Complications Arising In The Final Year Of Life In Men Dying From Advanced Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Palliative Care / Hospice Care;  Urology / Nephrology
Article Date: 02 Aug 2007 - 0:00 PDT

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UroToday.com- Dr. Khafagy and investigators from Manchester, UK report on prostate cancer (CaP), end of life complications, and palliative management in the Journal of Palliative Medicine. This type of data acquisition and analysis of management outcomes has not been previously reported.

The authors sought to determine if palliative interventions were of benefit to patients with androgen independent prostate cancer (AICaP). The CaP database of the Salford Royal Hospitals was reviewed and 226 men with AICaP who died from their disease between 1995 and 2002 were identified. Complications and therapeutic interventions that occurred in the last 12 months of life were recorded. Recorded complications included anemia, symptomatic LUTS, progressive renal failure, bone pain requiring treatment, pathologic fractures, spinal cord compression, and rectal bleeding. Interventions included channel TURP, blood transfusion, long-term bladder catheter usage, nephrostomy tube placement, and/or external beam radiotherapy for bone metastasis.

Median age at death from AICaP was 77 years. On beginning the final year of life 6% had abnormal renal function, 1.8% received prior outlet obstruction surgery, and 0.4% had a nephrostomy tube. Complications arising during the final year of life were LUTS in 27%, progressive renal dysfunction in 12%, anemia in 10%, bone pain despite analgesia (9%), pathologic fractures in 2.6%, spinal cord compression in 2.2%, and skeletal related complications in 14%.

In total 104 men (46%) had an AICaP related complications with 25% (56 men) requiring an intervention. Interventions included TURP (14%), bladder catheter drainage (7.5%), blood transfusion (7.5%), radiotherapy for bone pain in 4.9%, upper tract diversion in 2.7%, and skeletal fracture fixation in 2.2%. Among men receiving an intervention 76% showed an improvement, 16% showing no significant change, and 8% showing deterioration. This report advises urologists to be aware of end of life complications from AICaP and to be proactive in providing intervention to improve patient well being.

Khafagy R, Shackley D, Samuel J, O'Flynn K, Betts C, Clarke N

J Palliative Med. 10(3):705-11, June 2007
doi:10.1089/jpm.2006.0185

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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