Highlights 8th International EAUN Meeting

Exchange of ideas, knowledge and research brings nurses closer together

The 8th International Meeting of the EAUN, held from 21 to 24 March in conjunction with the 22nd Annual EAU Congress, was very successful. No less than 245 nurses with experience in urological care visited the congress to get the latest updates about their profession. The interested audience could make use of simultaneous translations from English to German.

A first for the EAUN was the course on prostate cancer, organised by the European School of Urology. Part 1 of the course was entitled metastatic prostate cancer. Dr. T.M. De Reijke of the Amsterdam Medical Centre (NL), highlighted the clinical picture, diagnosis and natural history of the disease. In 30% of patients a biochemical relapse occurs, i.e. their PSA value goes up after radical prostatectomy. When a certain PSA threshold is reached this means that the prostate cancer has reappeared in either a local or metastatic form in other tissues and organs. Dr. De Reijke stressed that even if PSA rises, it may take more than 8 years before metastatic disease develops. This is important to keep in mind, especially in elderly patients.

When PSA>20 ng/ml, Gleason score>7 or in case of bilateral tumours, lymph node dissection should be performed which gives an 87% accuracy. Very small iron oxide particles are injected. They are not absorbed by the metastases and are thus visible under an MRI scan.

A new phenomenon in the diagnosis of metastasized prostate cancer is the use of tracers, although questions remain about where to inject the tracer. Since the metastases are usually found in the bone, a bone scan would seem a logical diagnostic instrument. However it is not very sensitive and
therefore CT and MRI scans are often used. But if the patient does not present any clinical symptoms it is unnecessary to look for visceral metastases.

Incurable but not untreatable
The treatment alternatives were presented by Mr Noel Clarke of the Christie Hospital Wilmslow Road, Manchester (UK). Patients usually suffer from multidisciplinary urinary problems. Due to cancerrelated complications they need intervention, sometimes more than one. Obstruction because of cancer growth may be treated with TURP, suprapubic catheters, ureteric stenting or a urinary bypass, but we have to keep in mind that the treatment may be more painful than the obstruction. The quality of life always needs to be evaluated together with the patient.

The main problems in this disease are bone marrow failure, bone pain, pathological fracture and cord compression. The treatments of choice for these conditions, although not always successful, are steroids, radiotherapy and hormone treatment. A subject of discussion is cytotoxic chemotherapy in
prostate cancer. It is said to improve overall survival, but when to start chemotherapy and for how long is still under debate. The conclusion may be that hormone refractory prostate cancer is incurable but not untreatable.

Lena Hohwü, nurse in the Aarhus University Hospital of Skejby (DK), highlighted the subject of nursing and pain management in patients with advanced prostate cancer. She explained the different types of pain and the choice of analgesics: morphine, oxycodone, methadone and patches. Her advice is not to give NSAIDs in pain management, since these drugs give more adverse effects after long-term use. Pain management remains a team effort of the GP, the primary care nurse and the palliative team.

Several treatment options
Part 2 of the programme was kicked off by Professor Gerald Mickisch from Bremen (DE). He informed the nurses that prostate cancer occurs more often than it used to, because of changes in our diet and the introduction of screening programmes. Professor Mickisch explained PSA and DRE and stressed that an ultrasound procedure and a biopsy can confirm the diagnosis of prostate cancer. There are several treatment options, such as watchful waiting,
hormonal treatment (only palliative for advanced cases), open and laparoscopic surgery and radiotherapy; the latter gives good results with regard to quality of life. Nowadays temperature treatments (HIFU and cryotherapy) have matured, although HIFU is only registered in Europe as palliative treatment for patients with advanced prostate cancer.

Incontinence and impotence
EAUN Board Member Patricia Slappendel, nurse at Andros Men’s Health Institute, talked about incontinence and impotence after prostate cancer
treatment. The number of prostate cancer patients is increasing and their age is decreasing. Younger men have more trouble accepting impotence and
incontinence after prostate cancer treatment, thus better care should be provided. Patients expect urological nurses to take a leading role and start
talking about the subject, since they themselves are too ashamed to talk.

What can nurses do to take better care of prostate cancer patients?
Ms Slappendel said that it is necessary to employ specialized, better trained nurses. There should be contact between patient and nurse before and after
the treatment, including better follow-up. Treatment protocols and exchange of information will definitely help as well as involving the partner in the procedure.
National support groups could offer a great deal of comfort to anyone suffering from prostate cancer, either as a patient or as a relative.