PUID: 59 || PLAB 2 Mock :: Counseling: Prostate Cancer Pain Management
- examiner mla
- Aug 16
- 2 min read
Summary:
This PLAB 2 case focuses on counseling and managing a patient with known metastatic prostate cancer presenting with severe back pain. The patient’s primary concern is effective pain relief to enable him to attend his daughter’s wedding. The scenario tests the candidate’s ability to balance clinical management, palliative care, patient-centered communication, and ethical considerations.
Key Points:
Main System Involved: Musculoskeletal & Oncology (Bone Metastasis)
Presenting complaint: Severe back pain due to prostate cancer metastasis.
Important to clarify onset, character, severity, associated neurological symptoms (e.g., cauda equina features).
Pain is the central issue—not further curative treatment.
Psychosocial Context
Patient understands his diagnosis and prognosis.
Motivation for attending consultation: To be well enough to attend his daughter’s wedding.
Expectation: Effective pain management rather than curative treatment.
Important Considerations:
Recognize the consultation as primarily counseling and palliative care.
Focus on symptom relief and quality of life rather than curative options.
Always use ICE (Ideas, Concerns, Expectations) to clarify why the patient has presented today.
Ensure holistic assessment: physical, psychological, and social well-being.
Diagnostic Approach:
History
Explore pain: SOCRATES (Site, Onset, Character, Radiation, Associations, Timing, Exacerbating/Relieving, Severity).
Screen for red flag symptoms (neurological deficits, bladder/bowel dysfunction).
Review past prostate cancer treatments (hormonal therapy, chemotherapy, radiotherapy).
Assess medication history: effectiveness, side effects.
Social history: support system, mobility, emotional impact.
Examination
General assessment and vitals.
Targeted spine/back exam: tenderness, range of motion.
Neurological exam of lower limbs.
Functional assessment (mobility, activities of daily living).
Investigations
MRI spine (exclude cord compression, assess extent of disease).
Bloods: renal/liver function, PSA (disease monitoring).
Review oncology records.
Management:
Pharmacological
First-line: Strong opioids (e.g., morphine, starting at a low dose and titrating).
Co-prescribe laxatives for opioid-induced constipation.
Consider adjuvant analgesics:
NSAIDs (if tolerated).
Bisphosphonates for bone pain.
Corticosteroids for reducing spinal cord pressure/pain.
Radiotherapy for focal painful bone metastases.
Non-Pharmacological
Gentle physiotherapy & occupational therapy.
Mobility aids to maintain independence.
Psychological support, reassurance, and counseling.
Referral & Support
Palliative care team involvement for holistic support.
Provide patient information leaflets on pain management and safe opioid use.
Arrange follow-up within days to reassess pain control.
Safety Netting
Advise on red flag symptoms requiring urgent review (neurological deficits, bladder/bowel issues).
Ensure clear follow-up plan before attending wedding.
Communication Skills:
Use empathetic, layman-friendly language.
Check understanding regularly.
Acknowledge patient’s emotions and wishes.
Focus on patient-centered goals (attending the wedding).
Encourage questions and shared decision-making.
Maintain professional but compassionate demeanor.
Ethical Considerations:
Respect patient autonomy in care planning.
Prioritize quality of life over aggressive treatment.
Maintain confidentiality and professional boundaries.
Apply Good Medical Practice principles: honesty, integrity, clear communication, and acting in the patient’s best interests.
Additional Resources:
NICE Guidelines: Prostate cancer and palliative care management.
WHO Pain Ladder for cancer pain.
GMC’s Good Medical Practice guidance.
PLAB examiner tips: Focus on patient-centered consultation, avoid rehearsed phrases, demonstrate logical management.
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