Complications arising in the final year of life in men dying from advanced prostate cancer.

OBJECTIVES: There are sparse anecdotal data on complications occurring in the final year of life in men dying of prostate cancer. The study aim was to record such data together with the interventions necessary and subsequent outcomes. METHODS: Using an established prostate cancer database detailing all men presenting to a single institute with the disease, case notes and the hospital electronic databases were examined from men diagnosed with hormone refractory prostate cancer that went on to die of their disease between January 1, 1995 and December 31, 2002 (n=226). The frequency of complications and subsequent therapeutic interventions within the final 12 months of life were recorded together with the effect of those interventions. RESULTS: The most common incident complications arose in the lower urinary tract. Overall, 27% (61 men) had lower urinary tract complications (LUTS), 12% (n=27) had progressive renal failure, 10% (n=23) became anemic, and 9% (n=21) had persistent bone pain despite analgesia. Fourteen percent (n=37) had skeletal-related complications (including bone pain, fractures, and cord compression). One hundred four men (46%) had a cancer-related complication with 25% (n=56) requiring related intervention(s). An improvement was observed in over three quarters of men (76%) who received an intervention. These included "channel" transurethral resection of prostate (TURP) (14% of men; n=32), long-term urethral or suprapubic catheterization (7.5%; n=17), blood transfusion (7.5%; n=17), external beam radiation for pain (4.9%; n=11), nephrostomy tube or ureteric stent insertion (2.7%; n=6), and fracture fixation (2.2%; n=5). CONCLUSIONS: The commonest adverse events in the final year of life in men dying of advanced prostate cancer are those of LUTS, renal failure, anemia, and bone pain with almost half of men developing at least one of these. The majority of men who had interventions demonstrated a subjective or objective improvement.

Can palliative radiotherapy influence prostate-specific antigen response in patients with castrate-resistant prostate cancer treated with systemic therapy (chemotherapy or abiraterone)?-a report of three cases.

Palliative radiotherapy (pRT) is primarily employed for palliation of bone pain in patients with castrate-resistant prostate cancer (CRPC). However, evidence that pRT influences prostate-specific antigen response in patients with CRPC on systemic therapy is lacking. We describe three cases of CRPC progressing after treatment with docetaxel (n=2) and abiraterone (n=1), who responded unusually after pRT for bone pain with the development of a significant biochemical response and restoration of response to systemic therapy. The possibility of pRT influencing metastatic disease in CRPC has not been previously reported, and raises the possibility of radiation-induced modulation of anti-tumor immune response mechanisms that may play a role in the restoration of response to systemic treatment.

Sequential maximum androgen blockade (MAB) in minimally symptomatic prostate cancer progressing after initial MAB: two case reports.

The management of castrate-resistant prostate cancer progressing after maximum androgen blockade (MAB) has evolved in the last decade with the development of several novel therapeutic options. However, the initial therapeutic strategy in these patients usually involves withdrawal of anti-androgen that can be associated with biochemical response in approximately 20% of patients. Notably, we have observed evidence of sustained biochemical response in two patients following second- and third-line MAB using rechallenge schedule of previously administered anti-androgen after latent interval. The possibility of response following sequential MAB using the same anti-androgen agent has not yet been reported.

Persistent Ureteric Dilatation due to Pelvic Actinomycosis Presenting as Pelvic Inflammatory Disease.

Actinomyces is a Gram-positive, filamentous bacterium that normally colonizes mucosal areas. Pelvic actinomycosis is a chronic granulomatous disease caused by Actinomyces israelii that frequently mimics ovarian tumors during presentation. It is diagnosed after surgery in most of the cases. Intravenous penicillin is the most preferred therapeutic agent, and it requires hospitalization up to one month. Pelvic actinomycosis is a rare cause of ureteric obstruction and renal failure. The final diagnosis is usually difficult and often apparent only after histological examination of an operative specimen. The present case led us to consider the etiology and clinical findings and to review the management of reported cases involving ureteric obstruction.

Male adnexal tumour of probable Wolffian duct origin.

Male adnexal tumours of Wolffian duct origin are very rare. They have variable malignant potential and surgical excision is recommended. We report the case of a 56-year-old male who presented with a swelling in the perineum thought to be a haematoma as the result of a complication of a laparoscopic inguinal hernia repair. It recurred after incision and two attempts at drainage and was then completely excised. Histology revealed the lesion to be an adnexal tumour of probable Wolffian duct origin. To our knowledge there have only been two previous cases of male adnexal tumour of Wolffian duct origin reported in the literature.