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Best Treatment For Stage 2 Prostate Cancer

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British Columbia Specific Information

What are the Treatment Options for Stage 2 Prostate Cancer?

You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.

Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency Prostate.

Top of the pageDecision Point

You may want to have a say in this decision, or you may simply want to follow your doctors recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

What Does It Mean To Have A Gleason Score Of 6 7 8 Or 9

Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6. These cancers may be called well differentiated or low-grade and are likely to be less aggressive that is, they tend to grow and spread slowly.

Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.

Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:

  • Gleason score 3+4=7 tumors still have a good prognosis , although not as good as a Gleason score 6 tumor.
  • A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.

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Stages Of Prostate Cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of the cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome . The following staging information is for adenocarcinoma, which makes up 95% of all prostate cancers. Other types of prostate cancer are staged differently.

The most common staging system for prostate cancer is the AJCC/UICC TNM system. Doctors often also use a simple staging system that describes whether the cancer has spread and if so, where it has spread. Doctors further classify prostate cancers into risk groups based on whether they are likely to come back .

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Impact Of Age On Treatment

The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests.10 Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.11,12

Chodak and associates12 evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.

Ng Tohu Matua: Te Maimoatanga Matepukupuku Repe Ure

Is Homoeo medicine effective for prostate cancer treatment? What is the ...
  • M te mhio ki te whanga o t matepukupuku repe ure, e whina i t rp maimoa ki te whakamahere i maimoatanga.
  • Ka whakaritea he whakamtau toto prostate specific antigen ki te ine i te taumata PSA kei roto i t toto. Mehemea
  • kua piki t PSA, he tohu tnei kua piki ake te mrea o t whai i te matepukupuku repe ure, e ai ki te tangata whai taumata PSA pai.
  • Ara an tahi atu take, atu i te matepukupuku, piki ai te PSA, n reira, kore e taea te whakamahi i te whakamtautau PSA anake ki te whakatau i te matepukupuku repe ure.
  • Ko te whakamtautau -mati tou, ko te porooro, ko te unuhanga tahi atu whakamtautau.Mehemea kei roto te matepukupuku i to tauira unuhanga, ka tauinetia m te whakamahi i te tauine ISUP .
  • He huarahi te mahi tauine ki te krero i te momo hua u ptau matepukupuku, te tere o t rtou tipu, me te hua o tna kaha ki te hrapa ki whi k o te tinana.Tr pea ka whakahaerehia tahi atu titiro whakatau pr ki te CT, ki te MRI rnei, , i tahi w, he titiro whakatau -kiwi.Ka whakamahia ng putanga o ng whakamtautau me ng titiro whakatau ki te krawarawa i te whanga taumata o t matepukupuku tna rahi, me tna kaha rauroha.

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When Is Brachytherapy Alone The Right Choice

For a patient with disease that is confined to the prostate and not too aggressive, brachytherapy alone is a good option. With the use of sophisticated real-time computer-based planning, we can use brachytherapy to deliver radiation in an extraordinarily precise way, with minimal exposure to the surrounding normal tissues. It is also convenient for the patient as it is done in an outpatient setting and most people are able to get back to work the next day.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would also be very reasonable. At MSK, our philosophy is that when the disease is caught very early meaning a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease then it would be very appropriate to do active surveillance and hold off on treatment.

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There Are Different Types Of Treatment For Patients With Prostate Cancer

Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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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.

Radiation Treatment For Prostate Cancer

Treatment decisions for prostate cancer in 2021.

Radiation treatment is the use of radiation beams to destroy cancer cells or slow their growth.

Radiation treatment is usually recommended for prostate cancer:

  • if you are not well enough for surgery
  • if you have had surgery for prostate cancer but there are signs that not all the cancer has been removed
  • to relieve pain caused by cancer that has spread to the bones
  • to shrink blocks in your lymphatic or urinary system
  • when radiation treatment is your preferred treatment option

There are three types of radiation treatment for prostate cancer:

External beam radiotherapyThe most common radiation treatment for prostate cancer. The radiation beams are given from outside the body onto the area affected by cancer.

Low-dose-rate brachytherapy Low-dose-rate brachytherapy is an internal radiation treatment where radioactive seeds are permanently placed inside the prostate gland.

It is used when the cancer is low-risk and found only inside the prostate. It is only available in a few private centres in New Zealand.

After your radiation treatment, you will be radioactive and need to take special care at home. Your treatment team will explain what to do.

High-dose-rate brachytherapy High-dose-rate brachytherapy is an internal radiation treatment where radioactive sources are temporarily placed into the prostate with needles.

It is usually used in combination with external beam radiotherapy to treat higher-risk prostate cancer. It may also be used alone to treat low-risk prostate cancer.

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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.

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 .

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If Your Prostate Cancer Comes Back

If your cancer goes into remission but later returns, follow-up treatments will depend on where the cancer is located and which treatments youâve already tried.

  • If the cancer is contained in your prostate, surgery or a second attempt at radiation is suggested. If you’ve had a radical prostatectomy, radiation therapy is a good option. If you had radiation, radical prostatectomy might be the best approach. Cryosurgery might also be an option.
  • If the cancer has spread to other parts of your body, hormone therapy might be the most effective treatment. External or IV radiation therapy or bisphosphonate drugs can relieve your bone pain.

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How Do Prostate Cancer Stages & Grades Affect Survival Rates

Prostate Cancer Stages

Overall, the prostate cancer survival rate is 97.5%most men will not die of prostate cancer, even if they have it until the end of life. However, if you look at survival rates by stage, it has been shown that the more advanced forms of prostate cancer have a lower survival rate .

The National Cancer Institutes Surveillance, Epidemiology, and End Results Program , which is the database that compiles the incidence and survival rates, sorts prostate cancer into localized, regional, and distant rather than using the TNM system :

  • LocalizedCancer has not spread outside of the prostate
  • RegionalCancer has spread outside of the prostate to adjacent structures and lymph nodes
  • DistantCancer has spread to remote parts of the body, such as bones, liver, or lungs

Here are the 5-year relative survival rates for men with prostate cancer based on the SEER database information :

Being diagnosed with cancer can be difficult for both you and your loved ones. There is a great deal of information available about staging, survival rates, treatments, etc. Talking to your healthcare providers about your cancer can help you translate the alphabet soup into an actionable plan.

It is important to remember that cancer affects each person differently doctors have guidelines to follow, but no single treatment plan works best for everyone. Work as a team with your healthcare provider to come up with the best strategy for you to manage your prostate cancer.

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What If My Biopsy Shows Cancer

If the biopsy shows prostate cancer, your doctor will determine how likely your cancer is to grow quickly and spread. Sometimes, prostate cancer grows slowly over many years. But other times, it grows quickly.

Your doctor can use your PSA level, Gleason score, and tumor score to determine your risk level. The following pages give more information about Gleason score, T-score, and prostate cancer risk levels.

Gleason Score

The Gleason score is a common scale used to determine how fast your prostate cancer is likely to grow. Gleason scores can range from 2 to 10, but most often range from 6 to 10. The higher the Gleason score, the more likely your cancer is to grow and spread.

Tumor Score

The T-score tells how far your prostate cancer has grown.

  • T1: The cancer is too small to be felt during a digital rectal exam or seen in an imaging test . The cancer is found from a biopsy done after a man has a high PSA level or has surgery for problems urinating. The cancer is only in the prostate gland.
  • T2: The cancer can be felt during a digital rectal exam and may be seen in an imaging test. The cancer is still only in the prostate gland.
  • T2a: The cancer is in one-fourth of the prostate gland .
  • T2b: The cancer is in more than one-fourth of the prostate gland , but has not grown into the other side of the prostate gland.
  • T2c: The cancer has grown into both sides of the prostate gland.

Risk Level

Table 1. Determining risk level

Risk Level*

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Living With Prostate Cancer

Receiving a prostate cancer diagnosis can be stressful. Even though most people who receive a diagnosis of prostate cancer live for many years after receiving the diagnosis, treatment can be exhausting and cause side effects that impact your quality of life.

Many resources are available to help you get through these difficult times:

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Does Overdiagnosis Lead To Overtreatment Of Older Men

The widespread use of PSA screening has led to an increase in the diagnosis and treatment of early localized prostate cancer. Data from the US Cancer of the Prostate Strategic Urological Research Endeavor database suggest a significant decrease in risk in the last 2 decades in the United States, with more patients being identified with low-risk disease at diagnosis,29 but the role of active treatment of low- and intermediate-risk disease in elderly men remains controversial.

The median time from diagnosis to death from prostate cancer for men with nonpalpable disease is approximately 17 years.30,31 Considering that the US male life expectancy at the age of 65 years is 16 years, aggressive therapy will hardly extend life expectancy of older men with no palpable prostate cancer at the time of diagnosis.32 Twenty to 30% of prostate cancers detected by PSA screening programs show Gleason scores of 6 or lower and, thus, are not poorly differentiated and have volumes smaller than 0.5 cm3.3335

Histologic evaluation of radical prostatectomy specimens demonstrated that about 20% to 30% of cancers are small volume, show low Gleason scores, and are consequently clinically harmless.35,36 Many of these cancers pose little threat to life, especially for older men. Has PSA screening resulted in prostate cancer overdiagnosis?

Getting Help With Treatment Decisions

Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

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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