Palliative care for prostate cancer

Prostate cancer is the most common cancer in men, and is usually localised. Metastatic prostate cancer is a stage of cancer in which the cancer has spread (metastasised) to other parts of the body.

In most cases, prostate cancer is diagnosed at the localised stage, meaning that it may be possible to cure it with surgery, radiation therapy, and medication. In some cases, all that’s required is surveillance. Sometimes prostate cancer comes back after treatment, or is found to have spread when it’s first found. Even if metastatic prostate cancer can’t be cured, treatment with drugs can slow down the cancer’s progression, sometimes for several years.

It’s important to let your attending physician and other members of your care team know about any symptoms you’re experiencing, because symptoms caused by metastases can be managed effectively. Palliative care, aimed at symptom management, is provided alongside chemotherapy, and continues after other treatments are stopped, in other words when moving to palliative care only.

Important

You don’t have to cope with your symptoms alone

Be sure to tell your attending physician and members of the nursing staff about your symptoms. Although effective cancer treatment also relieves the symptoms, other treatment methods are often needed as well. Good symptom management does not affect other aspects of cancer treatment, but rather, these different approaches enhance one another and help you live a life that is as good and active as possible.

Symptoms depend on where the metastases are located. Prostate cancer typically spreads to the bones or nearby lymph nodes, and less commonly to other internal organs. Read on for more information about the most common symptoms caused by metastases.

Bone pain and other symptoms related to bone metastases

Since bone metastases are very common in metastatic prostate cancer and tend to cause pain, especially when moving, pain relief is an important consideration. The aim is to maintain functional capacity so that the patient can cope with daily activities without being limited by pain. Both pain medicines and radiation therapy are effective. Bone metastases occurring in prostate cancer are also treated with radioisotopes. These are radioactive substances that collect in the bones and treat the skeleton with short-range radiation therapy. Radioisotopes are given into a vein as an outpatient procedure carried out by a cancer treatment unit.

Bone metastases can also cause fractures, and metastases in the spine can press on the spinal cord. These situations call for acute medical attention.

In the case of widespread bone metastases, bone marrow function may be disrupted, leading to low haemoglobin levels (anaemia). Symptoms may include fatigue, shortness of breath on exertion, and in those with heart disease, chest pain. These symptoms may have many different causes, which is why it’s good to bring them up with your attending physician. Sometimes anaemia is treated with interventions such as red blood cell transfusions.

Symptoms caused by tumours in the pelvic area

If cancer spreads to local lymph nodes in the pelvic and abdominal area, it may not show any symptoms for a long time. The metastases may interfere with the lymphatic flow, leading to swelling (oedema) in the legs. Oedema can be treated with compression products (socks) or bandages. If an enlarged lymph node is causing problems such as pain or obstruction in the ureter or lymphatic system, radiation therapy may be used to shrink it. Obstruction of the ureter may also be treated by placing a ureteral catheter during a bladder examination procedure (cystoscopy), or by placing a small tube through the skin and into the kidney (percutaneous nephrostomy).

Locally recurrent prostate cancer, and in some cases, local treatments targeting the prostate (surgery, radiation therapy), may cause difficulty with urination or problems with the rectum. In such cases, it’s good to bring this up with the attending physician, since many of these problems can be managed.

Psychological strain

Having an illness puts strain on the mind too. Living with a long-term illness includes both good and bad moments. It’s good to talk to the care team about how you’re coping mentally. Depression and anxiety can be managed both by talking and with medication. Peer support may also be helpful.

While cancer treatment is still ongoing, it’s advisable to contact the unit responsible for your care if your general condition worsens, you develop symptoms that interfere with your life, or your symptoms get worse. Units specialised in cancer treatment have expertise in palliative care, including symptom relief and pain management. All cancer units in university hospitals, and most central hospitals, have palliative care units that can help with symptom management. Psychosocial support and talk support is also available. It’s a good idea to get acquainted with the local palliative unit while undergoing active cancer treatment, so that palliative care can be offered and planned early on.

When it’s time to end active cancer treatment, palliative care continues – at this point, the patient should be assigned a care provider in charge of their palliative care, and provided with a palliative care plan. No one should be left to cope with their illness alone.

At the end of life, the care provider in charge of the patient’s care preferably attends to the patient either at or close to the patient’s home. This can be a palliative outpatient clinic, inpatient ward at a regional hospital (formerly health centre hospital), home hospital, palliative ward, or a hospice. For assistance with essential care needs, home care services are employed. The important thing is to have a plan ready for where to get help at any time of the day or week.

At the end of life, going to the emergency department is a taxing experience. That’s why it’s preferably avoided by cooperating with the care team ahead of time to prepare a plan for what to do if the patient’s condition gets worse or if their symptoms change. Unless it’s an acute medical emergency, it’s advisable to contact the unit responsible for the patient’s care before visiting the emergency department. If the patient has pre-existing access to home hospital services, a nurse or doctor can visit the patient at home and assess the situation, if necessary, or make arrangements for transfer to inpatient care (support ward) without the need to visit the emergency department.

Palliative services

Most common symptoms