Palliative treatment of prostate cancer

Most patients with metastatic prostate cancer suffer in varying degrees from pain, compression fractures of vertebral bodies, pathological fractures and compression of the spinal cord. To prevent these conditions, drugs from the bisphosphonate group (zoledronic acid) can be used. The studies performed show their high effectiveness in relation to pain (response in 70-80% of patients), pathological bone fractures and their consequences, suggesting early use of bisphosphonate group preparations with the corresponding symptoms in patients with metastatic prostate cancer.

For relief of pain caused by bone metastases, it is possible to use remote radiation therapy, radionuclide treatment (Str, Sa), analgesics, glucocorticoids.

Spinal cord compression is an urgent condition requiring the appointment of hormonal treatment (if it is not prescribed earlier), the use of glucocorticoids, radiotherapy and in some situations of rapid decompression.

[1], [2], [3], [4], [5]

Infravesical obstruction

This complication occurs both in acute and chronic forms. As a rule, hormonal treatment allows to reduce the degree of obstruction in 2/3 patients, however from the moment of the beginning of treatment to the development of the effect it can take up to 3 months, therefore, measures for urinary diversion are needed.

In patients to whom hormone treatment did not help, it is possible to perform TURP of the prostate. Also, surgical treatment is indicated in case of massive hematuria with a source in the neck of the bladder and prostate. The effectiveness of the intervention reaches up to 60%. TUR must be performed cautiously because of the high risk of developing urinary incontinence.

Ureteral obstruction

The compression of the ureter with impairment of urinary efflux from the kidneys is usually the result of tumor invasion or metastasis in the regional lymph nodes. Clinical manifestations of obstruction of the ureter - azotemia pain, septic reaction or asymptomatic hydronephrosis.

The treatment of prostate cancer (prostate cancer) largely depends on the patient's somatic status. With asymptomatic unilateral hydronephrosis and adequate functional reserves of the contralateral kidney, dynamic observation is possible. In other cases, given that retrograde stent placement is often impossible, the main method of treatment is puncture nephrostomy.

Complications of advanced prostate cancer

Antiandrogenic treatment of prostate cancer (prostate cancer) usually does not save patients for a long time. The focus of Late Cancer therapy is shifted to maintaining an adequate quality of life and eliminating symptoms. The most problematic symptoms of late prostate cancer are bone pain, spinal cord compression, urinary tract obstruction, anemia.

[6], [7], [8], [9], [10],

Pain in the bones

Bone pain is the most common symptom in patients with advanced prostate cancer. Typically, it occurs in the lumbar spine and in the pelvis, although metastases of prostate cancer can be found in any of the bones. Bony metastases lead to pathological fractures, most often fractures of the femoral neck. Operative treatment for the purpose of bone stabilization is necessary not only in case of pathological fractures, but also in places of suspected fractures with a significant loss of bone tissue (more than 50% of the cortical bone layer is destroyed).

Treatment of bone pain

Treatment of bone pain is a decisive moment in maintaining the quality of life. Currently, several measures are possible for the treatment of pain - radiation therapy and the use of bisphosphonates.

Radiation therapy

Radiation therapy is an effective method of controlling pain associated with tumor growth. For selected sites, the use of radiation therapy can prevent pain in 75% of patients for up to 6 months. Usually a single or short 2-3-week course (3000 kGy for 10 sessions) is performed. When multiple foci are present, local therapy is less effective. Alternative to intravenous RFP, accumulating in the bones of Str, Sa). Reduction of pain for a short period of time reaches 50% of patients. Side effects include thrombocytopenia, leukopenia, which limit the use of more aggressive chemotherapy.

Criteria for the possibility of using RFP:

• multiple metastases;
• the number of leukocytes is more than 3х10 ⁹ / l;
• the number of platelets - more than 60x10 ⁹ / l;
• life expectancy is more than 3 months.

Bisphosphonates

Bisphosphonates are analogues of pyrophosphate (aleldronic or clodronic acid), direct inhibitors of osteoclast activity. Their clinical efficacy is proven for Paget's disease, multiple myeloma, for patients with breast cancer and lytic bone metastases. Although most metastases in the bone of prostate cancer are osteoblastic, there is a risk of increased osteoclast activity. In patients with anti-androgen therapy, the risk of demineralization is very high. The use of bisphosphonates can be effective in these patients.

[11], [12], [13], [14],

Compression of the spinal cord

Most often, compression occurs in the thoracic and upper lumbar regions. This is a consequence of a compression fracture of the vertebral metastasized or intradural tumor growth. The main symptoms are radicular pain, motor weakness, lack of sensitivity, bladder dysfunction. This can be either a chronic process, or acute, accompanied by rapid progression and paraplegia.

Compression of the spinal cord is an emergency. An immediate antiandrogenic treatment is needed if it has not been performed before. MRI is the best method for visualizing the involved area.

Successful treatment of spinal cord compression involves appropriate diagnosis and treatment. Immediate administration of glucocorticoids is necessary. The next step is operational decompression and radiation therapy or only radiation therapy. In most cases, radiation therapy is effective and avoids surgical intervention. Retrospective analysis did not demonstrate a clear advantage of any approach to treatment. Both treatments reduce pain in 2/3 of the patients. Complete paraplegia, as a rule, remains.

[15], [16], [17]

Infravesical obstruction

Acute or chronic IVO is another common complication of prostate cancer. The use of antiandrogens can reduce the degree of obstruction in 2/3 of the patients. However, the development of the effect is possible within 3 months, and, accordingly, drainage of the bladder. TUR of the prostate can be performed in patients with ineffective antiandrogenic treatment, and also in conditions of massive hematuria with a source in the neck of the bladder and in the prostate. The operation must be performed carefully because of the high risk of developing urinary incontinence. Ureteral obstruction

Unilateral or bilateral obstruction of the ureters may be a consequence of locally advanced prostate cancer due to invasion or compression by enlarged lymph nodes. Clinical manifestations of azotemia, pain, sepsis and asymptomatic hydronephrosis.

The treatment of prostate cancer (prostate cancer) depends on the patient's somatic status. Asymptomatic unilateral hydrotransmission with preservation of kidney function can only be observed. Typically, retrograde stent placement is not possible if the base of the bladder and the urinary bladder are involved in the process, due to the difficulty in visualizing ureteral orifices. It is possible to perform nephrostomy and internal drainage through nephrostomy. Rarely use the cutaneous lead of urine.

Anemia

Anemia rarely develops in patients with advanced forms of prostate cancer. Several factors play a role, including metastatic lesions of erythropoiesis (pelvis, long tubular bones, vertebral bodies). Malaise and anorexia may be due to a lack of iron in food. Also anemia is a consequence of a chronic oncological disease. Usually anemia proceeds secretly, patients tolerate it quite well. Some patients still need treatment, during which they use preparations of the gland, vitamins and erythropoietins. Sometimes blood transfusion (erythrocyte mass) is used, which, as a rule, improves the general condition of patients.

[18], [19]