LymphedemaV1, Pmc, Corpus, bibRecord, 002589

Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines

Identifieur interne : 002589 ( Pmc/Corpus ); précédent : 002588; suivant : 002590

Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines

Source :

Indian Journal of Urology : IJU : Journal of the Urological Society of India [ 0970-1591 ] ; 2007.

RBID : PMC:2721501

Abstract

Treatment of hormone-resistant prostate cancer can be a challenging situation. The first important step in treating this condition is to assess if one has achieved the castrate level or not. If the castrate levels are not achieved, attempt should be made to achieve so. If the castrate level is achieved, then androgen withdrawals may be of help. Supportive care, care of the clinical problems forms an integral part of the treatment. Cancer-specific chemotherapy is certainly an option in progressive disease.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721501

DOI: 10.4103/0970-1591.30271
PubMed: 19675767
PubMed Central: 2721501

Links to Exploration step

PMC:2721501

Le document en format XML

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<author><name sortKey="Khochikar, Makarand V" sort="Khochikar, Makarand V" uniqKey="Khochikar M" first="Makarand V." last="Khochikar">Makarand V. Khochikar</name>
<affiliation><nlm:aff id="AF0001">Department of Uro-oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India</nlm:aff>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines</title>
<author><name sortKey="Khochikar, Makarand V" sort="Khochikar, Makarand V" uniqKey="Khochikar M" first="Makarand V." last="Khochikar">Makarand V. Khochikar</name>
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<series><title level="j">Indian Journal of Urology : IJU : Journal of the Urological Society of India</title>
<idno type="ISSN">0970-1591</idno>
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<front><div type="abstract" xml:lang="en"><p>Treatment of hormone-resistant prostate cancer can be a challenging situation. The first important step in treating this condition is to assess if one has achieved the castrate level or not. If the castrate levels are not achieved, attempt should be made to achieve so. If the castrate level is achieved, then androgen withdrawals may be of help. Supportive care, care of the clinical problems forms an integral part of the treatment. Cancer-specific chemotherapy is certainly an option in progressive disease.</p>
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<pmc article-type="meeting-report"><pmc-dir>properties open_access</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Indian J Urol</journal-id>
<journal-id journal-id-type="publisher-id">IJU</journal-id>
<journal-title-group><journal-title>Indian Journal of Urology : IJU : Journal of the Urological Society of India</journal-title>
</journal-title-group>
<issn pub-type="ppub">0970-1591</issn>
<issn pub-type="epub">1998-3824</issn>
<publisher><publisher-name>Medknow Publications</publisher-name>
<publisher-loc>India</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">19675767</article-id>
<article-id pub-id-type="pmc">2721501</article-id>
<article-id pub-id-type="publisher-id">IJU-23-67</article-id>
<article-id pub-id-type="doi">10.4103/0970-1591.30271</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Symposium</subject>
</subj-group>
</article-categories>
<title-group><article-title>Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Khochikar</surname>
<given-names>Makarand V.</given-names>
</name>
<xref ref-type="aff" rid="AF0001"></xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
</contrib-group>
<aff id="AF0001">Department of Uro-oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India</aff>
<author-notes><corresp id="cor1"><bold>For correspondence:</bold>
 Makarand V. Khochikar, Department of Uro-oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India. E-mail: <email xlink:href="khochikar@rocketmail.com">khochikar@rocketmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Jan-Mar</season>
<year>2007</year>
</pub-date>
<volume>23</volume>
<issue>1</issue>
<fpage>67</fpage>
<lpage>69</lpage>
<permissions><copyright-statement>© Indian Journal of Urology</copyright-statement>
<copyright-year>2007</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>Treatment of hormone-resistant prostate cancer can be a challenging situation. The first important step in treating this condition is to assess if one has achieved the castrate level or not. If the castrate levels are not achieved, attempt should be made to achieve so. If the castrate level is achieved, then androgen withdrawals may be of help. Supportive care, care of the clinical problems forms an integral part of the treatment. Cancer-specific chemotherapy is certainly an option in progressive disease.</p>
</abstract>
<kwd-group><kwd>Cancer-specific chemotherapy</kwd>
<kwd>castrate levels</kwd>
<kwd>hormone-resistant prostate cancer</kwd>
<kwd>psycho-oncology</kwd>
<kwd>secondary hormonal therapy</kwd>
<kwd>supportive care</kwd>
</kwd-group>
</article-meta>
</front>
<body><p>The first important step in treating hormone-resistant prostate cancer (HRPC) is to find out if complete castrate levels are achieved or not. It has significant bearing on planning the further course of treatment. If the serum testosterone is at noncastrate level then further androgen suppression should be achieved.[<xref ref-type="bibr" rid="CIT1">1</xref>
] If the castrate levels are achieved, then one could have options of either withdrawing antiandrogens or changing antiandrogens or trying intermittent androgen therapy or even trying secondary hormonal therapy. Continued androgen suppression with the same drugs or change of AA has been found to be effective in some patients.[<xref ref-type="bibr" rid="CIT2">2</xref>
<xref ref-type="bibr" rid="CIT3">3</xref>
] Antiandrogen withdrawal has significant effect on the PSA decline – the first report came in 1993 as ‘Flutamide withdrawal syndrome’.[<xref ref-type="bibr" rid="CIT4">4</xref>
] The overall response could be in the range of 15-33% lasting for more 3.5 + months to more than five months in various studies.[<xref ref-type="bibr" rid="CIT5">5</xref>
–<xref ref-type="bibr" rid="CIT8">8</xref>
]</p>
<p>Secondary hormonal therapy also has a significant role to play in HRPC. Its beneficial effect has been found to be in the range of 30-60% with drugs like ketocanazole and aminoglutethimide.[<xref ref-type="bibr" rid="CIT9">9</xref>
–<xref ref-type="bibr" rid="CIT11">11</xref>
] Use of diethylstilbestrol has shown a response rate of 20-40% in various studies.[<xref ref-type="bibr" rid="CIT12">12</xref>
]</p>
<graphic xlink:href="IJU-23-67-g001.jpg" position="float"></graphic>
<p>Secondary hormonal therapy may include DES, ketocanazole, prednisolone, finasteride, dutasteride, estramustine, aminoglutethimide, etc.</p>
<table-wrap id="d32e119" position="float"><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Noncastrate levels</th>
<th align="left" rowspan="1" colspan="1"></th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Previous treatment</td>
<td align="left" rowspan="1" colspan="1">Plan of action</td>
</tr>
<tr><td align="left" colspan="2" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">LH-RH analogues</td>
<td align="left" rowspan="1" colspan="1">Add antiandrogens[<xref ref-type="bibr" rid="CIT14">14</xref>
–<xref ref-type="bibr" rid="CIT15">15</xref>
]</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">LH-RH + antiandrogens</td>
<td align="left" rowspan="1" colspan="1">Change antiandrogens[<xref ref-type="bibr" rid="CIT16">16</xref>
]</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Secondary orchidectomy</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">AA alone</td>
<td align="left" rowspan="1" colspan="1">Add LH-RH</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Secondary orchidectomy?</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Change AA</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Bilateral orchidectomy</td>
<td align="left" rowspan="1" colspan="1">Add antiandrogens</td>
</tr>
</tbody>
</table>
</table-wrap>
<graphic xlink:href="IJU-23-67-g002.jpg" position="float"></graphic>
<table-wrap id="d32e177" position="float"><table frame="hsides" rules="groups"><thead><tr><th align="left" colspan="3" rowspan="1">Clinical problems and the care</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Clinical problem</td>
<td align="left" rowspan="1" colspan="1">Options</td>
<td align="left" rowspan="1" colspan="1">Comment</td>
</tr>
<tr><td align="left" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">BOO</td>
<td align="left" rowspan="1" colspan="1">Indwelling catheter/SPC</td>
<td align="left" rowspan="1" colspan="1">High rate of incontinence</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Channel TURP</td>
<td align="left" rowspan="1" colspan="1">after TURP</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Prostatic stents</td>
<td align="left" rowspan="1" colspan="1">Blockage of stents</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Hematuria</td>
<td align="left" rowspan="1" colspan="1">Bladder washout</td>
<td align="left" rowspan="1" colspan="1">Haemostatic RT quiet useful</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Haemostatic agents</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Haemostatic RT</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Urinary incontinence</td>
<td align="left" rowspan="1" colspan="1">Indwelling catheter</td>
<td align="left" rowspan="1" colspan="1">Can be nuisance despite catheterization</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Ureteric obstruction</td>
<td align="left" rowspan="1" colspan="1">Antegrade stenting</td>
<td align="left" rowspan="1" colspan="1">Most difficult problem is decision-making 'to</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">PCN</td>
<td align="left" rowspan="1" colspan="1">treat or not to treat'.</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Steroids</td>
<td align="left" rowspan="1" colspan="1">Certainly not for dialysislndividual situations</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Honvon</td>
<td align="left" rowspan="1" colspan="1">may make decisions easier</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">? leave alone</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Bony pains</td>
<td align="left" rowspan="1" colspan="1">NSAID</td>
<td align="left" rowspan="1" colspan="1">Use ‘WHO’ ladder for pain relief[<xref ref-type="bibr" rid="CIT17">17</xref>
]</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Opiates</td>
<td align="left" rowspan="1" colspan="1">local RT effective</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Local RT</td>
<td align="left" rowspan="1" colspan="1">Side-effect profile of NSAIDs, opiates,</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Biphosphonates</td>
<td align="left" rowspan="1" colspan="1">strontium can be bothersome</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Strontium[<xref ref-type="bibr" rid="CIT18">18</xref>
]</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">P-32</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Steroids</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Pathological fractures</td>
<td align="left" rowspan="1" colspan="1">Stabilization</td>
<td align="left" rowspan="1" colspan="1">Fixation improves QOL and prevents inherent</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Postfixation-RT</td>
<td align="left" rowspan="1" colspan="1">complications of fractures[<xref ref-type="bibr" rid="CIT19">19</xref>
]</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Spinal cord compression</td>
<td align="left" rowspan="1" colspan="1">Steroids</td>
<td align="left" rowspan="1" colspan="1">Timely treatment essential for impending</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Local RT</td>
<td align="left" rowspan="1" colspan="1">neurodeficit</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Decompression</td>
<td align="left" rowspan="1" colspan="1">A</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Anemia</td>
<td align="left" rowspan="1" colspan="1">RBC component therapy</td>
<td align="left" rowspan="1" colspan="1">Overenthusiastic treatment to be avoided[<xref ref-type="bibr" rid="CIT20">20</xref>
]</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Blood transfusion</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Erythropoietin</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Bone marrow stimulants</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Nutritional support</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Coagulopathy</td>
<td align="left" rowspan="1" colspan="1">Platelets, FFP?</td>
<td align="left" rowspan="1" colspan="1">Apart from the disease, look for any drugs</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Heparin</td>
<td align="left" rowspan="1" colspan="1">responsible for coagulation disorder</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Lymphoedema</td>
<td align="left" rowspan="1" colspan="1">Steroids</td>
<td align="left" rowspan="1" colspan="1">Rarely useful</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Stockings</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Rectal obstruction/</td>
<td align="left" rowspan="1" colspan="1">? Colostomy</td>
<td align="left" rowspan="1" colspan="1">Rarely justified</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">rectovesical fistula</td>
<td align="left" rowspan="1" colspan="1">? ? ? Urinary diversion</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Psychological issues</td>
<td align="left" rowspan="1" colspan="1">Antidepressants</td>
<td align="left" rowspan="1" colspan="1">Psycho-oncology is an emerging branch. Such</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Mood elevators</td>
<td align="left" rowspan="1" colspan="1">professional help can be rewarding</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Counseling[<xref ref-type="bibr" rid="CIT21">21</xref>
<xref ref-type="bibr" rid="CIT22">22</xref>
]</td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>AA - Antiandrogens, BOO - Bladder outflow obstruction, SPC - Suprapubic catheter, RT - Radiotherapy, FFP - Fresh frozen plasma</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>Secondary orchidectomy has a definite role to play if the castrate levels are not achieved. The response rate would be in the range of 5-70% depending on the prior hormone manipulation used and partly due to inconsistent use of the drugs.[<xref ref-type="bibr" rid="CIT13">13</xref>
]</p>
</body>
<back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold>
 Nil</p>
</fn>
<fn fn-type="conflict"><p><bold>Conflict of Interest:</bold>
 None declared.</p>
</fn>
</fn-group>
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</pmc>
</record>

Pour manipuler ce document sous Unix (Dilib)

EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Pmc/Corpus

HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 002589 | SxmlIndent | more

HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 002589 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Wicri/Sante
   |area=    LymphedemaV1
   |flux=    Pmc
   |étape=   Corpus
   |type=    RBID
   |clé=     PMC:2721501
   |texte=   Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines
}}

Pour générer des pages wiki

HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i   -Sk "pubmed:19675767" \
       | HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd   \
       | NlmPubMed2Wicri -a LymphedemaV1

This area was generated with Dilib version V0.6.31.
Data generation: Sat Nov 4 17:40:35 2017. Site generation: Tue Feb 13 16:42:16 2024

	Serveur d'exploration sur le lymphœdème
	Attention, ce site est en cours de développement ! Attention, site généré par des moyens informatiques à partir de corpus bruts. Les informations ne sont donc pas validées.

Serveur d'exploration sur le lymphœdème

Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines

Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines

Source :

Abstract

Links to Exploration step

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri

Pour générer des pages wiki