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As posted on October 5th by www.clinical-genitourinary-cancer.com. With Dr. Neal Shore.
Introduction
Prostate cancer is the second most common malignancy in men worldwide, with an estimated 1.1 million men across the world diagnosed in 2012, and the fifth leading cause of cancer-related death in men, with 307,000 deaths reported worldwide in 2012.1 Prostate cancer is an androgen-dependent disease that initially responds to androgen-deprivation therapy (ie, chemical or surgical castration). However, most men will become resistant to androgen deprivation therapy over time, developing nonmetastatic castration-resistant prostate cancer (CRPC), in which a rise in prostate-specific antigen is often the first detectable sign.2, 3, 4 For some men, nonmetastatic CRPC will progress to metastatic CRPC, which is still uniformly incurable, although several new treatment options have been shown to significantly improve survival, including traditional taxane chemotherapy (docetaxel), new androgen receptor pathway antagonists (enzalutamide, abiraterone), novel taxanes (cabazitaxel), immunotherapy (sipuleucel-T), and targeted alpha therapy (radium-223).5, 6
A large majority of men with metastatic CRPC (90%) will develop bone metastases, which are often initially asymptomatic.6, 7 Although a small proportion of patients are de novo diagnosed with metastatic disease, most bone metastases develop in patients who have failed local treatment and progress under androgen-deprivation therapy. Bone metastases are strongly associated with increased mortality in men with metastatic CRPC, and the risk of death is even higher in men with skeletal-related events.8, 9 In addition to increased mortality, bone metastases are a major cause of disability, bone pain, impaired quality of life (QoL), and excessive treatment costs.6, 10 Pain is the most common symptom, occurring in 75% of symptomatic patients with metastatic prostate cancer,7 while spinal cord compression occurs in up to 12% of patients and may be the first sign of bone metastases.11
To better understand the symptoms associated with advanced prostate cancer (aPC) and the impact of symptoms on the lives of patients and their caregivers, an international survey was commissioned by the International Prostate Cancer Coalition. The goals of the survey were to describe the disease burden, highlight barriers that prevent men from discussing symptoms, explore the patient-caregiver dynamic, and raise awareness of the importance of discussing symptoms with healthcare providers.
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