the chosen treatment • Sharing of protocols • Online educational resources • Agreement on prescribing policies • Provision of contact numbers for requests for information The local patient support network, e.g. partner/family, must be included in the information/education process through the use of: • Patient information materials • Audio visual materials such as videos, DVDs and Web-based information 51
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 and 48: Chemotherapy, Strontium and Bisphos
Page 49: Bisphosphonates • The benefits of
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

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