Where Is My Prostate Cancer Likely To Spread In My Body
Your prostate cancer may spread to several places in your body.
- The most common places your prostate cancer will spread are to your bones. The bones most often affected when prostate cancer spreads will be in your lower and upper back, hips, upper legs and ribs. If this happens you may have pain in those areas of your body. Remember, if you have pain, it can be controlled. Speak with your doctor or health care team if you have pain.
- And, in very rare cases, it may spread to your liver. If this happens, you may find that you are not as hungry as usual. You may be more tired or weak. You may have pain in your stomach area. Your legs and feet may become swollen. And your body will not be able to handle alcoholic drinks.
There are ways you can work with your doctor and health care team to take care of the problems you may have if your prostate cancer spreads to other areas of your body. The goal is to take care of your pain or any other problems you have so that you may continue doing your daily activities as well as you are able. If you have any problems, talk to your doctor or health care team.
How Does Chemotherapy Work
Healthy cells in your body divide and grow. Each cell divides in half to make another cell just like itself. Cancer cells do not divide and grow, as they should. Instead of making just one cell like itself, the cancer cell makes many copies of itself. After a while, your body becomes overworked because of all the cancer cells. Chemotherapy medicine keeps cancer cells from copying themselves. By killing the cancer cells, chemotherapy medicine tries to keep the cancer from moving to other parts of your body.
Considering Complementary And Alternative Methods
You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.
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Standards Of Care In Hormone Therapy
Most doctors agree that hormone therapy is the most effective treatment available for patients with advanced prostate cancer. However, there is disagreement on exactly how and when hormone therapy should be used. Here are a few issues regarding standards of care:
Timing of Cancer Treatment
The disagreement is due to conflicting beliefs. One is that hormone therapy should begin only after symptoms from the metastases, like bone pain, occur. The counter belief is that hormone therapy should start before symptoms occur. Earlier treatment of prostate cancer is associated with a lower incidence of spinal cord compression, obstructive urinary problems, and skeletal fractures. However, survival is not different whether treatment is started early, or deferred.
The only exception to the above, is in lymph node-positive, post-prostatectomy patients, given androgen deprivation as an adjuvant immediately after surgery. In this situation, immediate therapy resulted in a significant improvement in progression free survival, prostate cancer specific survival, and overall survival.
Length of Cancer Treatment
The disagreement in this situation is between continuous androgen deprivation and intermittent androgen deprivation.
Combination vs. Single-Drug Therapy
At What Point Are Prostate Cancer Patients Cured
Nov. 1, 1999 — Patients with prostate cancer whose prostate-specific antigen blood levels return to normal range and stay there for at least 5 years after radiation therapy have a high likelihood of being cured of their cancer, according to this study that appears in the Oct. 15 issue of Cancer, a journal published by the American Cancer Society.
Prostate cancer is the most common cancer in men, and the second most fatal. According to figures from the American Cancer Society, 179,300 men will be diagnosed with prostate cancer in 1999, and 37,000 will die from the disease. Although prostate cancer has few, if any, symptoms in its early stages, it is highly treatable. Therefore, the American Cancer Society recommends annual PSA screening and digital rectal examinations in all men aged 50 and older.
In patients who are diagnosed with prostate cancer and undergo treatment, including surgery or radiation therapy, PSA testing is used to determine the effectiveness of treatment. PSA levels below 4.0 are considered normal.
These authors found that patients have a high likelihood of cure if their PSA levels remain normal for about three and a half years following treatment, and rarely have treatment failure if they do well for four years after radiation therapy. In those patients in whom radiation treatment failed, 95% had increasing PSA levels during the first four years after treatment.
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What Is Prostate Cancer
Prostate cancer is cancer that affects the prostate gland in men. Prostate cancer is the second-leading cause of cancer deaths for men in the US.
Growth in the prostate can be of two types
Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.
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What Can Be Done To Treat Or Reduce Side Effects
Once chemotherapy treatment is complete, its side effects will typically cease. However, steps can be taken to combat any side effects as they occur. For instance, medications can help prevent nausea and vomiting, laxatives or stool-binding medications can manage constipation or diarrhea, respectively, and numbing gel can soothe mouth sores. Additionally, chemotherapy dosages can be changed or alternative chemo drugs can be considered, if appropriate.
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Are There Side Effects With Chemotherapy
Yes, there can be side effects or unwanted changes in your body when you have chemotherapy. Side effects are different from person to person, and may be different from one treatment to the next. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. The strong anticancer medicines used in chemotherapy are made to kill cells in your body that grow and divide very quickly. This is why you may have side effects with chemotherapy. Along with your prostate cancer cells, chemotherapy also kills healthy cells in your body that grow and divide very quickly. Some kinds of these healthy cells that may be affected by your chemotherapy treatment include: cells that make your hair grow, cells that make new blood cells, and cells that cover the inside of your mouth, stomach, and intestines. Most of the side effects slowly go away after you finish your chemotherapy. There are ways to make the side effects easier to deal with while you are having chemotherapy.
Chemotherapy For Metastatic Prostate Cancer
Chemotherapy is a common treatment for metastatic or advanced prostate cancer. Chemotherapy uses anti cancer drugs to destroy prostate cancer cells. The drugs circulate throughout the body in the bloodstream. The most common type of chemotherapy used for prostate cancer is docetaxel.
Metastatic prostate cancer is a cancer that began in the prostate and has spread to other parts of the body such as the bones.
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How May Prostate Cancer Spread Through My Body
Prostate cancer cells spread through your body in three ways:
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
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How Psma Lights Up Cancer Cells
In 2021, the U.S. Food and Drug Administration issued national approval to two new prostate cancer imaging tests based on similar technology. On a PET scan, the test lights up the cancerous cells that would otherwise be hidden, enabling doctors to precisely target treatment.
Both advances in imaging and therapy rely on targeting PSMA, which is not found on most normal cells but is overexpressed in cancer cells, especially those that have spread. The PSMA molecule was cloned at MSK in the early 1990s.
The Molecular Imaging and Therapy Service, led by Heiko Schöder, played a key role in the development and testing of a slightly different PSMA-directed imaging technology at MSK.
This advance is the result of years of work by the community of physicians promoting the use of PSMA agents, Dr. Schöder says. Its gratifying to see a collaborative effort result in a breakthrough that has the potential to make a difference for so many patients with advanced prostate cancer.
Before receiving the therapy, patients in the VISION trial were scanned with PSMA-directed PET imaging to make sure enough PSMA was present in the cells to make them likely to respond to the treatment. If so, they received the radioactive drug by injection over four to six sessions, spaced six weeks apart.
As a next step, Dr. Morris and colleagues are looking into using the PSMA-directed therapy earlier rather than only after the prostate cancer has spread.
Michael Morris
What Chemotherapy Drugs Are Used To Treat Prostate Cancer
The chemotherapy drugs used for prostate cancer are typically used one at a time. These drugs include:
In most cases, the first chemotherapy drug given to patients with metastatic prostate cancer is Taxotere.
If Taxotere doesnt work or stops working, the next chemotherapy drug doctors typically try is Jevtana, although doctors may try other drugs or treatment options.
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Cabazitaxel: Role As Second
After failure of docetaxel as first-line chemotherapy, second-line treatment options included mitoxantrone, retreatment with docetaxel, or clinical trials.8 It was not until 2010 that another chemotherapeutic drug, cabazitaxel, was FDA approved for the treatment of PCa.
The PROSELICA trial was a Phase III study that sought to compare two different dosing of cabazitaxel at 20 mg m2 versus cabazitaxel at the standard dose of 25 mg m2 in 1200 patients with mCRPC who progressed after docetaxel. The study results showed the noninferiority of the 20 mg m2 as compared to 25 mg m2 dose of cabazitaxel every 3 weeks in combination with prednisone and it showed that the 20 mg m2 dose had less adverse events . Particularly, the rate of Grade 4 neutropenia was 21.3% in the lower dose and 48.6% in the higher dose groups.56 The FIRSTANA trial was a Phase III study that compared cabazitaxel to docetaxel in chemotherapy-naïve patients with mCRPC and recent results did not reveal superiority in OS ,57 therefore showing that docetaxel remains the most appropriate first-line chemotherapy regimen for patients with mCRPC.
Cabazitaxel therefore remains an option for patients with mCRPC who have failed docetaxel and there are no data to support greater efficacy of cabazitaxel over docetaxel in the chemotherapy-naïve patients.
Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
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Surgery For Prostate Cancer
In some cases of advanced or recurrent prostate cancer, surgeons may remove the entire prostate gland in a surgery known as “salvage” prostatectomy. They usually do not perform the nerve-sparing form of prostatectomy. Often, surgeons will remove the pelvic lymph nodes at the same time.
Cyrosurgery may be used in cases of recurrent prostate cancer if the cancer has not spread beyond the prostate. Cryosurgery is the use of extreme cold to destroy cancer cells.
To reduce testosterone levels in the body, doctors may sometimes recommend removing the testicles, a surgery called orchiectomy. After this surgery, some men choose to get prosthetics that resemble the shape of testicles.
Doctors may also remove part of the prostate gland with one of two procedures, either a transurethral resection of the prostate or a transurethral incision of the prostate . This relieves blockage caused by the prostate tumor, so urine can flow normally. This is a palliative measure, which means it is done to increase the patient’s comfort level, not to treat the prostate cancer itself.
What Happens Without Treatment
Healthcare providers will sometimes talk about a particular diseases natural history or typical progression if it is left untreated indefinitely.
With regard to prostate cancer, most cases of the disease are discovered while the cancer is still confined to the prostate itself. This is called local disease or localized disease.
The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present.
If left untreated, however, prostate cancer can proceed on a number of different paths.
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New Treatment Approved For Late
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
In late March, the FDA approved a new therapy for advanced prostate cancer that is metastasizing, or spreading, in the body. Called Pluvicto , and delivered by intravenous infusion, the treatment can seek out and destroy tumors that are still too small to see with conventional types of medical imaging.
Pluvicto is approved specifically for men who have already been treated with other anticancer therapies, including chemotherapy and hormonal therapies that block the tumor-promoting hormone testosterone. The drug contains two parts: one that binds to a protein on prostate cancer cell surfaces called PSMA, and a radioactive particle that kills the cancer cells. Most normal cells do not contain PSMA, or do only at very low levels. This allows Pluvicto to attack tumors while sparing healthy tissues.
To confirm whether a man is eligible for the drug, doctors first inject a radioactive tracer that travels the bloodstream looking for and then sticking to PSMA proteins. Cancer cells flagged by the tracer will show up on a specialized scanning technology called positron-emission tomography. About 80% of prostate cancer patients have PSMA-positive tumors for those who do not, the treatment is ineffective.