Best Treatment For Early Prostate Cancer

Screening For Prostate Cancer

At UCSF, we believe in testing men so they know if they have prostate cancer, but that doesnât mean every man diagnosed should have aggressive treatment. Screening is the only way to detect high-risk, potentially life-threatening prostate cancer early, while it can still be cured.

Most prostate cancers in the U.S. are identified through the following screening tests:

• Prostate-specific antigen . This simple blood test checks levels of prostate-specific antigen, a protein produced by prostate cells. The higher the PSA level, the more likely prostate cancer is present. But PSA elevations can also occur in benign conditions, most commonly benign prostatic hyperplasia, in which the prostate enlarges, as occurs in most men over their lifetime.
• Digital rectal exam . For this physical examination, your doctor inserts a lubricated gloved finger into your rectum to feel for any irregular or abnormally firm areas. While most prostate cancers are detected by PSA screening, some cancers produce little PSA but are detected by DRE.

In some circumstances, your doctor may order a repeat PSA or other tests to help determine whether a benign condition led to an elevated PSA. These tests may include:

• Multiparametric MRI

What Causes Prostate Cancer

Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:

• Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
• Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.

Intermediate Risk Localised Prostate Cancer

In men with intermediate risk prostate cancer, the cancer may start to grow or spread within a few years. Your doctor is likely to suggest surgery to remove the prostate gland or radiotherapy. This may be external radiotherapy to the prostate or internal radiotherapy . If you have radiotherapy you also have hormone therapy before, during or after the treatment.

Surgery and radiotherapy work equally well in curing the cancer but they have different risks, benefits and side effects. Your doctor can explain these to you. If you dont want to have surgery or radiotherapy straight away, your doctor may offer active monitoring of the cancer .

Your doctor may offer you cryotherapy or high frequency ultrasound therapy as part of a clinical trial. These are not readily available in Ireland but are available in the UK.

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Questions To Ask Your Doctor Or Nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment. If youre choosing a treatment, you might find it helpful to ask your doctor or nurse some of these questions.

• What treatments are suitable for me?
• How quickly do I need to make a decision?
• What are the advantages and disadvantages of each treatment? What are their side effects?
• How effective is my treatment likely to be?
• Can I see the results of treatments youve carried out?
• Is the aim to keep my prostate cancer under control, or to get rid of it completely?
• If the aim of my treatment is to get rid of the cancer, what is the risk of my cancer coming back after treatment?
• If the aim of my treatment is to keep the cancer under control, how long might it keep it under control for?
• What treatments and support are available to help manage side effects?
• Are all of the treatments available at my local hospital? If not, how could I have them?
• After treatment, how often will I have check-ups and what will this involve? How will we know if my cancer starts to grow again?
• If my treatment doesnt work, what other treatments are available?
• Can I join any clinical trials?
• If I have any questions or get any new symptoms, who should I contact?

Watchful Waiting And Active Surveillance

Prostate cancer often grows very slowly. You might not need to treat it right away — or at all — especially if you’re older or have other health issues.

For some men, the treatments themselves have risks that are greater than the benefit of getting rid of the cancer. Watchful waiting may be an option in this case. It means you and your doctor will look out for symptoms and treat them if they start. The doctor may do tests from time to time to see if the cancer is growing.

Active surveillance might be a choice if the cancer is likely to grow very slowly, if at all, but you would still want to cure it if it does get worse. Your doctor will do tests, including PSA blood tests and rectal exams, usually about every 3-6 months to check on the cancer. You might also have a biopsy, where your doctor takes a small piece of tissue from your prostate and checks it under a microscope.

These options donât mean that you ignore your cancer. Your doctor will keep a close eye on your health to be sure the disease doesnât cause any problems for you. If it does, your doctor will talk to you about starting treatment.

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Dana Farber Cancer Institute Trial

This trial sought to evaluate the effect of the addition of androgen deprivation therapy to RT on survival, disease-specific mortality, survival free from salvage hormonal therapy, and all-cause mortality. To this end, 206 men with T1bT2b, N0, M0 adenocarcinoma of the prostate and either a Gleason score of at least 7 , a serum PSA of at least 10 ng/ml, or, in patients with low-risk cancer, MRI evidence of extra-prostatic disease or seminal vesicle invasion, were randomized to receive 70 Gy via 3DCRT alone or in combination with 6 months of androgen suppression therapy . All patients received an initial 45 Gy to the prostate and seminal vesicles followed by an additional 25.35 Gy boost to the prostate plus a 1.5 cm margin via a four-field 3DCRT technique. Leuprolide or goserelin were used in combination with flutamide to achieve androgen blockade. At a median 4.52 years of follow up, patients randomized to receive combined modality therapy had significantly higher survival, lower prostate-cancer-specific mortality, and higher survival free of salvage hormonal therapy. Five-year survival rates favored CMT by 10 percentage points . At 7.6 years of follow up, the KaplanMeier 8-year survival estimates were 74% and 61% respectively for patients receiving AST versus those receiving RT alone. The increased risk in all-cause mortality was significant only in those patients randomized to RT with or without minimal comorbid pretreatment disease .

What Is The Prognosis For People Who Have Prostate Cancer

Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.

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Active Surveillance And Watchful Waiting

Active surveillance means that no treatment is administered. Instead, youre given routine tests to monitor how the cancer changes over time.

Doctors usually recommend active surveillance if your cancer is unlikely to spread to organs far away from your prostate. Active surveillance typically involves regular PSA screenings and visits with a doctor. You may also get a prostate biopsy every few years to look for the presence of cancerous cells.

Watchful waiting may also be used if youre older or have any other serious health issues. You wont receive treatment or routine tests during watchful waiting, but you may be given treatment to help relieve symptoms and improve your quality of life.

What Are The Treatment Options For Low

Men with low-risk prostate cancer have four treatment options: active surveillance, external radiotherapy, internal radiotherapy and surgery to remove the prostate.

• Active surveillance involves monitoring the prostate cancer, and only treating it if there are signs that it is progressing. This approach is based on the fact that low-risk prostate cancer often grows very slowly or doesn’t grow at all, so treatment often isnt needed.
• In external radiotherapy, the cancer is exposed to radiation from outside the body, through the skin.
• In internal radiotherapy , the cancer is exposed to radiation from slightly radioactive seeds that are implanted inside the body.
• The aim of surgery wird is to remove the tumor, together with the whole prostate, seminal vesicles and outer capsule.

Radiation and the surgical removal of the prostate are also referred to as “curative” treatments because the aim is to remove all of the tumor cells. But a few cancer cells may stay in the body, or new cancer cells might develop. For this reason, men who have had radiotherapy or surgery are still advised to have regular PSA tests.

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The Initial Causes What Is The Best Treatment For Early Prostate Cancer

One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

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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What Questions Should I Ask My Healthcare Provider

If you have prostate cancer, you may want to ask your healthcare provider:

• Why did I get prostate cancer?
• What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
• Has the cancer spread outside of the prostate gland?
• What is the best treatment for the stage of prostate cancer I have?
• If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
• What are the treatment risks and side effects?
• Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
• Am I at risk for other types of cancer?
• What type of follow-up care do I need after treatment?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.

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Causes Of Early Prostate Cancer

Certain things called risk factors may increase the risk of developing prostate cancer. If you are Black, you have a much higher risk of developing prostate cancer. You are also more likely to develop it at a younger age. Having a strong family history of prostate cancer is also a risk factor.

We have more information about the risk factors of prostate cancer.

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You usually start by seeing your GP to have your symptoms checked. Your GP usually arranges some tests. The first tests used to diagnose prostate cancer are:

• Rectal Examination

  The doctor gently inserts a gloved finger into your back passage . The rectum is close to the prostate gland so your doctor can feel for anything unusual in the prostate. A rectal examination test is quick and it should not be painful. It is also sometimes called Digital Rectal Examination .

• PSA test

  The PSA test is a blood test to measure the level of prostate-specific antigen in your blood. Prostate cancer often causes a raised level of PSA. But different things such as non-cancerous prostate conditions and getting older can also increase your PSA.

If your PSA level is raised or your rectal examination is unusual your GP refers you to a specialist doctor . Your GP may test your PSA level again if it is raised but your prostate feels normal.

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Cancer Staging May Miss Errant Cells

Once a pathologist confirms that cancer is present, the doctor will next determine how far the cancer extends a process known as cancer staging and discuss the implications with you. This is perhaps the most important information of all for you to obtain, as it determines whether the cancer is likely to be curable, or whether it has already spread to additional tissues, making prognosis much worse.

If you were my patient, I would ask you to consider two important points. First, cancer staging actually occurs in two phases: clinical and pathological . Of the two, pathological staging is more accurate.

A second point to understand, however, is that even pathological staging can be inaccurate . A cancer spreads, or metastasizes, once a primary tumor sheds cancer cells that travel elsewhere in the body and establish other tumor sites. Metastasis is a complex process that researchers do not fully understand. What is clear is that this process involves multiple genetic mutations and steps, and that each type of cancer spreads in a unique way.

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In active monitoring, men with localized prostate cancer do not get surgery or radiation right after theyre diagnosed. Instead, they have regular biopsies, blood tests, and MRIs to see if their cancer is progressing. If it is, they can receive treatment.

Although some oncologists advise men with early, low-grade prostate cancer to choose active surveillance and professional groups such as the American Society of Clinical Oncology recommend it many patients recoil at what sounds like lets just wait for your cancer to become really advanced. A decade ago fewer than 10 percent of men diagnosed with prostate cancer chose monitoring, UCLA researchers found. But that is changing. Now at least half of men do.

That made sense to Garth Callaghan, author of the best-selling Napkin Notes, a book of missives he tucked into his daughters lunch box. Diagnosed with early prostate cancer in 2012, he said, none of the choices seemed particularly attractive to a 43-year-old man who dreaded the possibility of side effects of surgery or radiation, including incontinence and impotence. I was completely torn. My previous experience was, just get it out of my body. But after his doctor explained that prostate cancer is grossly overtreated in the United States, I did a complete 180 and chose active monitoring.

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How Do The Treatment Options Compare

A study known as the ProtecT trial is the most important study on treatments for low-risk prostate cancer so far. ProtecT stands for prostate testing for cancer and treatment. This trial compared three treatment options: active surveillance, external radiotherapy and surgery to remove the prostate. A total of 1,643 men between the ages of 50 and 69 took part in the trial. They all agreed to be randomly assigned to one of the three treatment groups. About two thirds of them had low-risk prostate cancer. The treatment outcomes were recorded over an average of ten years, and then compared with each other at the end of the trial.

The following was found over a period of ten years:

• no difference in mortality rate between the active surveillance, radiotherapy and surgical removal groups,
• a somewhat higher risk of metastases in the active surveillance group,
• a much higher risk of accidental urine leakage in men who had surgery,
• a much higher risk of erection problems in men who had radiotherapy or surgery .
• a somewhat higher risk of accidental stool leakage in men who had radiotherapy.

Based on the results of this trial and other research, we have developed a decision aid that can help men who have low-risk prostate cancer to weigh the pros and cons of the various treatment options for example, together with their friends, family and doctors.