Skip to main content

Palliative Care for Metastatic Symptomatic CRPC

  • Chapter
  • First Online:
  • 823 Accesses

Abstract

Symptom development in advanced castration-resistant prostate cancer (CRPC) patients can be attributed to local invasion of the tumor, metastasis to the bone, or compression of the spinal cord. Along the course of disease progression, 50–70% of the patients will eventually develop complications. Bone metastasis and consequent skeletal complications are the most common manifestations which may increase the risk of death from prostate cancer and decrease life quality. The clinical manifestations of bone metastasis include pain, skeletal-related events, and additional medical cost. Advancements in the understanding of the disease have resulted in the development of new palliation strategies. In this chapter, we examine several interventional options for local and systemic disease manifestation, bone-targeted palliative agents, and bone-targeted agents which potentially improve survival and management strategies for spinal cord compression. These treatments include various agents, namely, bisphosphonates, human monoclonal antibodies, and alpha- and beta-emitting radiopharmaceuticals.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Cameron MG, Kersten C, Guren MG, Fosså SD, Vistad I. Palliative pelvic radiotherapy of symptomatic incurable prostate cancer—a systematic review. Radiother Oncol. 2014;110(1):55–60.

    Article  PubMed  Google Scholar 

  2. Banning A, Sjogren P, Henriksen H. Pain causes in 200 patients referred to a multidisciplinary cancer pain clinic. Pain. 1991;45(1):45–8.

    Article  CAS  PubMed  Google Scholar 

  3. Nielsen OS, Munro AJ, Tannock IF. Bone metastases: pathophysiology and management policy. J Clin Oncol. 1991;9(3):509–24.

    Article  CAS  PubMed  Google Scholar 

  4. Roodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004;350(16):1655–64.

    Article  CAS  PubMed  Google Scholar 

  5. Wagner G. Frequency of pain in patients with cancer. Recent Results Cancer Res. 1984;89:64–71.

    Article  CAS  PubMed  Google Scholar 

  6. Porter AT, McEwan AJ, Powe JE, Reid R, McGowan DG, Lukka H, et al. Results of a randomized phase-III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phys. 1993;25(5):805–13.

    Article  CAS  PubMed  Google Scholar 

  7. Tiedje LB, Kingry MJ, Stommel M. Patient attitudes concerning health behaviors during pregnancy: initial development of a questionnaire. Health Educ Q. 1992;19(4):481–93.

    Article  CAS  PubMed  Google Scholar 

  8. Pathological fractures due to bone metastases. Br Med J (Clin Res Ed). 1981;283(6294):748.

    Google Scholar 

  9. Galasko CS. The management of skeletal metastases. J R Coll Surg Edinb. 1980;25(3):144–61.

    PubMed  CAS  Google Scholar 

  10. Lane MD, Le HB, Lee S, Young C, Heran MK, Badii M, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients. Skelet Radiol. 2011;40(1):25–32.

    Article  Google Scholar 

  11. Miles CL, Fellowes D, Goodman ML, Wilkinson S. Laxatives for the management of constipation in palliative care patients. Cochrane Database Syst Rev. 2006;18(4):CD003448.

    Google Scholar 

  12. Smith MR. Zoledronic acid to prevent skeletal complications in cancer: corroborating the evidence. Cancer Treat Rev. 2005;31(Suppl 3):19–25.

    Article  CAS  PubMed  Google Scholar 

  13. Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L. Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. J Natl Cancer Inst. 2004;96(11):879–82.

    Article  CAS  PubMed  Google Scholar 

  14. Smith MR, McGovern FJ, Zietman AL, Fallon MA, Hayden DL, Schoenfeld DA, et al. Pamidronate to prevent bone loss during androgen-deprivation therapy for prostate cancer. N Engl J Med. 2001;345(13):948–55.

    Article  CAS  PubMed  Google Scholar 

  15. Smith MR, Eastham J, Gleason DM, Shasha D, Tchekmedyian S, Zinner N. Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer. J Urol. 2003;169(6):2008–12.

    Article  CAS  PubMed  Google Scholar 

  16. Berry S, Waldron T, Winquist E, Lukka H. The use of bisphosphonates in men with hormone-refractory prostate cancer: a systematic review of randomized trials. Can J Urol. 2006;13(4):3180–8.

    PubMed  Google Scholar 

  17. Van den Wyngaert T, Huizing MT, Fossion E, Vermorken JB. Bisphosphonates in oncology: rising stars or fallen heroes. Oncologist. 2009;14(2):181–91.

    Article  CAS  PubMed  Google Scholar 

  18. Fizazi K, Carducci M, Smith M, Damião R, Brown J, Karsh L, et al. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. Lancet. 2011;377(9768):813–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sartor O, Reid RH, Hoskin PJ, Quick DP, Ell PJ, Coleman RE, et al. Samarium-153-Lexidronam complex for treatment of painful bone metastases in hormone-refractory prostate cancer. Urology. 2004;63(5):940–5.

    Article  PubMed  Google Scholar 

  20. Roqué I, Figuls M, Martinez-Zapata MJ, Scott-Brown M, Alonso-Coello P. Radioisotopes for metastatic bone pain. Cochrane Database Syst Rev. 2011;(7):CD003347.

  21. Tu SM, Millikan RE, Mengistu B, Delpassand ES, Amato RJ, Pagliaro LC, et al. Bone-targeted therapy for advanced androgen-independent carcinoma of the prostate: a randomised phase II trial. Lancet. 2001;357(9253):336–41.

    Article  CAS  PubMed  Google Scholar 

  22. Henriksen G, Fisher DR, Roeske JC, Bruland ØS, Larsen RH. Targeting of osseous sites with alpha-emitting 223Ra: comparison with the beta-emitter 89Sr in mice. J Nucl Med. 2003;44(2):252–9.

    PubMed  CAS  Google Scholar 

  23. Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013;369(3):213–23.

    Article  CAS  PubMed  Google Scholar 

  24. Grossman SA, Lossignol D. Diagnosis and treatment of epidural metastases. Oncology (Williston Park). 1990;4(4):47–54; discussion 55,58.

    CAS  Google Scholar 

  25. George R, Jeba J, Ramkumar G, Chacko AG, Leng M, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev. 2015;9:CD006716.

    Google Scholar 

  26. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kyo Chul Koo .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Koo, K.C. (2018). Palliative Care for Metastatic Symptomatic CRPC. In: Kim, C. (eds) Management of Advanced Prostate Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-6943-7_25

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-6943-7_25

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-6942-0

  • Online ISBN: 978-981-10-6943-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics