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TRANSCRIPT
Prostate cancer
Treatments – Side effects and
management in the community setting
Kristoffer Ohlin – CNS Urology
Janice Minter – Lead Cancer Nurse
St George’s Hospital
Agenda
• Prostate cancer treatments
– Radiotherapy
– Surgery
– Focal therapies
- Who is offered what
• Side effects of treatment
– Management in the community setting
• Breakout session on ED and Continence
• Hands on training – Holistic needs assessments & care plans
Prostate cancer is a very
treatable form of cancer
• Many different treatment
options with similar
outcomes
• Who is offered what and
why?
8Re-referral
3MRI/Biopsy
2Review
1Referral
5Diagnostic
Interventions
Diagnosis and how it impacts treatment- The diagnostic pathway
4MDT
6Treatment
7Follow-up
Staging of the prostate cancer affects
choice of treatment
Staging made simple
Localised prostate cancer
(stage 1 and 2)
Locally advanced prostate
cancer (stage 3)
Advanced prostate cancer
(stage 4)
Focal treatments – Stage 1 and 2a+b
• Cryotherapy
• Hifu
• Nanoknife
• Targeted photodynamic therapy
Focal treatments
• The main cancer lesion(s) within the prostate are targeted with
the treatment – the whole gland is not treated – the patient will
likely require multiple such treatments over his lifetime.
Curative treatments – Prostate cancer
stage 1 – 3
Can be divided into two treatment types
Radical treatment – Treatment aimed at the whole gland
• Surgery
• Radical radiotherapy
• (Permanent seed brachytherapy)
Radical prostatectomy
Radical prostatectomy
• The prostate is removed in its entirety, together with the
seminal vesicles and sometimes with extended lymph node
clearance in order to cure the cancer.
External beam
radiotherapy
Radiotherapy
• The whole prostate is treated with radiation daily over 6 weeks,
destroying the prostate tissue and the prostate cancer – often
combined with hormone treatment
Permanent seed
brachytherapy
Permanent seed brachytherapy
• Seeds of radioactive material are inserted directly into the
prostate through the perineum using a mapping template,
these seeds over time will destroy the prostate tissue and the
prostate cancer. Not suitable for men with BPE.
Androgen deprivation
therapy (hormone
therapy)
Used for Advanced
prostate cancer or in
conjunction with
radiotherapy
Androgen deprivation therapy (Stage 4 or
used in conjunction with radiotherapy)
• Stops the production of the male hormone testosterone that
allows the prostate cancer to grow and spread
• Used as monotherapy for men with cancer that can’t be cured
or with radiotherapy in order to stop the cancer from spreading
while the treatment is ongoing.
Side effects resulting from treatment
• Incontinence
• Erectile dysfunction
• Infertility
• Cystitis
• Bowel irritation
• Urinary retention
• Fatigue
• Mood changes
• Loss of libido
• Depression
• Cardiovascular events
• Osteoporosis
• Hot flushes
• Memory problems
Side effects of surgery
• Side effects are immediate and include
– Fatigue
– Incontinence
– Erectile dysfunction
Side effects likely to improve over time with good
management
Continence Pelvic floor muscle exercises will
strengthen the support for the
bladder and most men will regain
continence within a year
In those men that do not regain
continence, surgical implants can
help
Erectile dysfunction PDE5 inhibitors like Viagra and
Cialis introduced early will improve
local blood flow and nerve
regeneration
Use of a vacuum device helps
preserve erectile tissues
Other medical treatments
Implants if not successful
Management of surgical side effects
Side effects of radiotherapy
• Immediate side effects include
– Fatigue
– Bowel problems – diarrhoea, blood in the stool, abdominal pain
– Irritation of bladder and urinary tract (dysuria, urgency, frequency, retention, leakage)
– Dysorgasmia
• Long term side effects can develop over time, including the above but also include
– Erectile dysfunction
– Incontinence
– Secondary cancers (more than 15 years later).
• Side effects are irreversible but can be managed symptomatically
Side effects of androgen deprivation
therapy
• Weight gain
• Hair loss
• Breast tenderness and enlargement
• Loss of libido
• Erectile dysfunction
• Hot flushes
• Fatigue
• Mood swings
Side effects of androgen deprivation
therapy continued
• Strength and muscle loss
• Osteoporosis
• Memory loss
• Increased risk for cardiovascular disease and events
• Increased risk of developing type 2 diabetes
• Increased risk of stroke
• Side effects last for as long as treatment continues and will
continue until testosterone levels normalise
• Some side effects may never improve
Management of side effectsfrom treatment is tailored based on the patient’s needs and wants.
A useful tool for measuring your patient’s distress levels and concerns is a Holistic Needs Assessment
• A simple questionnaire that
is completed by a person
affected by cancer
• 3 Parts- set of questions,
Discussion, Written Care
Plan
Holistic Needs Assessment
Holistic Needs Assessment
Men with urological cancer
Common concerns
Any Questions?
Hands on training:Holistic needs assessments and care plans
In your groups, consider this scenario, review the holistic needs assessment, and make a care plan.
A 54 year old African Caribbean gentleman comes to see you at work. He had his prostatectomy a year ago and is struggling emotionally and financially and is having regrets about having the operation. His stage of cancer was T3a, which means his cancer was just breaching the capsule of the gland. He does not seem to understand what his stage of cancer means. He had partially nerve sparing surgery, but is yet to have return of erections usable for sexual intercourse. He is still suffering from incontinence and uses two pads per day. He has grown estranged from his life partner and his children, struggling to connect, as he himself feels inadequate as a man. He feels ashamed of himself, and has not talked to anyone else about his issues. He does not feel comfortable around the doctors and nurses in the hospital and is struggling to open up to them. From your conversation it becomes apparent that he has not spoken to anyone in his community about his issues.