End Stage Of Prostate Cancer
Prostate cancer is a malignant tumor which generally affects men older than the age of 50. The tumor develops inside the gland located just below the bladder, called the prostate gland. The disease has its own specific course and goes through a distinct;stages.
The rate and nature of the progression of prostate cancer is individual and the first symptoms occur when the tumor becomes large enough to;initiate;compression or infiltrate;nearby organs and tissues. Prostate cancer;can be also diagnosed “accidentally”, when the man has a medical checkup for unrelated reasons and the tumor is found over the course of this treatment.
Unfortunately, prostate cancer may remain asymptomatic for a long period of time. In such cases it is diagnosed late, when it has already resulted in bone metastases.
What Is the Life Expectancy for Patients with Prostate Cancer?
End stage prostate cancer also called the terminal stage of prostate cancer ;is the most advanced stage of the disease. This stage of prostate cancer has its own distinct symptoms and signs which may vary from patient to patient but what is common for all people with end stage of the disease is soon, inevitable lethal outcome. End stage prostate cancer is simply incurable.
In The Last Days Of Life Patients And Family Members Are Faced With Making Decisions About Treatments To Keep The Patient Alive
Decisions about whether to use life-sustaining treatments that may extend life in the final weeks or days cause a great deal of confusion and anxiety. Some of these treatments are ventilator use, parenteral nutrition, and dialysis.
Patients may be guided by their oncologist, but have the right to make their own choices about life-sustaining treatments. The following are some of the questions to discuss:
- What are the patients goals of care?
- How would the possible benefits of life-sustaining treatments help reach the patient’s goals of care, and how likely would this be?
- How would the possible harms of life-sustaining treatments affect the patient’s goals of care? Is the possible benefit worth the possible harm?
- Besides possible benefits and harms of life-sustaining treatments, what else can affect the decision?
- Are there other professionals, such as a chaplain or medical ethicist, who could help the patient or family decide about life-sustaining treatments?
Dad Terminal Prostate Cancer
hi I originally posted in another thread on ‘Introduce yourself’. I haven’t been on here for a while.
my dad was diagnosed with terminal prostate cancer back in January – he’s been on hormone therapy since then. He was told the cancer had spread to his lymph nodes and lungs and that it was incurable. They couldn’t say how long he ahead left to live. He couldnt have chemo as he has a history of stroke, high blood pressure.;He had a bone scan sometime in the summer which came back clear. However, he had another appointment recently and he’s been told that the cancer has now spread to the bone on one area of his;spine in the lower back and it has spread even further in his lungs. I was dreading it spreading to his bone and this can be the worse. :((( however, he does seem ok physically for now, he’s not in pain but he keeps suffering from incontinence problems at both ends, mainly urgency to urinate and not making it in time. This is getting worse. So he’s going to be put on aberitarone and steroids as well to help control the cancer but has he already suffers with diabetes and a history of stroke, high blood pressure, this new drug will make all of that worse, but it will control his cancer more. So its a gamble and more added pressure and worry. Dreading what’s to come, and this latest news has just knocked us all as well. Taking each day as it comes
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Treatment For Advanced Prostate Cancer
Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.
A multidisciplinary team ;will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.
The main treatments are:
- Hormonal therapy
Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.
Chemotherapy uses anti-cancer drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.
Radiotherapy is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. Its given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.
Surgery to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.
Your doctor or nurse will usually ask you to sign a form giving your permission for them to give you the treatment. They cannot give treatment without your consent.
How Is Advanced Prostate Cancer Diagnosed
If youve previously been diagnosed with prostate cancer, be sure to tell your doctor if you have any new symptoms, even if youve completed treatment.
To determine if prostate cancer has returned or has spread, your doctor will likely order some imaging tests, which may include:
- PET scans
- bone scans
You probably wont need all of these tests. Your doctor will choose the tests based on your symptoms and physical exam.
If any of the images reveal abnormalities, it doesnt necessarily mean that you have cancer. Additional testing may be necessary. If they find a mass, your doctor will probably order a biopsy.
For a biopsy, your doctor will use a needle to remove samples from the suspicious area. A pathologist will then analyze the removed cells under a microscope to see if theyre cancerous. The pathologist can also determine if you have an aggressive form of prostate cancer.
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Advanced Prostate Cancer Symptoms
Men with advanced prostate cancer may experience additional symptoms. Thats because the cancer has spread from the prostate to other parts of the body, such as the bones or lymph nodes.
A wide range of treatment options are available for managing advanced cancer. These treatments kill cancer cells, but they may also help patients manage pain.
Signs of metastatic prostate cancer may include:
- Swelling in legs or pelvic area
- Numbness or pain in the hips, legs or feet
- Bone pain that persists or leads to fractures
Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer.;However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
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Patients And Their Families May Have Cultural Or Religious Beliefs And Customs That Are Important At The Time Of Death
After the patient dies, family members and caregivers may wish to stay with the patient a while. There may be certain customs or rituals that are important to the patient and family at this time. These might include rituals for coping with death, handling the patient’s body, making final arrangements for the body, and honoring the death. The patient and family members should let the healthcare team know about any customs or rituals they want performed after the patient’s death.
Understanding What Happens Immediately After Death
When death occurs, the person’s muscles will relax, breathing will stop, the heart will stop beating, and there will be no pulse.
Even when death is expected, it is commonand normalfor caregivers to feel a sense of shock and disbelief. Although home health or hospice staff and the person’s doctor should be notified, a natural death is not an emergency. There is usually no need to call medical personnel immediately. Many people find it comforting to take some time to sit with their loved one, perhaps talking quietly, holding hands, or watching their loved one at peace.
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Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
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Care That Supports A Patient’s Spiritual Health May Improve Quality Of Life
A spiritual assessment is a method or tool used by doctors to understand the role that religious and spiritual beliefs have in the patient’s life. This may help the doctor understand how these beliefs affect the way the patient copes with cancer and makes decisions about cancer treatment.
Serious illnesses like cancer may cause patients or family caregivers to have doubts about their beliefs or religious values and cause spiritual distress. Some studies show that patients with cancer may feel anger at God or may have a loss of faith after being diagnosed. Other patients may have feelings of spiritual distress when coping with cancer. Spiritual distress may affect end-of-life decisions and increase depression.
Doctors and nurses, together with social workers and psychologists, may be able to offer care that supports a patient’s spiritual health. They may encourage patients to meet with their spiritual or religious leaders or join a spiritual support group. This may improve patients’ quality of life and ability to cope. When patients with advanced cancer receive spiritual support from the medical team, they are more likely to choose hospice care and less aggressive treatment at the end of life.
See the PDQ summary on Spirituality in Cancer Care for more information.
What Is The Outlook
No cure is available for stage 4 prostate cancer. Your healthcare team will work with you to help control the cancer for as long as possible while maintaining a good quality of life.
Your outlook will depend on how fast the cancer is spreading and how well you respond to therapies.
With treatment, you can live for many years with metastatic prostate cancer.
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Are Older Men Undertreated
Schwartz and colleagues reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.
Thompson and colleagues investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Getting More Information About What To Expect
- National Institute for Health and Care Excellence.;Palliative care for adults: strong opioids for pain relief. Clinical guideline 140. ; 2012.;
- National Institute for Health and Care Excellence.;Prostate cancer: Diagnosis and treatment. NICE clinical guideline 175. 2014.;
- Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, DAndrea G, et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res CR. 2005 Jun;24:2037.;
- Thompson JC, Wood J, Feuer D. Prostate cancer: palliative care and pain relief. Br Med Bull. 2007;83:34154.;
- Vinjamoori AH, Jagannathan JP, Shinagare AB, Taplin M-E, Oh WK, Van den Abbeele AD, et al. Atypical Metastases From Prostate Cancer: 10-Year Experience at a Single Institution. Am J Roentgenol. 2012 Aug;199:36772.
- Kate Bullen, Head of School for Applied Social Science, University of Brighton, Brighton
- Jackie Dawson, Community Palliative Care Clinical Nurse Specialist, Guys and St Thomas NHS Foundation Trust
- Hazel Parsons, Palliative Care Nurse Specialists, Dorothy House Hospice, Winsley, Bradford on Avon
- Elizabeth Rees, Lead Nurse for end of life care, Leeds Teaching Hospitals
- Our Specialist Nurses
Emotional And Spiritual Needs
Palliative care extends far beyond the physical. Experts can recommend support groups and counselors to help you manage depression, fear, and anxiety. They can also help you open the doors of communication with your partner to talk about sensitive issues like sex.
Chaplains and other palliative care professionals can discuss spiritual or religious issues. They can even help you achieve lifelong goals. Palliative care staffers helped one person with cancer, who regretted not marrying their fiancee, to tie the knot right at their bedside.Â;
If you decide to stop treatment and move into hospice care, a palliative care team can help with that as well.
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Possible Changes In Body Function
- Profound weakness usually the patient cant get out of bed and has trouble moving around in bed
- Needs help with nearly everything
- Less and less interest in food, often with very little food and fluid intake for days
- Trouble swallowing pills and medicines
- More drowsiness the patient may doze or sleep much of the time if pain is relieved, and may be hard to rouse or wake
- Lips may appear to droop
- Short attention span, may not be able to focus on whats happening
- Confusion about time, place, or people
- Limited ability to cooperate with caregivers
- Sudden movement of any muscle, jerking of hands, arms, legs, or face
What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages.
- Stages I & II: The tumor has not spread beyond the prostate. This is often called early stage or localized prostate cancer.
- Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called locally advanced prostate cancer.
- Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called advanced prostate cancer.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . If prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer. Stage IV prostate cancer is not curable, but there are many ways to control it. Treatment can stop advanced prostate cancer from growing and causing symptoms.
There are several types of advanced prostate cancer, including:
If your Prostate Specific Antigen level has risen after the first treatment but you have no other signs of cancer, you have “biochemical recurrence.”
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs
Metastatic Hormone-Sensitive Prostate Cancer
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