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

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An Australian cross-sectional study of 195 men diagnosed with prostate cancer between 7 and 71 months previously reported that 12% of the sample had clinically significant levels of anxiety, and 16% had similar levels of depression. 41 None of the subjects in this study had advanced disease. A cross-sectional study of 716 men with prostate cancer aged 50-93 years evaluated depression using the Hospital Anxiety and Depression Scale. This study found that aging was related to less distress and less anxiety, but greater depressive symptoms. 42 Research in patients with advanced prostate cancer is similarly limited. A prospective study conducted in the US examined depression and fatigue in 53 men with recurrent or advanced prostate cancer who had been randomised to treatment with either parenteral leuprolide or oral bicalutamide. 43 Over a 12 month period rates of at least mild depression ranged from 10.4% to 16.3%, with no significant differences between the groups, and no significant change in depression over time, despite the fact that fatigue increased during this period. The following studies relate to mixed cancer populations with advanced disease. One study of 33 males and 35 females with advanced cancer reported prevalence of anxiety and depression as 25% and 22% respectively. 44 Although structured measures of mood were used, the response rate was low, and only 13% of the subjects had prostate cancer. A cross-sectional study of 74 patients attending a palliative care day unit found that depression affected one in four patients. 45 Pain and low mood were noted to be closely related, although the direction of causality is not clear. The proportion of patients with prostate cancer in the sample was not stated, although the male/female ratio was equal and all patients had advanced disease. Detection and treatment of anxiety and depression is important for several reasons. Analysis of studies involving 16,922 patients with chronic medical illness demonstrated that patients with depression had significantly greater symptoms when severity of medical illness was controlled for. 46 Furthermore, depression has been reported to be associated with reduced adherence to recommended treatments amongst patients with medical illness. 47 The identification of depression is aided by attention to known risk factors for psychological morbidity. These include advanced stage of disease; presence of pain or functional disability; side-effects of treatment; fatigue and poor prognosis. 19 Individual risk factors include a past history of depression, economic adversity, lack of social support and poor marital or family functioning. 19 Treatment of anxiety and depression is generally effective and ideally incorporates psychotherapeutic interventions and often the use of medications. 19 However, an Australian randomised controlled trial of antidepressant medication in patients with advanced cancer demonstrated no survival advantage and no benefit for mood for patients who did not meet criteria for major depressive disorder. Evidence summary Level Reference There is little high-quality evidence describing the prevalence of anxiety and depression in patients with advanced prostate cancer. Recommendations: III-3 44, 45, 47 Health professionals should be aware of risk factors for the development of anxiety and depression and be prepared to treat appropriately. Grade B Evidence from research in mixed cancer populations is that anxiety and depression are important comorbidities experienced by patients with advanced cancer, and that effective treatments are available. 11 Psychosocial care
Note: Further information about practical approaches to the diagnosis of anxiety and depression, effective treatments and strategies for referral for specialist treatment is contained in the Clinical Practice guidelines for the psychosocial care of adults with cancer. These guidelines and the consumer resource: Cancer: How are you travelling? can be downloaded from the National Breast and Ovarian Cancer Centre website http://nbocc.org.au/health-professionals/clinical-best-practice/psychosocial-guidelines The Prostate Cancer Foundation of Australia has produced a booklet: Maintaining your well-being: information on depression and anxiety for men with prostate cancer and their partners, in collaboration with Beyondblue, the national depression initiative: http://www.prostate.org.au/articleLive/pages/Download-Information.html http://www.beyondblue.org.au References 1. Green HJ, Pakenham KI, Headley BC et al. Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: a randomized controlled trial. BJU Int 2002;90(4):427-432. 2. Davison BJ, Goldenberg SL, Wiens KP, Gleave ME. Comparing a generic and individualized information decision support intervention for men newly diagnosed with localized prostate cancer. Cancer Nurs 2007;30(5):E7-15. 3. Flynn D, van Schaik P, van Wersch A, Ahmed T, Chadwick D. The utility of a multimedia education program for prostate cancer patients: a formative evaluation. Br J Cancer 2004;91(5):855-860. 4. Steginga SK, Occhipinti S, Gardiner RA, Yaxley J, Heathcote P. Prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer. Urology 2004;63(4):751-756. 5. Wong F, Stewart DE, Dancey J et al. Men with prostate cancer: influence of psychological factors on informational needs and decision making. Journal of Psychosomatic Research 2000;49(1):13-19. 6. Eton DT, Lepore SJ. Prostate cancer and health-related quality of life: a review of the literature. Psychooncology 2002;11(4):307-326. 7. Steginga SK, Pinnock C, Gardner M, Gardiner RA, Dunn J. Evaluating peer support for prostate cancer: the Prostate Cancer Peer Support Inventory. BJU Int 2005;95(1):46-50. 8. Steginga SK, Occhipinti S, Dunn J, Gardiner RA, Heathcote P, Yaxley J. The supportive care needs of men with prostate cancer (2000). Psychooncology 2001;10(1):66-75. 9. Couper J, Bloch S, Love A, Macvean M, Duchesne GM, Kissane D. Psychosocial adjustment of female partners of men with prostate cancer: a review of the literature. Psychooncology 2006;15(11):937-953. Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer 12
Page 1: Clinical Practice Guidelines for th
Page 4 and 5: 4 Biochemical relapse .............
Page 6 and 7: FOREWORD The management of prostate
Page 8 and 9: SUMMARY OF CLINICAL PRACTICE RECOMM
Page 10 and 11: SUMMARY OF RECOMMENDATIONS Chapter
Page 12 and 13: Chapter Recommendations Grade Refs
Page 20 and 21: 1 INTRODUCTION 1.1 Natural history
Page 22 and 23: 2 PSYCHOSOCIAL CARE The diagnosis a
Page 24 and 25: 2.2 Effect of psychological and cog
Page 26 and 27: Evidence summary Level References T
Page 28 and 29: Recommendation Men with advanced pr
Page 32 and 33: 10. Dunn J, et al. A review of peer
Page 34 and 35: 41. Sharpley CF, Christie DRH. An a
Page 36 and 37: different treatments from different
Page 38 and 39: Evidence summary Level References I
Page 40 and 41: Evidence summary Level References F
Page 42 and 43: Despite these reservations and the
Page 44 and 45: For non-metastatic disease there we
Page 46 and 47: Evidence summary Level References T
Page 48 and 49: monotherapy for low-to-intermediate
Page 50 and 51: Evidence summary Level References M
Page 52 and 53: for surgery, suggesting that surger
Page 54 and 55: Microscopic fully resected node pos
Page 56 and 57: All three trials demonstrated impro
Page 58 and 59: Evidence summary Level References B
Page 60 and 61: of an international multicentre ran
Page 62 and 63: 45. Melton LJ, III, Alothman KI, Kh
Page 64 and 65: 76. Little DJ, Kuban DA, Levy LB, Z
Page 66 and 67: 105. Thompson IM, Tangen CM, Parade
Page 68 and 69: 4.2 Androgen deprivation therapy (e
Page 70 and 71: Evidence summary Level References F
Page 72 and 73: therapy since such studies would be
Page 74 and 75: apparent in trials comparing CAB wi
Page 76 and 77: QLQ instrument published by Cleary
Page 78 and 79: 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
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hydrocortisone respectively. Tannoc
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5. Manikandan R, Srirangam SJ, Pear
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33. Elomaa I, Kylmala T, Tammela T
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60. Janknegt RA, Abbou CC, Bartolet
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physiotherapists, occupational ther
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7.5 Q2: Symptom control There was e
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Informal or family caregivers deriv
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8. Hughes SL, Weaver FM, Giobbie-Hu
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8 COMPLEMENTARY AND ALTERNATIVE (UN
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corresponding benefit in obstructiv
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3. Eisenberg DM, Kessler RC, Van Ro
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areas of the state were more likely
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8 Miller DC, Litwin MS, Bergman J,
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10 EMERGING THERAPIES It is impossi
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APPENDIX 1 GUIDELINE DEVELOPMENT PR
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study type. Studies published befor
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Grade of recommendation Description
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2. National Health and Research Cou
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Dr Carole Pinnock AM Principal rese
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Surgery Professor Villis Marshall A
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APPENDIX 3 TNM CLASSIFICATION OF PR
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Summary Prostate T1 T2 T3 T4 N1 M1a
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APPENDIX 4 ABBREVIATIONS AND GLOSSA
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Glossary Actuarial survival A metho
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Effectiveness The extent to which a
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Lymph nodes Small, generally pea-si
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Each stage is divided into subgroup
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APPENDIX 6 - ORGANISATIONS WHICH PR
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Consultant Urologist, Royal Brisban
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No conflict of interest to declare.
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Index to Clinical practice guidelin
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cardiovascular mortality 19, 54, 55
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androgen deprivation therapy (ADT)
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and surgery 32-34 survival 18 toxic
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and chemotherapy 89-90 see also bon
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spinal cord compression 62-63 see a
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systemic 141 Tasmania Association f
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