First-line Therapy Oestrogens are non-standard first-line therapies CAB not recommended for routine use Intermittent hormone treatment is experimental BAUS MPC Guidelines 2005.
Second-line Systemic Therapies Chemotherapy - major part of management Alternative therapies not recommended –Use should be discussed openly Clinical trials - discuss and consider BAUS MPC Guidelines 2005.
Systemic Management of Metastatic Bone Disease Metastatic Bone Disease (MBD) is common in prostate patients Skeletal Related Events –Bone Pain –Fracture –Spinal Cord Compression BAUS MPC Guidelines 2005.
Systemic Management of Metastatic Bone Disease In HRPC, evidence suggests a role for early bisphosphonate therapy to reduce risk and/or delay progression to SRE –Zoledronic acid is the only bisphosphonate proven to reduce this risk BAUS MPC Guidelines 2005.
Systemic Management of Metastatic Bone Disease For established SREs –Treatment options also include: Radiotherapy, surgery and analgesics BAUS MPC Guidelines 2005.
Radiotherapy Early referral External beam and Radionuclide therapy BAUS MPC Guidelines 2005.
Spinal Cord Compression Consider in any prostate cancer patient presenting with back pain Patient should be asked about –numbness –weakness and –bladder/bowel dysfunction BAUS MPC Guidelines 2005.
Spinal Cord Compression Once confirmed –immediate action to prevent irreversible effects BAUS MPC Guidelines 2005.
Obstructive Uropathy Regular monitoring of serum creatinine Urinary tract US or CT to confirm diagnosis Urgency of intervention determined by degree of renal failure and hyperkalaemia BAUS MPC Guidelines 2005.
Palliative Care Identify and refer early on Needs of the patient and their carers should be addressed Pain must be assessed and treated Access to specialist services BAUS MPC Guidelines 2005.
Patient Perspective Good communication skills are key Diagnosis is usually emotionally devastating Men’s involvement in their own care should be assessed on an ongoing basis BAUS MPC Guidelines 2005.