Prostate Cancer Diagnosis Do You Really Know All Your Treatment Options
The American Brachytherapy Society finds many men diagnosed with Prostate Cancer are not presented with a highly effective minimally invasive treatment option: Prostate Brachytherapy Seed Implants.
We live in an era of information overload, frequently confusing and contradictory. The challenge and difficult task of evaluating and understanding available treatment options for prostate cancer is not immune to this quandary.
Other than skin cancer, prostate cancer is the most common cancer and is the second leading cause of cancer death in American men, behind lung cancer. About 1 man in 9 will be diagnosed with prostate cancer during his lifetime. The American Cancer Society estimates about 164,690 men will be diagnosed and about 29,430 men will die from prostate cancer in the United States in 2018.1
Know Your Options: Prostate Brachytherapy is one of the most effective treatment options for prostate cancer
Prostate Brachytherapy Seed implants, also known as Low-dose-rate brachytherapy is a highly effective minimally invasive treatment for organ-confined prostate cancer. It can be offered as a single treatment for low-risk disease, or in conjunction with external beam radiotherapy and/or androgen-deprivation therapy for intermediate and high-risk disease.
Unfortunately, many men diagnosed with Prostate Cancer are never presented with Prostate Brachytherapy Seed implants as a treatment option and/or, more regrettably, presented with misinformation.
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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:
Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
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Watchful Waiting And Active Surveillance
Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.
Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.
Considering Prostate Cancer Treatment Options
For most men diagnosed with prostate cancer, the cancer is found while it’s still at an early stage — it’s small and has not spread beyond the prostate gland. These men often have several treatment options to consider.
Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors such as your age and general health, and the likelihood that the cancer will cause problems for you to consider before deciding what to do. You should also think about the possible side effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side effects such as incontinence or erection problems for as long as possible. Other men are less concerned about these side effects and more concerned about removing or destroying the cancer.
If you’re older or have other serious health problems and your cancer is slow growing , you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may think more about watchful waiting or active surveillance, and less about treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best reason for your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.
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What Are Prostate Tests And How Is Prostate Cancer Diagnosed
Tests which check for prostate cancer include:
- A digital rectal exam . In this exam, your provider feels your prostate for lumps or anything unusual by inserting a lubricated, gloved finger into your rectum.
- A prostate-specific antigen blood test. A high PSA blood level may be a sign of prostate cancer. But many other things can cause high PSA levels, too.
- Imaging tests. These tests may use ultrasound or MRI to make pictures of your prostate.
If these tests show that you might have prostate cancer, the next step is usually a prostate biopsy. A biopsy is the only way to diagnose prostate cancer.
During a biopsy, a doctor uses a hollow needle to remove some prostate tissue. The tissue is studied under a microscope to look for cancer cells.
What Are The Treatments For Prostate Cancer
Your treatment options usually depend on your age, your general health, and how serious the cancer is. Your treatment may include one or more of options:
- Observation,which is mostly used if you are older, your prostate cancer isn’t likely to grow quickly, and you don’t have symptoms or you have other medical conditions. Your doctor will keep checking on your cancer over time so to see whether you will need to start treatment for the cancer. There are two types of observation:
- Watchful waiting means having little or no testing. If symptoms begin or change, you will get treatment to relieve them, but not to treat the cancer.
- Active surveillance means having regular tests to see if your prostate cancer has changed. If the tests show the cancer is starting to grow or if you develop symptoms, then you will have treatment to try to cure the cancer.
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Stage I Prostate Cancer Treatment
In This Section
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer. In the CLIN1001 PCM301 randomized trial, 413 men with low-risk cancer were randomly assigned in an open-label trial to receive either the photosensitizing agent, padeliporfin , or active surveillance. Median time to local disease progression was 28.3 months for patients receiving padeliporfin and 14.1 months for patients who were assigned to active surveillance . However, the appropriate population for photodynamic therapy may be quite narrow, as it may overtreat men with very low-risk disease and undertreat men with higher-risk disease.
New Pcf Webinar Series Launches September 20
The Prostate Cancer Foundation is excited to announce a new series of webinars hosted by Charles J. Ryan, MD, PCF President and CEO. PCF aims to connect patients and caregivers with current, essential information across the various stages of the prostate cancer journey. Each month, Dr. Ryan will speak with leaders in the field of prostate cancer diagnosis, treatment, research, and survivorship and answer your questions during these live virtual events.
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Some Things To Consider When Choosing Among Treatments
Before deciding on treatment, here are some questions you may want to ask yourself:
- Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
- Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
- Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
- Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
- Which potential treatment side effects might be most distressing to you?
- How important for you are issues like the amount of time spent in treatment or recovery?
- If your initial treatment is not successful, what would your options be at that point?
Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.
Symptoms Of Prostate Cancer Include:
- Trouble Urinating
- Blood in your urine
- Pain in your hips or back
- Erectile dysfunction
- Weight Loss
Because these symptoms may overlap with those of other conditions, it is important to get the correct diagnosis to find the right treatment. To help determine the best option for you the American Cancer Society recommends prostate screenings.
What is a Prostate Screening?
As with all cancers, an important part of the treatment process is detecting the cancer as early as possible. San Bernardino Cancer Center recommends following the American Cancer Societys guide for prostate cancer screening. The screening process will include the following:
- A digital rectal exam
- PSA testing
- Imaging of the prostate gland
Typically, if an initial digital rectal exam comes back with abnormal results, the next step would be a PSA blood test followed by an imaging test of the prostate gland. Should your PSA levels be high, a prostate biopsy may be recommended as a follow up to the screening. A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. If prostate cancer is found on a biopsy, this test can also help tell how likely it is that the cancer will grow and spread quickly.
If you are interested in getting a prostate screening, please fill out the form, and one of our team members will contact you to set up an appointment.
How do we treat prostate cancer?
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Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
What Is The Prostate And What Does It Do
The prostate gland is a small gland about the size of a walnut. It lies below your bladder, just in front of your rectum .
A tube that carries urine runs through your prostate and into your penis. This tube is known as your urethra or water pipe. If the prostate gland is enlarged it can cause trouble passing urine because it presses on the urethra.
The prostate makes a thick white fluid that mixes with sperm . It also makes a protein called prostate specific antigen , which turns semen into liquid.
If your PSA level is higher than normal, it can sometimes be a sign of prostate cancer. However it can also be a sign of a less serious condition like a prostate or urinary infection.
Note:
We use the term man / men in our prostate cancer information but we understand that not everyone who has a prostate gland identifies as a man.
It doesnt matter who you are or where you come from, we are here for you. For confidential advice, information and support, contact our Support Line on Freephone 1800 200 700.
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Expert Review And References
- American Cancer Society. Treating Prostate Cancer. 2019: .
- American Society of Clinical Oncology. Prostate Cancer. 2020: .
- Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
- Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
- Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatmentand follow-up. Annals of Oncology. 2020: 31: 1119-1134. .
How We Treat Prostate Cancer
The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.
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What Are The Symptoms Of Prostate Cancer
Prostate cancer doesn’t always cause symptoms, especially at first. If it does cause symptoms, they may include:
- Problems urinating , such as:
- A urine stream that’s weak, hard to start, or starts and stops
- Urinating often, especially at night
- Pain or burning when urinating
- Blood in your urine or semen
But many of these symptoms may be from other common prostate problems that aren’t cancer, such as an enlarged prostate.
You should discuss your prostate health with your health care provider if you:
- Have symptoms that could be prostate cancer
- Have a high risk for developing prostate cancer
- Had a screening test that suggests you could have prostate cancer
What Are The Stages Of Prostate Cancer
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score .
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.
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