Prostate Restored
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What happens in the final stages of metastatic prostate cancer?

It is most common that PC metastasizes to bone (particularly the pelvis and spine), which can lead to incapacitating pain and fractures. Bone metastases occur in 70% of men with advanced disease and are present in 90% of men who die from PC.

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The results of this study showed that men with mPC generally rated their QoL and physical functioning poorly, compared to clinically important threshold values. All three groups of men rated their QoL and physical functioning lower than the threshold values, indicating the need for clinical attention. The ratings for pain and fatigue were higher than the threshold values in the groups of men that died < 6 months and 6–18 months before the last questionnaire. Another finding in this study was that men that died during or after 2006 generally rated their QoL and functioning lower and symptoms like pain and fatigue higher than the group that died before 2006. From a palliative care perspective QoL is the main outcome along with symptom alleviation [29], hence the great proportion of men in all three groups that rated their QoL under the threshold value and their high ratings of symptoms like pain and fatigue compared to threshold values should be taken seriously. In the present study, the men that died < 6 months after the last questionnaire generally rated more symptoms than the two other groups, which of course could be attributed to the more advanced disease. A cancer trajectory usually entails a reasonably predictable decline of the physical health [30] with a more rapid deterioration in the last months before death [31], and in this late phase, increasing bodily symptoms will often be a dominant part of the person’s life [13]. Earlier research has found that a palliative care approach to life-threatening illness could reduce the symptom burden and improve QoL [32], indicating that it may be appropriate for men with mPC [8]. It is also important to stress that even though men who were closer to death had worse ratings, focus should not just be at men with mPC in their final months of life. A Cochrane review found that an early integration of palliative care interventions in advanced cancer could lead to less symptom burden and a higher QoL. Palliative care provides an additional layer of support that can improve QoL also for patients with longer life expectancy and not just supportive care at end of life [5]. No significant differences were found between the groups with regards to urinary or sexual problems, which are typically associated with PC. All men in this sample had been treated with radiation therapy, and since this treatment, as well as castration therapy, have a long-term effect on men’s sexuality and urinary symptoms [33, 34] this may explain that there were no differences between the groups regarding sexual and urinary symptoms.

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It is noteworthy that men in the group that died after 2006 rated their QoL and functioning significantly lower and their pain and fatigue higher than the group that died before 2006. After 2006, the palliative care services in Sweden have expanded, focus on palliative care have also increased in other settings, and new policy documents have been presented that give this form of care a high priority [35]. Therefore, it is surprising that men who died after 2006 rate variables that traditionally are given a high focus in palliative care worse than those who died before 2006. A reason behind these ratings could be that new life-prolonging treatments also have side effects [36, 37], which could contribute to lower QoL ratings and higher symptom ratings. These results highlight the importance of balancing between life expectancy and QoL in treatment decisions for these patients. Symptom relief, particularly for pain, has been declared an essential human right [38], and should be given a high priority in the care of patients with mPC. Screening instruments could be used to capture changes in the patient’s ratings and threshold values could be used to evaluate the need for clinical attention. Although palliative care has traditionally been introduced in late stages of illness, cooperation between oncologists and palliative care teams can take place to provide the best care for men in all phases of mPC. An early integration of palliative care could be offered alongside life-prolonging therapies but also when the patient is approaching the end of life [5, 9]. In conclusion, there is a place for a palliative care approach in all time periods for patients with mPC.

Strengths and limitations

Strengths of this study included a reasonably large sample of participants and a very long follow-up time. The fact that all data are based on patient reported outcomes is another strength. Both parametric and non-parametric tests were performed, and the nonparametric tests confirmed the results from parametric tests. The results were also confirmed through a correction for multiple comparisons which could reduce the risk of committing Type-1 errors. There are also limitations to this study, which makes it necessary to be cautious in the interpretation of the results. The EORTC QLQ C-30 was initially developed for studying QoL, function and symptoms as an outcome for anti-cancer treatment in clinical trials and not for patients with advanced disease, although it has been used in several studies in this context. Also, the three groups in this study were not of equal size as the > 18 months group was more than twice as large as the < 6 months group.

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Is decaf coffee OK for enlarged prostate?

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The findings are based on just one measurement of men with PC in their last years before death. To further verify the results in this study, it would be interesting to study men with mPC over time, through the various phases before death. Another limitation is the assumption that the men in this study died from mPC. Because information on the actual causes of death was not available in this study, it could be possible that they died for other reasons. It would also have been valuable to have more information on which treatments the men received, as this field has developed rapidly over the last decade. The division between men who died before and after 2006 was based on the median for this sample and could be considered arbitrary. However, as has been previously stated, this was an important year for the development of palliative care in Sweden. New life-prolonging treatments for mPC had also been presented in 2004 and Swedish policy documents imply that they were not fully implemented until a couple of years later.

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What foods to avoid after prostate surgery?

The first few days after your surgery, you should have light foods until you have your first bowel movement. Light foods include a sandwich,...

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