Alterations of sexual function in men with cancer.

OBJECTIVES: To provide an overview of the challenges in sexuality men face when they have been diagnosed and treated for various types of cancer. DATA SOURCES: Review and research articles, abstracts, books, electronic databases, clinical experience. CONCLUSIONS: An in-depth assessment of sexual needs and issues specific to men includes physical and psychosocial problems related to sexuality. Interventions include psychosocial sexual interventions, coping strategies, communication strengthening exercises, or alternative sexual techniques that will assist if physical functioning is diminished. Various medical, surgical, or pharmacologic approaches are available. IMPLICATIONS FOR NURSING PRACTICE: Although it is recognized that male sexuality in the cancer arena has been overlooked in the past, nurses have the opportunity to change this trend in the clinical setting and improve sexual health care delivery for men.

A phase I and pharmacokinetic study of silybin-phytosome in prostate cancer patients.

Silibinin is a polyphenolic flavonoid isolated from milk thistle with anti-neoplastic activity in several in vitro and in vivo models of cancer, including prostate cancer. Silybin-phytosome is a commercially available formulation containing silibinin. This trial was designed to assess the toxicity of high-dose silybin-phytosome and recommend a phase II dose. Silybin-phytosome was administered orally to prostate cancer patients, giving 2.5-20 g daily, in three divided doses. Each course was 4 weeks in duration. Thirteen patients received a total of 91 courses of silybin-phytosome. Baseline patient characteristics included: median age of 70 years, median baseline prostate specific antigen (PSA) of 4.3 ng/ml, and a median ECOG performance status of 0. The most prominent adverse event was hyperbilirubinemia, with grade 1-2 bilirubin elevations in 9 of the 13 patients. The only grade 3 toxicity observed was elevation of alanine aminotransferase (ALT) in one patient; no grade 4 toxicity was noted. No objective PSA responses were observed. We conclude that 13 g of oral silybin-phytosome daily, in 3 divided doses, appears to be well tolerated in patients with advanced prostate cancer and is the recommended phase II dose. Asymptomatic liver toxicity is the most commonly seen adverse event.

The use of trastuzumab in the treatment of hormone refractory prostate cancer; phase II trial.

PURPOSE: To investigate the efficacy and toxicity of the antibody to the HER-2/neu receptor (trastuzumab, Herceptin) in the treatment of advanced hormone-refractory prostate cancer (HRPC). MATERIALS AND METHODS: Eighteen patients with HRPC were recruited for this phase II trial in which they received trastuzumab for 12 weeks or until disease progression or unacceptable toxicity was documented. HER-2 receptor overexpression was evaluated using immunohistochemistry (IHC) and dual-color fluorescence in-situ hybridization (FISH) assays. RESULTS: Trastuzumab as a single agent demonstrated little efficacy in treating HRPC. Two patients demonstrated stable disease based on a decrease in PSA level to less than 50% of baseline. No patient demonstrated a regression of radiographic bony or soft tissue metastatic disease. The medication was well tolerated in 16 patients (89%), and 2 patients (11%) had to be hospitalized for cardiac complications. CONCLUSIONS: Trastuzumab (Herceptin) as a single agent demonstrated poor efficacy in treating HRPC. Based on promising results in treating breast cancer with regimens using Herceptin and cytotoxic agents, a similar combination approach might demonstrate better efficacy in treating HRPC.

Metronomic therapy with cyclophosphamide and dexamethasone for prostate carcinoma.

BACKGROUND: The current study was designed to evaluate the efficacy and toxicity of the continuous oral administration of a combination of cyclophosphamide (50 mg/day given in the morning) and dexamethasone (1 mg/day given in the evening) in patients with prostate specific antigen (PSA) progression despite single or multiagent hormone therapy and antiandrogen withdrawal. METHODS: The authors retrospectively evaluated the medical records of all patients with prostate carcinoma who were treated with dexamethasone and cyclophosphamide and who were unable to participate in Phase II drug trials or had failed previous chemotherapy regimens. RESULTS: Using clinical response guidelines set forth by the Prostate Specific Antigen Working Group, 29% of patients were found to have a > or = 80% reduction in PSA, 39% were found to have a 50-79% reduction in PSA, 6% were found to have a < 50% decrease in PSA, and 26% experienced disease progression while receiving treatment. The duration of response was 8 months (95% confidence interval [95% CI], 4-10 months). The duration of treatment was 9 months (95% CI, 6-14 months). The treatment was reported to be well tolerated with side effects being primarily bruising, Cushingoid facies, and gastrointestinal distress. CONCLUSIONS: In the current study, low-dose dexamethasone and cyclophosphamide demonstrated efficacy as salvage therapy in the treatment of patients with hormone-refractory prostate carcinoma.

A qualitative investigation of fatigue among healthy working adults.

Despite considerable attention to fatigue in acute and chronic illnesses, little is known about fatigue in a healthy population. A detailed exploration of fatigue, therefore, was conducted to answer the broad question of what fatigue is to a basically healthy population and to lay the groundwork for establishing an empirically based definition of fatigue. Qualitative and quantitative methods were used. Results of the qualitative phase of the study, in which 40 persons were interviewed, are presented here. Categories and themes of the experience of fatigue were identified. Based on the qualitative findings, we propose that fatigue in generally healthy adults is an acute, subjective, sometimes overwhelming, but temporary state (with physical, emotional, and behavioral manifestations) caused by stress and overwork in one's life roles, which disrupts activity and alerts the person to take restorative measures.