End-stage pain in prostate cancer

In the context of a terminal prostate cancer, various and extremely strong pain can occur. A very important part of the treatment is an adequate pain therapy. Patients should contact their treating physician directly when pain occurs and not only when the pain is unbearable.

Due to medical progress, pain can now be minimized in 8-9 out of 10 cancer patients. To this end, both drug and non-drug measures are used. The treatment plan is drawn up by the treating physician, pain therapists and other specialists.

In case of lighter pain, pain medication is used. Opioids may be effective for more severe pain. If the pain originates directly from a nerve, it has certain characteristics and usually cannot be reduced with the usual painkillers.

This pain is described in medical terminology as neuropathic pain. In neuropathic pain, various other medications can relieve the pain. These can also be drugs that are not actually painkillers, but which can relieve pain in addition to their main effect.

These drugs include certain antidepressants, for example. This means that the active substance is then not used because of depression, but because of the pain. Accordingly, a different, lower dosage is chosen than if the drug were used to treat depression.

Chemo-, radiation-, hormone and antibody therapies can also relieve the pain. In some cases, nerve lines that trigger the pain are blocked. This is done by injecting a drug that numbs the pain directly and locally near the spinal cord. Non-drug therapies can also provide additional relief.These include certain physiotherapy and occupational therapy measures, acupuncture or nerve stimulation procedures.

End-stage metastases from prostate cancer

Starting from prostate cancer, cells can detach and spread to other parts of the body. Via the bloodstream, the cancer cells can enter the liver, which is well supplied with blood, and form tumor foci, liver metastases. Doctors speak of hematogenic scattering.

Although prostate cancer is not one of the classic tumors of origin of liver metastases, which otherwise occur mainly in esophageal, gastric or colon cancer, it can certainly spread to the liver. There are different types of liver metastases: Synchronous liver metastases are detected simultaneously with the prostate tumor. Metachromatic metastases develop in an already treated prostate cancer only in the further course of the disease.

Single liver metastases are single tumor metastases, whereas multiple metastases lead to multiple metastases. The size, location, appearance and number of liver metastases are decisive for treatment options and prognosis. Liver metastases can have a different appearance.

A sharply defined liver metastases, which can be easily distinguished from the rest of the liver tissue, can be distinguished from extensive metastases that grow without a sharp border. Cells of the prostate tumor can also settle in the spinal area via the bloodstream. The resulting spinal metastases can constrict nerves, muscles and vertebrae, which can cause various complaints.

Pain, sensation and movement disorders can occur if the nerve cords in the spinal cord are affected. The affected body regions depend on the exact location (height and lateral alignment) of the spinal metastasis. Bone metastases are again formed via the bloodstream.

Bone metastases are often associated with severe pain and bone fractures. However, they can also remain completely asymptomatic. If bone metastases are suspected, a special examination, a bone scintigraphy, is performed.

It is possible to irradiate the bone metastases relatively specifically in order to stabilize the bones and reduce pain. There are various options for irradiating the bone metastases: In addition to the classical irradiation, irradiation with radionuclides is also possible. Radionuclides are radiating particles that the body incorporates into the bone, where they finally take effect.

In addition, so-called bisphosphonates are used for bone metastases. These are drugs that influence the metabolism of the bone. In addition, specially produced antibodies are now also frequently used to minimize damage to the bone.

Migrating cancer cells of prostate carcinoma can spread throughout the body not only via the bloodstream but also via the lymphatic system. Thus, lymph node metastases can occur primarily in the lymph nodes in the pelvic area, but also outside the pelvis. The lymph nodes are usually the first to be affected by metastases, as cancer cells reach the lymphatic system earlier than the bloodstream.

However, lymph node metastases do not necessarily cause perceptible symptoms for those affected. The examination measures and search for lymph node metastases depend on the treatment plan. Accordingly, an ultrasound, magnetic resonance imaging (MRI) and/or surgery are performed.

Lymph node metastases can be detected most reliably in the course of a surgical intervention, and in cases of doubt, they can be removed directly. The operation is usually performed minimally invasive by laparoscopy. In the case of a large number of affected lymph nodes, it must be considered whether their removal is still appropriate in the final stage.

If prostate cancer cells enter the brain via the blood, they can multiply and spread via the cerebrospinal fluid (liquor). Metastases in the brain not only compress brain tissue through their growth, but also cause fluid accumulation and swelling of brain structures, thus additionally increasing the pressure on healthy tissue in the brain. Accordingly, brain metastases can trigger various and serious complaints.

Depending on which area is affected and how severe the damage to nerve and brain tissue is, the symptoms and complaints can vary. For example, brain metastases can lead to headaches, nausea, circulatory problems with dizziness, visual disturbances, seizures, speech disorders, cognitive limitations, mental disorders or paralysis.When the cancer cells migrate along the nerve water spaces and the meninges to the spinal cord, the technical jargon speaks of meningiosis carcinomatosa. In this case, those affected often suffer from headaches, nausea, vomiting and personality disorders. In addition, the so-called cranial nerves can be damaged so that swallowing disorders can occur. The voice can also be impaired.