If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Ultimate Outcomes Are Similar Regardless Of The Surgical Approach
In general, while each approach has its advantages, all have been shown to have similar outcomes, adds Dr. Sprenkle. There are no significant differences in outcomes for patients between the open surgery and robotic ones. There is less blood loss on average with robotic surgery, and in the hands of a good surgeon, continence and sexual preservation is the same, he says, adding that while it varies from patient to patient, average recovery time is six weeks. And cancer control is the same. Put another way: Its better to focus on finding the right surgeon rather than the approach or type of surgery.
As far as what that means for patients deciding on which surgery they should get, Dr. Sprenkle says that its important to take time to think about all of your options.
And ask a lot of questions, he says.
Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
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Determining The Prostate Cancer Treatment Thats Right For You
Once prostate cancer has been detected, graded, and given a Gleason score, your doctor will most likely refer you to a cancer specialist called an oncologist. The cancer care team will review the data and other factors like your age, the stage of the cancer, the presence of symptoms, and your overall general health before making the best recommendation.
The stage of cancer helps your oncologist determine how far cancer has spread throughout the body if at all.
- Stage 1 prostate cancer exists in the prostate only.
- Stage 2 prostate cancer has advanced more than stage 1 but hasnt yet spread to any other body parts.
- Stage 3 prostate cancer may still only exist on the prostate but covers more prostate than stage 2 and is accompanied by an abnormal PSA level. Stage 3 prostate cancer has sometimes spread to some of the surrounding tissues.
- Stage 4 prostate cancer has spread to other parts of the body.
This is only a brief overview of the stages, as they can be further broken down for each patients unique situation. Learn more about the staging of prostate cancer.
If the cancer has moved outside of the prostate , youre more likely to need treatment right away. But for those patients who have cancer thats contained inside the prostate and is low grade, there are a few treatment options to consider starting with a watchful waiting approach.
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
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Large Prostate With Few Symptoms
Patients with very enlarged prostates may have few symptoms or mild symptoms. Doctors verify that there are no problems with kidney or bladder function. If not, they know that the enlarged prostate is not harming the body. In this case, doctors may recommend just watching the prostate or doing non-surgical treatments. Options include changing certain eating and drinking habits and urinating less often. Patients can take medications that relax the prostate, such as tamsulosin, or shrink the prostate, such as finasteride or dutasteride. Patients also may try supplements like saw palmetto to help their symptoms.
Other Items To Consider:
Should I choose surgery or radiation for my prostate cancer?
For men deciding between surgery and radiation for prostate cancer treatment, that may help you weigh the pros and cons of each option.
Genomic testing and prostate cancer
Genomic tests can help determine how aggressive your prostate cancer is, and this may influence your treatment decisions. Genomic testing can also help you and your doctor learn more about how your cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively, therefore influencing treatment decisions.
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How To Compare Radiation Vs Surgery For Prostate Cancer
When trying to decide between radiation and surgery for localized prostate cancer, many men still ask whether one approach is better or safer than the other.
Research from the ProtecT trial shows us that radiation and surgery are good options, with the caveat that the specifics of your personal health condition could make one more advisable than the other. If thats not the case, rest assured that youre not at risk of making a terrible decision: Radiation and surgery are both solid options.
How to evaluate radiation vs. surgery comes down to understanding the disease and the research on treatment outcomes, getting a thorough understanding of your specific situation and then deciding which pathway you feel is right for you.
Getting Help With Treatment Decisions
Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.
Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.
You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.
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How Long Does It Take For The Prostate Gland To Heal After A Biopsy
The recovery process after biopsy depends on factors such as a patients age and overall health. While doctors keep saying prostate biopsy is easy, the recovery process isnt that simple.
It may take four to six weeks to recover. For some men, it can take longer than that, even when they adhere to all the instructions.
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Large Prostate With Significant Symptoms
For patients who have moderate or severe symptoms that have failed medical therapy from very enlarged prostates, the optimal treatment is often surgery. For very enlarged prostates, there are four main surgical options:
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After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
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Uf Health Proton Therapy Cancer Experts
As a major non-profit academic medical center, the University of Florida Health Proton Therapy Institute has treated more than 10,000 patients and led the way for innovative cancer care in the Southeast U.S. since 2006. As an academic health center, our published research is setting the standards for proton therapy cancer care worldwide, with dozens of clinical trials and more than 300 published research articles in peer-reviewed journals.
When you become a patient at UF Health Proton Therapy Institute, you are assured of receiving the highest quality cancer care as measured by state and national standards. We are committed to delivering the best possible patient outcomes. Our 125+ employees are dedicated to delivering proton cancer treatment in a way that takes the entire patient into account, so you can keep living life to the fullest.
1 Bryant C, Smith TL, Henderson RH, Hoppe BS, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Su Z, Li Z, Lee D, Mendenhall NP. Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life Following Delivery of Dose- Escalated Image-Guided Proton Therapy for Prostate Cancer. International Journal of Radiation, Oncology, Biology, Physics. 2016 95:435-43.
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Benefits Of Getting A Prostate Biopsy
A prostate biopsy is the only way to definitively determine whether you have prostate cancer and, if you do, how aggressive it is.
While prostate biopsies arent always conclusive, in general, a biopsy gives men the reassurance of knowing whether they have cancer or not. If you know you have prostate cancer, youre more likely to be appropriately treated.
Localized prostate cancer is categorized into six risk categories, which range from very low-risk to very high-risk. The risk group is determined by the stage of your cancer, your PSA levels and the Gleason score obtained from the biopsy pathology report.
The National Comprehensive Cancer Network guidelines outline appropriate treatment options based on risk categories and whether the cancer has already metastasized.
Patients whose cancer is confined to the prostate and falls into the very low-risk and low-risk categories tend to have slow-growing cancers. Treatment options for these patients often include active surveillance, radiation therapy or surgery. Similar treatment options may be recommended to patients in the low-risk and favorable intermediate prostate cancer risk categories.
The NCCN guidelines recommend immediate treatment for patients with high-risk disease or those patients whose cancer has metastasized.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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