scholarly journals Management of cancer pain with analgetic adjuvant and weak opioid in prostate cancer bone metastases: A case series

2020 ◽  
Vol 60 ◽  
pp. 575-578
Author(s):  
Jufriady Ismy ◽  
Dessy Rakhmawati Emril ◽  
Rizkidawati
Keyword(s):  
Prostate Cancer ◽  
Cancer Pain ◽  
Bone Metastases ◽  
Case Series ◽  
Weak Opioid

Efficacy and toxicity of extending bone modifying agents beyond two years for bone metastases in breast or castrate-resistant prostate cancer patients: A systematic review.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24083-e24083
Author(s):  
Terry L. Ng ◽  
Megan M. Tu ◽  
Mohammed FK Ibrahim ◽  
Bassam Mohammed Basulaiman ◽  
Sharon McGee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Systematic Review ◽  
Bone Metastases ◽  
Randomized Clinical Trials ◽  
Case Series ◽  
Randomized Studies ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

e24083 Background: Randomized clinical trials evaluated bone modifying agents (BMAs) such as bisphosphonates and denosumab for bone metastases for 1-2 years in duration even though BMA therapy is commonly administered for much longer. A systematic review on the risk-benefit of continuing BMAs for longer than 2 years in breast cancer or castrate-resistant prostate cancer was conducted. Methods: Medline, Embase and Cochrane Register of Controlled Trials were searched (1970 - February 2019) for randomized studies, observational studies, and case series reporting on BMA efficacy and toxicity beyond 2 years. Efficacy was assessed by skeletal-related event (SRE) rates and quality of life metrics. Toxicity was assessed by rates of osteonecrosis of the jaw (ONJ), renal impairment, hypocalcemia, and atypical femoral fractures (AFF). Results: Of 2107 citations, 64 studies were identified. A total of 3 prospective and 9 retrospective studies were eligible. Data beyond 2 years was limited to subgroup analyses in all studies. Three studies [zoledronate (ZOL) (n = 481), pamidronate (PAM) (n = 87), PAM-ZOL (n = 43) ibandronate (n = 30)] reported on SRE-related endpoints. Only one study reported SRE rates based on duration of BMA exposure and showed reduced SRE rates from 27.6% (0-24 months) to 15.5% ( > 24 months) over time. None reported on quality of life. All 12 studies [denosumab (n = 948), ZOL (n = 1036), PAM (n = 163), PAM-ZOL (n = 522), ibandronate (n = 118)] reported on at least one toxicity outcome. Data from 7 bisphosphonate studies (n = 1077) and 1 denosumab study (n = 948) reported on ONJ incidence. In 3 studies (n = 67, n = 221, n = 948), ONJ incidence ranged from 1-4% in the first 2 years and from 3.8-18% beyond 2 years. In another study (n = 252), the cumulative hazard of ONJ was 0% (1% ZOL), 3% (7% ZOL), 7% (21% ZOL) and 11% (21% ZOL) at 12, 24, 36, and 48 months, respectively (p = 0.005); 4 remaining studies reported 1 (n = 181), 3 (n = 57), 7 (n = 99) and 2 (n = 200) cases of ONJ, all after 24 months. Incidence of clinically significant hypocalcemia ranged from 1-2%. Incidence of severe renal function decline was ≤ 3%. AFF occurred in two subjects in one of two studies after 37 and 79 months of BMA exposure. Conclusions: Although the evidence informing the use of BMA is heterogeneous and based on retrospective analysis, BMA exposure beyond 2 years is associated with reduced SRE risk and increased ONJ incidence. Prospective randomized studies addressing the use of BMA for more than 2 years is needed with greater emphasis on quality of life.

Successful use of buprenorphine/naloxone to treat opioid addiction after cancer therapy.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 126-126 ◽  
Author(s):  
Natalie Moryl
Keyword(s):  
Prostate Cancer ◽  
Cancer Pain ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Metastatic Prostate Cancer ◽  
Addiction Treatment ◽  
Case Series ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Opioid Use

126 Background: Cancer pain prevalence is 55-70% and it is treated with opioids. Tapering opioids after completion of cancer treatment may be complicated by addiction, one of the known side effects of chronic opioid use. To improve access to addiction treatment Suboxone has become widely available to patients with addiction and non-malignant pain. We present a case series of successful use of Suboxone in cancer survivors and patients. Methods: Our comprehensive cancer center (CCC) Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 2320 chronic pain cancer patients seen in 2011-2016 in outpatient palliative and pain service clinics. We respectively reviewed the database and EMR to evaluate prevalence of addiction and use of Suboxone in cancer pain patients. Results: Of 134 (6%) patients with ICD-9/10 diagnosis of opioid dependence 11 (8%) patients received Suboxone. Eight were male and average age was 55. Eight patients were cancer survivors, one with stable metastatic prostate cancer and two developed end-stage bladder and breast cancer. Eight cancer survivors and one patient with stable metastatic prostate remained on Suboxone and received no other opioids. The two patients with advanced cancers were ultimately taken off Suboxone and discharged to hospice on TD fentanyl and hydromorphone. Suboxone was prescribed by outside prescribers for eight patients and by a CCC certified Suboxone prescriber for three patients: 75-y-o female dependent on morphine for over 10 years was successfully tapered off morphine and ultimately off Suboxone, 51-y-o lymphoma survivor remains in stable remission for addiction, and a 67-y-o man with stable metastatic prostate cancer and stable remission for addiction has been refusing opioids other than Suboxone for 2 years. Conclusions: Although cancer patients are appropriately exempt from CDC opioid guidelines cancer patients with comorbid addiction may benefit from stopping opioids when pain resolves. In addition to screening for opioid use disorder, use of Suboxone may further improve care for the patients with cancer pain and addiction and increase safety for the caregivers and community.

Computerized Tomography (CT) Updates and Challenges in Diagnosis of Bone Metastases During Prostate Cancer

2020 ◽  
Vol 16 (5) ◽  
pp. 565-571
Author(s):  
Jinguo Zhang ◽  
Guanzhong Zhai ◽  
Bin Yang ◽  
Zhenhe Liu
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Bone Metastases ◽  
Computerized Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Major Complication ◽  
Tracer Uptake ◽  
Emission Computed Tomography ◽  
Pet Ct

Prostate cancer is one of the most common cancers in men. This cancer is often associated with indolent tumors with little or no lethal potential. Some of the patients with aggressive prostate cancer have increased morbidity and early deaths. A major complication in advanced prostate cancer is bone metastasis that mainly results in pain, pathological fractures, and compression of spinal nerves. These complications in turn cause severe pain radiating to the extremities and possibly sensory as well as motor disturbances. Further, in patients with a high risk of metastases, treatment is limited to palliative therapies. Therefore, accurate methods for the detection of bone metastases are essential. Technical advances such as single-photon emission computed tomography/ computed tomography (SPECT/CT) have emerged after the introduction of bone scans. These advanced methods allow tomographic image acquisition and help in attenuation correction with anatomical co-localization. The use of positron emission tomography/CT (PET/CT) scanners is also on the rise. These PET scanners are mainly utilized with 18F-sodium-fluoride (NaF), in order to visualize the skeleton and possible changes. Moreover, NaF PET/CT is associated with higher tracer uptake, increased target-to-background ratio and has a higher spatial resolution. However, these newer technologies have not been adopted in clinical guidelines due to lack of definite evidence in support of their use in bone metastases cases. The present review article is focused on current perspectives and challenges of computerized tomography (CT) applications in cases of bone metastases during prostate cancer.

scholarly journals Radiotherapy of oligometastatic prostate cancer: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Paul Rogowski ◽  
Mack Roach ◽  
Nina-Sophie Schmidt-Hegemann ◽  
Christian Trapp ◽  
Rieke von Bestenbostel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Predictive Factors ◽  
Therapeutic Potential ◽  
Case Series ◽  
Current Evidence ◽  
Oligometastatic Disease ◽  
Psma Pet ◽  
Oligometastatic Prostate Cancer ◽  
Prognostic And Predictive Factors

Abstract Background Due to improved imaging sensitivity, the term “oligometastatic” prostate cancer disease is diagnosed more often, leading to an increasing interest in metastasis-directed therapy (MDT). There are two types of radiation based MDT applied when treating oligometastatic disease: (1) stereotactic body radiation therapy (SBRT) generally used for bone metastases; or (2) SBRT for isolated nodal oligometastases combined with prophylactic elective nodal radiotherapy. This review aims to summarize current evidence data, which may shed light on the optimal management of this heterogeneous group of patients. Methods A systematic review of the Medline database through PubMed was performed according to PRISMA guidelines. All relevant studies published up to November 2020 were identified and screened. Fifty-six titles were included. Besides outcome parameters, different prognostic and predictive factors were assessed, including site of metastases, time between primary treatment and MDT, use of systemic therapies, hormone sensitivity, as well as pattern of recurrence. Findings Evidence consists largely of retrospective case series and no consistent precise definition of oligometastasis exists, however, most investigators seem to acknowledge the need to distinguish between patients presenting with what is frequently called “synchronous” versus “metachronous” oligometastatic disease. Available data on radiotherapy as MDT demonstrate high local control rates and a small but relevant proportion of patients without progressive disease after 2 years. This holds true for both hormone sensitive and castration resistant prostate cancer diseases. The use of 68Ga-PSMA PET/CT for staging increased dramatically. Radiation doses and field sizes varied considerably among the studies. The search for relevant prognostic and predictive factors is ongoing. Conclusions To our best knowledge this review on oligometastatic prostate cancer included the largest number of original articles. It demonstrates the therapeutic potential and challenges of MDT for oligometastatic prostate cancer. Prospective studies are under way and will provide further high-level evidence.

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