Complications arising in the final year of life in men dying from advanced prostate cancer

Objectives: There are sparse anecdotal data on complications occurring in the final year of life in men dying of prostate cancer. The study aim was to record such data together with the interventions necessary and subsequent outcomes. Methods: Using an established prostate cancer database detailing all men presenting to a single institute with the disease, case notes and the hospital electronic databases were examined from men diagnosed with hormone refractory prostate cancer that went on to die of their disease between January 1, 1995 and December 31, 2002 (n = 226). The frequency of complications and subsequent therapeutic interventions within the final 12 months of life were recorded together with the effect of those interventions. Results: The most common incident complications arose in the lower urinary tract. Overall, 27% (61 men) had lower urinary tract complications (LUTS), 12% (n = 27) had progressive renal failure, 10% (n = 23) became anemic, and 9% (n = 21) had persistent bone pain despite analgesia. Fourteen percent (n = 37) had skeletal-related complications (including bone pain, fractures, and cord compression). One hundred four men (46%) had a cancer-related complication with 25% (n = 56) requiring related intervention(s). An improvement was observed in over three quarters of men (76%) who received an intervention. These included channel transurethral resection of prostate (TURP) (14% of men; n = 32), long-term urethral or suprapubic catheterization (7.5%; n = 17), blood transfusion (7.5%; n = 17), external beam radiation for pain (4.9%; n = 11), nephrostomy tube or ureteric stent insertion (2.7%; n = 6), and fracture fixation (2.2%; n = 5). Conclusions: The commonest adverse events in the final year of life in men dying of advanced prostate cancer are those of LUTS, renal failure, anemia, and bone pain with almost half of men developing at least one of these. The majority of men who had interventions demonstrated a subjective or objective improvement.