Clinical Practice Guidelines for the management of locally advanced ...

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Lymph nodes Small, generally pea-sized pieces of tissue found all over the body but easier to feel in the neck, armpits, and groins. Lymph nodes act as filters for foreign substances and commonly become inflamed if there is an infection nearby. They can also harbour cancer cells that have spread from elsewhere. Malignant Cancerous. Margin-positive See Surgical margins. Maximal androgen blockade Another term for combined androgen blockade (CAB). Medical oncologist A specialist in the treatment of cancer who uses chemotherapy. Metastasis The secondary or distant spread of cancer, away from its primary (initial) site in the body. Metastatic Relating to secondary cancer. Monitoring The process in which patients are followed up after initial diagnosis and treatment. Monitoring may include clinical examination and/or the regular performance of tests. Magnetic resonance imaging (MRI) Nodules Small lumps. A way of imaging the inside of the body using magnetic forces and without using x-rays. Oncologist A specialist in the treatment of cancer. Orchidectomy (also orchiectomy) Partial remission (or response) A type of operation which removes the testicles, but usually leaves the scrotal sac or scrotum. The situation when, following treatment, signs of the disease process have partially resolved but have not disappeared completely. Pelvis/pelvic The area of the body below the waist and surrounded by the hip and pubic bones. Pituitary Part of the brain which produces the hormones that stimulate the testicles to produce testosterone (male hormone) and other hormones. Primary The site where the cancer began. Prognosis The course and likely outcome of a disease, as estimated by a person’s doctor or treatment team. Prostatectomy An operation to remove all or part of the prostate. Prostatitis Inflammation of the prostate. It can be caused by bacteria. Protocol A well-defined program for treatment. Prostate specific antigen (PSA ) 139 Appendices A protein produced by the cells in the prostate, which is usually found in the blood in larger amounts when prostate cancer is present. It can be used as a test for prostate cancer or to monitor its recurrence.
Psychosocial Referring to the emotional, psychological, social and spiritual aspects of human life. Quality of life (QOL) A person’s overall appraisal of his or her situation and wellbeing. Radiation oncologist A specialist in the treatment of cancer using x-ray techniques. Radical prostatectomy An operation which removes the prostate and the seminal vesicles. This is usually done through a cut in the lower abdomen. Radiotherapy The use of radiation as x-rays or electrons to kill tumour cells. Rectum The last part of the bowel, leading to the anus, and through which stools pass. Recurrence The re-occurrence of cancer some time after it was first treated. Reliability (of a test) The ability to measure something in a reproducible and consistent fashion. Response A change in the size or extent of disease due to treatment. Retrograde ejaculation Also called reverse ejaculation. This may occur after surgery for benign conditions of the prostate. The ejaculate travels back into the bladder instead of exiting out through the penis. This means a man is usually infertile (cannot produce offspring in the conventional way), but he can still achieve orgasm. Scrotum A pouch of skin which contains the testicles and some other parts of the male reproductive system. It hangs outside the body and below the penis. Secondary tumour Spread of cancer from where it began to another part of the body. The secondary cancerous growths are known as metastases or ‘secondaries’. The process of spread is known as metastasis. Seminal vesicles Glands that lie very close to the prostate and produce secretions which form part of the ejaculate. Staging The process of determining the extent of the disease. A system for describing how far the cancer has spread. The most common is the TNM system described in Appendix 3. A second and older system sometimes referred to, is the Jewett system: Stage A—Prostate cancer that began and is found in the prostate only. Divided into two stages. Stage B—Prostate cancer began in the prostate and is more advanced than Stage A. Stage C—Prostate cancer that began in the prostate, has grown beyond the outer layer of the prostate to nearby tissues, and may be found in seminal vesicles (glands that help produce semen). Stage D—Prostate cancer that began in the prostate and has spread to lymph nodes or far from the prostate, or to other parts of the body, often to the bones. Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer 140
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Clinical Practice Guidelines for th
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4 Biochemical relapse .............
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FOREWORD The management of prostate
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SUMMARY OF CLINICAL PRACTICE RECOMM
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SUMMARY OF RECOMMENDATIONS Chapter
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Chapter Recommendations Grade Refs
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1 INTRODUCTION 1.1 Natural history
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2 PSYCHOSOCIAL CARE The diagnosis a
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2.2 Effect of psychological and cog
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Evidence summary Level References T
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Recommendation Men with advanced pr
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An Australian cross-sectional study
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10. Dunn J, et al. A review of peer
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41. Sharpley CF, Christie DRH. An a
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different treatments from different
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Evidence summary Level References I
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Evidence summary Level References F
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Despite these reservations and the
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For non-metastatic disease there we
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Evidence summary Level References T
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monotherapy for low-to-intermediate
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Evidence summary Level References M
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for surgery, suggesting that surger
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Microscopic fully resected node pos
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All three trials demonstrated impro
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Evidence summary Level References B
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of an international multicentre ran
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45. Melton LJ, III, Alothman KI, Kh
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76. Little DJ, Kuban DA, Levy LB, Z
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105. Thompson IM, Tangen CM, Parade
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4.2 Androgen deprivation therapy (e
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Evidence summary Level References F
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therapy since such studies would be
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apparent in trials comparing CAB wi
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QLQ instrument published by Cleary
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Note: Larger well-powered studies h
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Eight trials examined acute toxicit
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half of patients experienced pain r
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olus) in addition to radiotherapy a
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References 1. Seidenfeld J, Samson
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Cooperative Group. Scandinavian Jou
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Oncology Group, TROG 96.05). Radiot
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trial. European Journal of Cancer 1
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6 CASTRATION-RESISTANT PROSTATE CAN
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the median overall survival for pat
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There are two points regarding bisp
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with bone pain at study entry. At n
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Recently, there have been reports o
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of these studies 56, 58 and in the
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Side effects (toxicity) As these ra
Page 108 and 109: hydrocortisone respectively. Tannoc
Page 110 and 111: 5. Manikandan R, Srirangam SJ, Pear
Page 112 and 113: 33. Elomaa I, Kylmala T, Tammela T
Page 114 and 115: 60. Janknegt RA, Abbou CC, Bartolet
Page 116 and 117: physiotherapists, occupational ther
Page 118 and 119: 7.5 Q2: Symptom control There was e
Page 120 and 121: Informal or family caregivers deriv
Page 122 and 123: 8. Hughes SL, Weaver FM, Giobbie-Hu
Page 124 and 125: 8 COMPLEMENTARY AND ALTERNATIVE (UN
Page 126 and 127: corresponding benefit in obstructiv
Page 128 and 129: 3. Eisenberg DM, Kessler RC, Van Ro
Page 130 and 131: areas of the state were more likely
Page 132 and 133: 8 Miller DC, Litwin MS, Bergman J,
Page 134 and 135: 10 EMERGING THERAPIES It is impossi
Page 136 and 137: APPENDIX 1 GUIDELINE DEVELOPMENT PR
Page 138 and 139: study type. Studies published befor
Page 140 and 141: Grade of recommendation Description
Page 142 and 143: 2. National Health and Research Cou
Page 144 and 145: Dr Carole Pinnock AM Principal rese
Page 146 and 147: Surgery Professor Villis Marshall A
Page 148 and 149: APPENDIX 3 TNM CLASSIFICATION OF PR
Page 150 and 151: Summary Prostate T1 T2 T3 T4 N1 M1a
Page 152 and 153: APPENDIX 4 ABBREVIATIONS AND GLOSSA
Page 154 and 155: Glossary Actuarial survival A metho
Page 156 and 157: Effectiveness The extent to which a
Page 160 and 161: Each stage is divided into subgroup
Page 162 and 163: APPENDIX 6 - ORGANISATIONS WHICH PR
Page 164 and 165: Consultant Urologist, Royal Brisban
Page 166 and 167: No conflict of interest to declare.
Page 168 and 169: Index to Clinical practice guidelin
Page 170 and 171: cardiovascular mortality 19, 54, 55
Page 172 and 173: androgen deprivation therapy (ADT)
Page 174 and 175: and surgery 32-34 survival 18 toxic
Page 176 and 177: and chemotherapy 89-90 see also bon
Page 178 and 179: spinal cord compression 62-63 see a
Page 180 and 181: systemic 141 Tasmania Association f
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