Editing Prostate cancer (section)

=== Supportive care ===

Bone metastases – present in around 85% of those with metastatic prostate cancer – are the primary cause of symptoms and death from metastatic prostate cancer.{{sfn|Coleman|Croucher|Padhani|Clézardin|2020|loc="Prevalence of bone metastases"}}{{sfn|Coleman|Croucher|Padhani|Clézardin|2020|loc="Prevalence of SREs"}} Those with constant pain are prescribed [[nonsteroidal anti-inflammatory drug]]s.{{sfn|Coleman|Croucher|Padhani|Clézardin|2020|loc="Analgesics used in CIBP"}} However, people with bone metastases can experience "breakthrough pain", sudden bursts of severe pain that resolve within around 15 minutes, before [[analgesic|pain medications]] can take effect.{{sfn|Coleman|Croucher|Padhani|Clézardin|2020|loc="Analgesics used in CIBP"}} Single sites of pain can be treated with [[external beam radiotherapy|external beam radiation therapy]] to shrink nearby tumors.{{sfn|Scher|Eastham|2022|loc="Pain management"}} More dispersed bone pain can be treated with radioactive compounds that disproportionately accumulate in bone, like [[radium-223]] and [[Samarium (153Sm) lexidronam|samarium-153-EDTMP]], which help reduce the size of bone tumors. Similarly, the systemic chemotherapeutics used for metastatic prostate cancer can reduce pain as they shrink tumors.{{sfn|Scher|Eastham|2022|loc="Pain management"}} Other bone modifying agents like [[zoledronic acid]] and [[denosumab]] can reduce prostate cancer bone pain, even though they have little effect on tumor size.{{sfn|Scher|Eastham|2022|loc="Pain management"}} Metastases compress the spinal cord in up to 12% of those with metastatic prostate cancer causing pain, weakness, numbness, and paralysis.{{sfn|Thompson|Wood|Feuer|2007|loc="Cord compression"}}<ref name=MSCC>{{cite web |url=https://prostatecanceruk.org/prostate-information-and-support/advanced-prostate-cancer/metastatic-spinal-cord-compression-mscc?scrollTo=symptoms-of-MSCC |access-date=25 June 2023 |title=What is Metastatic Spinal Cord Compression (MSCC)? |publisher=Prostate Cancer UK |date=June 2022 |archive-date=26 June 2023 |archive-url=https://web.archive.org/web/20230626033230/https://prostatecanceruk.org/prostate-information-and-support/advanced-prostate-cancer/metastatic-spinal-cord-compression-mscc?scrollTo=symptoms-of-MSCC |url-status=live }}</ref> Inflammation in the spine can be treated with high-dose steroids, as well as surgery and radiotherapy to shrink spinal tumors and relieve pressure on the spinal cord.{{sfn|Thompson|Wood|Feuer|2007|loc="Cord compression"}}<ref name=MSCC/>

Those with advanced prostate cancer suffer fatigue, lethargy, and a generalized weakness. This is caused in part by gastrointestinal problems, with [[loss of appetite]], weight loss, nausea, and [[constipation]] all common. These are typically treated with appetite-increasing drugs – [[megestrol acetate]] or corticosteroids – [[antiemetic]]s, or treatments that focus on underlying gastrointestinal issues.{{sfn|Thompson|Wood|Feuer|2007|loc="Gastrointestinal symptoms"}} General weakness can also be caused by [[anemia]], itself caused by a combination of the disease itself, poor nutrition, and damage to the bone marrow from cancer treatments or bone metastases.{{sfn|Thompson|Wood|Feuer|2007|loc="General debility"}} Anemia can be treated in various ways depending on the cause, or can be addressed directly with [[blood transfusion]]s.{{sfn|Thompson|Wood|Feuer|2007|loc="General debility"}} Organ damage and metastases in the lymph nodes can lead to uncomfortable accumulation of fluid (called [[lymphedema]]) in the genitals or lower limbs. These swellings can be extremely painful, curtailing an affected person's ability to urinate, have sex, or walk normally. Lymphedema can be treated by applying pressure to aid drainage, surgically draining pooled fluid, and cleaning and treating nearby damaged skin.{{sfn|Thompson|Wood|Feuer|2007|loc="Lymphoedema"}}

People with prostate cancer are around twice as likely to experience [[anxiety]] or [[Depression (mood)|depression]] compared to those without cancer.{{sfn|Mundle|Afenya|Agarwal|2021|loc="Estimates of anxiety, depression, and distress"}} When added to normal prostate cancer treatments, psychological interventions such as [[psychoeducation]] and [[cognitive behavioral therapy]] can help reduce anxiety, depression, and general distress.{{sfn|Mundle|Afenya|Agarwal|2021|loc="Abstract"}}

As those severely ill with metastatic prostate cancer approach the end of their lives, most experience confusion and may [[hallucinate]] or have trouble recognizing loved ones.{{sfn|Thompson|Wood|Feuer|2007|loc="Delirium"}}<ref name=PCUK>{{cite web|url=https://prostatecanceruk.org/prostate-information-and-support/advanced-prostate-cancer/dying-from-prostate-cancer/what-to-expect |access-date= 25 June 2023 |title=Dying from Prostate Cancer – What to Expect |publisher=Prostate Cancer UK |date=July 2018}}</ref> Confusion is caused by various conditions, including [[kidney failure]], [[sepsis]], [[dehydration]], and as a side effect of various drugs, especially [[opioid]]s.{{sfn|Thompson|Wood|Feuer|2007|loc="Delirium"}} Most people sleep for long periods, and some feel drowsy when awake.<ref name=PCUK/> Restlessness is also common, sometimes caused by physical discomfort from constipation or [[urinary retention]], sometimes caused by anxiety.<ref name=PCUK/> In their last few days, affected men's breathing may become shallow and slow, with long pauses between breaths. Breathing may be accompanied by a [[terminal secretions|rattling noise]] as fluid lingers in the throat, but this is not uncomfortable for the affected person.<ref name=PCUK/><ref name=ASCO>{{cite web |url=https://www.cancer.net/navigating-cancer-care/advanced-cancer/care-through-final-days |access-date=25 June 2023 |title=Care Through the Final Days |date=November 2022 |publisher=American Society of Clinical Oncology |archive-date=26 June 2023 |archive-url=https://web.archive.org/web/20230626033230/https://www.cancer.net/navigating-cancer-care/advanced-cancer/care-through-final-days |url-status=live }}</ref> Their hands and feet may cool to the touch, and skin become blotchy or blue due to weaker blood circulation. Many stop eating and drinking, resulting in dry-feeling mouth, which can be aided by moistening the mouth and lips.<ref name=PCUK/> The person becomes less and less responsive, and eventually the heart and breathing stop.<ref name=ASCO/>