Management of Prostate Cancer: Global Strategies

Managing cancer-related fatigue in men with prostate cancer: a systematic review of non-pharmacological interventions

The aim of this systematic review was to synthesize the best available evidence informing the effectiveness of non-pharmacological interventions for managing cancer-related fatigue in men treated for prostate cancer. This review considered experimental studies that included men with prostate cancer (regardless of staging, previous treatment or comorbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months. Three interventions were identified for the management of cancer-related fatigue in men with prostate cancer. Evidence from five studies including 447 participants demonstrates the effectiveness of physical activity, both aerobic and resistance exercise, and from three studies including 153 participants suggesting the benefits of psychosocial interventions including education and cognitive behavioural therapy. Health professionals require knowledge of a range of effective interventions aimed at reducing cancer-related fatigue in men with prostate cancer and should incorporate those interventions into their patient management. Although physical activity appears to show the greatest benefit, other non-pharmacological interventions such as education and cognitive behavioural therapy have demonstrated benefit and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.

Prostate cancer in Spain: from guidelines to clinical practice

OBJECTIVE

• To determine how closely practice in prostate cancer (PCa) follows European Association of Urology (EAU) guidelines.

MATERIALS AND METHODS

• This project involving 242 experts comprised four phases: (1) selection of controversial topics by a panel of experts; (2) preparation of case descriptions and associated questionnaires; (3) determination of their face validity; and (4) completion (November 2007 to January 2008). • The primary endpoint was percentage agreement with the recommendations given by the EAU guidelines. Topics not specifically addressed in these guidelines were also analysed.

RESULTS

• For the selected controversial topics, the overall mean adherence to the guidelines was 52.1%. Topics with a mean adherence <40% are detailed below. • For localized/locally advanced PCa the lowest adherence was found for the type of anaesthesia used during biopsy (30.3%, sd= 14.4), local staging (17.3%, sd= 10.4), new criteria for biochemical relapse after radiotherapy (32.9%, sd= 27.6), and the interpretation of raised PSA after prostatectomy (34.4%, sd= 20.1). • For metastatic PCa, the lowest adherence referred to androgen blockade (34.5%, sd= 24.94) and the reintroduction of hormone therapy (21.8%, sd= 13.5). • Regarding the monitoring of patients, 83.9% of the urologists stated that they measure testosterone levels at some point, and the conventional threshold level of 50 ng/dL testosterone was only used by 17.4%. • Differences in opinion were also observed for the recommendation for a digital rectal examination at each visit (agreed by only 22.3%).

CONCLUSION

• The PROSEO project represents an opportunity to consolidate and improve EAU guidelines by identifying issues that, on the basis of clinical practice in PCa and topics of current concern to urologists, have not been fully addressed or might need specific recommendations.