Prostate cancer therapies, complications and sixteen questions that the patients and the multidisciplinary team are interested in

Bernardo-Filho, Mario; Missailidis, Sotiris; Santos-Filho, Sebastião and Fonseca, Adenilson (2009). Prostate cancer therapies, complications and sixteen questions that the patients and the multidisciplinary team are interested in. Gene Therapy and Molecular Biology, 13(B) pp. 254–263.



Prostate cancer (PC) is the most common solid cancer in men worldwide and studies involving the health care of prostate cancer patients are of particular importance. The determination of the prostate specific antigen (PSA), and development of new techniques, such as rectal touch and ultrasonography, significantly aid in the early diagnosis of the PC. Radical prostatectomy (RP) and radiation therapy (RT) are considered radical/curative therapies. Clinical complications, however, such as urinary incontinence (UI) and erectile dysfunction (ED) have been associated with these therapies. The aim of this work is to review current therapies for prostate cancer and identify in the literature papers that present questions related with the patients with PC, such as the personal attitudes, the convenient type of treatment, the knowledge about the possible complications and the treatments available to minimize the clinical complications. The identified questions were related to (a) personal situations related with the possible treatments (PST), (b) clinical conditions after the RP (CCARP), (c) clinical conditions after RT (CCART), (d) laboratory evaluations and medications (LEM) and (e) available procedures to minimize the clinical complications of the PR or of the RT (PMCC). When the PST was considered, the questions were (i) the care to avoid urgent decisions or treatments, (ii) the involvement of the partner, (iii) the knowledge of what the man believes and what stories he has heard and (iv) the dimension of the risks of the complications. When the CCARP was considered, the questions were related with (v) the pelvic pain that is common mainly in the young men, (vi) the UI that will occur in the postoperative period, (vii) the ED and whether the erectile functioning might return slowly over years after RP, (viii) the penile shortening or fibrosis that might occur after surgery and whether (ix) sexual activity should be compromised. When the LEM are considered, the questions were (x) the phosphodiesterase-5 inhibitors that have limited actions in the cases of ED and (xi) the velocity that is a more reliable indicator of recurrence than an isolated PSA measurement. When the CCART was considered, the questions were that (xii) the bladder irritation is common after RT, (xiii) the bowel complications might occur in the long-term and have high incidence during external beam RT and (xiv) the ED can be early in the surgery in the comparison with RT. When the PMCC was considered, the questions were that the (xv) decrease of the appearance of complications occurs in patients that have undergone physiotherapy before the surgery and (xvi) improvement of the symptoms is observed due to procedures of the physiotherapy after the surgery of PC. This knowledge could help the multi-disciplinary team, as well as the patients with PC to make decisions together, so as to minimize the consequences of the different types of treatments available.

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