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INTRODUCTION

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Managing patients with advanced prostate cancer is a challenge to all members of the multidisciplinary team. These patients often have numerous problems – physical, social and psychological. It is all too easy to lose sight of the bigger picture – that of improving the patient’s quality of life and treating symptoms without increasing the patient’s morbidity.

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WHY PALLIATIVE CARE?

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Palliative care has traditionally been the active total care of patients whose disease is not being treated with a curative intent [1]. However, this can now be applied as an approach at all stages of the patient’s journey. This approach has been recognized in the UK by National Institute for Clinical Excellence (NICE) guidance [2] in urological cancers and in the publication of Improving Outcomes in Urological Cancers Manual and Improving Supportive and Palliative Care for Adults with Cancer Manual.

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Palliative care as an approach looks at the individual and uses a multidisciplinary approach to providing care either in the person’s home, in hospital or in the hospice. It focuses on quality of life as well as symptom control.

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This chapter is written from the perspectives of both the oncologist and palliative care physician and hopes to put the message across that symptom control should be part of the patient’s journey from the point of diagnosis to death. Symptom control should be the responsibility of all members of the multidisciplinary team and primary care team. Where the treatment occurs should be determined by patient choice.

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We aim to give an overview of the treatment strategies available to treat the common symptoms of advanced prostate cancer. It is important that they are used appropriately and at the right time as the window of opportunity may be narrow.

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Carcinoma of the prostate is now the second most common cause of cancer death in the UK for men [3], and it is anticipated that this will increase with an aging population. In this group, 60% will have advanced disease when they are first seen [4] and this translates into symptoms. As with many cancers the disease can take on a chronic pattern with good hormonal control but, because of patient age, there are often a multitude of other medical problems that also need to be treated actively.

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Treatments are changing for prostate carcinoma, but they remain essentially palliative in nature and they often cause a raft of side-effects that need to be palliated themselves. Data looking at prostate cancer deaths showed that 61% of patients needed palliative interventions (radiation, urological intervention) before death and that, on average, they spent 5 weeks in hospital [6]. This shows that the use of acute services is high for this group. However, separate data shows that the same group are the third most common being referred to ...

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