Prescrire international
-
Prescrire international · Feb 2013
ReviewFirst-line treatment of metastatic prostate cancer. Androgen suppression for symptomatic disease.
Prostate cancer sometimes metastasizes, especially to bone, which may cause pain, fractures and spinal cord compression. What are the best first-line treatment options for patients with metastatic prostate cancer? To answer this question, we conducted a review of the literature, using the standard Prescrire methodology. Suppressing androgen secretion by surgically removing the testicles (orchiectomy) or by administering a gonadorelin agonist relieves the pain associated with bone metastases in about 80% of patients. ⋯ First-line hormonal treatments are initially very effective in relieving symptoms of metastatic prostate cancer. Our analysis of the available data suggests that the best treatment option is androgen suppression with goserelin. Flutamide monotherapy is an alternative for some patients.
-
Surgical errors recorded between 2002 and 2008 in a US medical liability insurance database have been analysed. Twenty-five wrong-patient procedures were recorded, resulting in 5 serious adverse events: three unnecessary prostatectomies were performed after prostate biopsy samples were mislabelled; vitrectomy was performed on the wrong patient in an ophthalmology department after confusion between two patients with identical names; and a child scheduled for adenoidectomy received a tympanic drain. There were also 107 wrong-site procedures, with one death resulting from implantation of a pleural drain on the wrong side. ⋯ Final pre-operative checks must be applied methodically and systematically. This includes asking the patient to confirm his/her identity and the intended site of the operation. Healthcare staff must be aware of these measures.
-
Prescrire international · Jan 2013
ReviewLocally advanced prostate cancer: effective treatments, but many adverse effects.
Locally advanced prostate tumours, i.e. those that extend beyond the prostate gland but are not metastatic, often carry a poor prognosis: between 10% and 40% of patients die within 5 years after diagnosis. Various treatments are proposed to improve their prognosis. Which treatments have a proven survival benefit, and what are their adverse effects? To answer these questions, we reviewed the literature using the standard Prescrire methodology. ⋯ The adverse effects of gonadorelin agonists often undermine patients' quality of life, due to hot flushes, loss of libido, erectile dysfunction, gynaecomastia, osteoporosis, weight gain, cardiovascular events, and diabetes. In mid-2012, European clinical practice guidelines recommend a combination of radiation therapy and androgen suppression for 2 to 3 years for most patients with locally advanced prostate cancer. Before choosing between therapeutic options, it is crucial to take into account the patient's priorities in terms of treatment efficacy and adverse effects, and reversibility of adverse effects.