The extent and pattern of symptom relief after surgical castration for patients with advanced prostate cancer treated at a Muhimbili National Hospital.

Abstract

Background: Advanced prostate cancer leads to many symptoms, notably bone pain and lower urinary tract symptoms; however, the degree and duration of pain relief, changes in LUTs severity and underlying factors that predict the extent of relief remain inadequately understood. Surgical castration has proven effective in relieving bone pain and urinary symptoms. Objective: To determine the extent and pattern of symptom relief in advanced prostate cancer patients following surgical castration at Muhimbili National Hospital. Methods: A prospective analytical study was conducted at MNH for a period of 6 months, and patients were followed for 30 days. The international prostate symptoms score tool was used for LUTs assessment, and the pain rating scale was used for assessing bone pain symptoms before and after surgery. Cross-tabulation with chi-square tests as a measure of association was used to test differences in pain relief across different participant characteristics. Modified Poisson regression was used to determine factors associated with complete bone pain relief. Both bivariate and multivariable analyses were performed. A p-value<0.05 was considered to indicate statistical significance. Results. A total of 210 adult men with a mean age of 72.3 years were recruited. The mean LUTs before surgical castration was 15.1 (95% CI 14.4 to 15.7), which was significantly greater than that after surgical castration (mean score 8.0, 95% CI 7.4 to 8.6), this showed a decrease of 7.1 (95% CI 6.4 to 7.7, p<0.001). The mean bone pain score before surgical castration was 74.3 (95% CI 72.4 to 76.3), and that after surgical castration was 34.5 (95% CI 30.6 to 38.4). There was an absolute decrease of 39.8% (95% CI 34.7 to 44.9, p<0.001) in the bone pain score after surgical castration, and more than half of the patients 111 (52.9%) reported bone pain relief within the first two weeks. Conclusion. Surgical castration affects both bone pain control and lower urinary tract symptoms in patients with advanced prostate cancer. Additionally, more studies should be conducted to assess the duration of bone pain relief after surgical castration.