Can You Survive Aggressive Prostate Cancer
Patients with the most aggressive form of prostate cancer who have surgery â radical prostatectomy â were found to have a 10-year cancer-specific survival rate of 92%, which is high, and a 77% overall survival rate, according to researchers from the Fox Chase Cancer Center and the Mayo Clinic, USA.
Treatment Of Locally Advanced Prostate Cancer: A Case Report And Narrative Review
Frank PeinemannAcademic Editor: Received
Abstract
Introduction. Treatment of locally advanced prostate cancer is under discussion. Differences between clinical and pathological staging and risk factors such as positive surgical margins and seminal vesicle involvement challenge the individual treatment decisions. Case Presentation. Clinical tumor stage before treatment was assessed to be T2. After radical prostatectomy, pathological examination revealed the stage pT3b N0 M0 including positive surgical margin and seminal vesicle involvement. Early adjuvant androgen deprivation therapy and late adjuvant radiation therapy were added in response to the pathological risk factors. No evidence of disease was observed for 15 years after the treatment. The unexpected pathological findings were not explained by the physicians in charge. Discussion. A narrative review of the recent literature showed that multiple treatment modalities including adjuvant radiotherapy following radical prostatectomy are consistent with current recommendations. The multimodal approach has possibly cured a high-risk patient and may also work successfully in other patients. An alternative treatment option with better preservation of health-related quality of life might have also achieved a similar good overall survival.
1. Introduction
2. Case Presentation
3. Discussion
Conflict of Interests
Hormone Therapy For Prostate Cancer
Also known as androgen suppression therapy, the purpose of hormone therapy is to mitigate the influence of any prostate cancer. What happens is that prostate cancer cells are feeding on male hormones in order to grow. Using hormone therapy, the body puts a stop on supplying cancer with what it requires in order to grow.
Nonetheless, hormone therapy is not a cure for prostate cancer. Doctors can recommend this procedure when the cancer has spread too far or before chemotherapy in order to shrink the tumor and maximize the efficiency of the treatment.
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Can People With Advanced Prostate Cancer Enroll In Clinical Trials
Major organizations such as the National Comprehensive Cancer Network recommend this course of action for all cancer patients. Researchers are exploring several new ways of diagnosing, monitoring, and treating prostate cancer. Clinical trialstest the safety and effectiveness of these new methods and treatments. There are risks and limitations in every clinical trial. For example, you may be assigned to the control group, and not get the new medicine. In that case, the control medicine is the best therapy already available. Placebo or ineffective treatment is rarely if ever used anymore, and if it will be used in the trial, you would be informed. Keep in mind that the new medicine under investigation in the clinical trial may not work. But clinical trials also offer early access to new treatments.
You can find out more about clinical trials by asking a medical oncologist, inquiring at an academic medical center, or browsing a clinical trials listing service. The National Institutes of Health lists clinical trials at www.clinicaltrials.gov.
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Lutetium Lu 177 Vipivotide Tetraxetan
Lutetium Lu 177 vipivotide tetraxetan is indicated for the treatment of men with prostate-specific membrane antigen -positive, metastatic castration-resistant prostate cancer who have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. It is a radioligand therapeutic agent. The active moiety is the radionuclide lutetium-177, which is linked to a moiety that binds to PSMA, a transmembrane protein expressed in prostate cancer, including mCRPC. Upon binding to PSMA-expressing cells, the lutetium-177 delivers beta-minus radiation to the cells, as well as to surrounding cells, inducing DNA damage that can lead to cell death.
Approval was based on the phase 3 VISION trial. Compared with patients receiving standard care , patients who received lutetium Lu 177 vipivotide tetraxetan plus standard care had significantly prolonged imaging-based progression-free survival and overall survival .
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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.
How Does Hormone Therapy Work
To grow, the prostate cancer cells need the male hormone testosterone. Hormone treatments work in different ways to prevent testosterone stimulating the prostate cancer cells. The LHRH agonists and GnRH antagonists will prevent testosterone from being produced by the testicles and are given as an injection. The anti-androgens block the action of testosterone on the prostate cancer cells and are given as tablets. They are both effective in treating this stage of prostate cancer but have different side effects.
It is important to know that many people will experience emotional as well as physical side effects while on hormone therapy. Many men on hormone therapy have less energy and feel less motivated, and you may also experience changes in your mood, such as feeling more sentimental, more irritable or more tearful than usual. This is nothing to be ashamed of.
What are the risks and side effects of anti-androgen drug therapy?
These drugs allow some men to maintain their sex drive and sexual activity and do not cause any reduction in bone strength, which can be a side effect of LHRH agonists and GnRH antagonists. In some men, the drugs cause loss of body hair, the breasts to grow and sore nipples.
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Chemotherapy For Prostate Cancer
While surgery is a cure for mild cases of prostate cancer, chemotherapy represents an option for patients whose tumors spread beyond the prostate. This therapy works by delivering drugs by mouth or intravenous to fight and kill cancer cells.
Unfortunately, in the process, healthy cells get damaged as well, leading to a slew of side effects:
- Changes at the level of the skin and nails
- Loss of appetite and libido.
However, if patients experience high fever, unexplained bleeding, rashes or any unusual pain, the doctors might alter the treatment plan. These are symptoms of a more serious problem.
Prostate Cancer Risk Assessment
Prostate cancer represents a wide spectrum of disease. Some prostate cancers progress and need treatment, while others grow slowly, if at all, and can be managed conservatively with a system of careful monitoring called active surveillance. It is important to learn the characteristics of your cancer before making treatment decisions. There are many ways to determine prostate cancer risk, most of which incorporate information from several parameters, including the PSA, Gleason score and tumor extent .
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Surgery In Metastatic Disease
Physicians have suggested that the benefits seen from radiation to the prostate point to the benefits of local therapy, raising the question of whether radical prostatectomy might have the same results. Trials are ongoing, and at present the use of surgery should be considered investigational and conducted only within the context of a trial. However, transurethral resection is sometimes needed in men who develop obstruction secondary to local tumor growth. Bilateral orchiectomy can be used to produce androgen deprivation in patients with widely advanced and metastatic prostate cancer.
Since the introduction of LHRH agonist and antagonist therapies, surgical intervention has been practiced less often. An indication for immediate bilateral orchiectomy is spinal cord compression, because it avoids the potential flare response that can occur during the first 3 weeks of treatment with an LHRH agonist.
What Does Your Tnm Prostate Cancer Stage Mean
The TNM system for describing prostate cancer uses the letters T, N, and M, which stand for tumor, nodes, and metastasis.
Specifically, stage 3 prostate cancer has extended through the capsule that surrounds the prostate but has not spread to distant sites in the body.
There are two sub-stages of stage 3 prostate cancer.
- T3a: The tumor has only gone through the capsule without invading the seminal vesicles.
- T3b: The tumor has invaded the seminal vesicles.
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Treatment Options For Prostate Cancer To Consider
Almost 90% of prostate cancer diagnoses are delivered at early stages. In these cases, there is plenty of room for doctors and their patients to discuss and address the situation at a steady pace.
Depending on the circumstances, doctors can call for monitoring the development of the tumor without taking any actionable steps. In the absence of harmful symptoms or a swift change in the progression of the disease, doctors usually incline towards prudent measures.
Given the slow progression of prostate tumors, it can take even years before medical specialists decide on a pragmatic approach. The moment the symptoms of prostate cancer start superseding the possible treatment side effects and affect the quality of life, a care plan is set into motion.
Does It Matter Where Treatment Is Performed
A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We donât have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.
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Standard Treatment Options For Stage I Prostate Cancer
Standard treatment options for patients with include the following:
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Evidence :
Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radicalprostatectomy may be difficult after a transurethral resection of the prostate .
Because about 40% to 50% of men with clinically organ-confined disease are found to have pathologic extension beyond the prostate capsule or surgical margins, the role of postprostatectomy adjuvant radiation therapy has been studied.
Evidence :
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What Are My Treatment Options
Treatments for locally advanced prostate cancer will aim to get rid of the cancer, or to keep it under control, depending on how far the cancer has spread.
The treatment options for locally advanced prostate cancer are:
- hormone therapy alone, sometimes with docetaxel chemotherapy
- surgery , usually with radiotherapy or hormone therapy and sometimes with both
- watchful waiting
Some men may be offered high-intensity focussed ultrasound or cryotherapy but this will usually be as part of a clinical trial.
Depending on how far your cancer has spread, you may have a choice of treatments. If so, your doctor or nurse will talk you through your treatment options and help you choose the right treatment for you. You might not be able to have all of the treatments listed above. Read more about choosing a treatment.
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Treating Advanced Prostate Cancer
Advanced prostate cancer has no cure, but there are many ways doctors can treat the disease to ease symptoms and help you feel better and live longer.
Hormone therapy. Hormone therapy is the most common treatment for men with this disease. Prostate cancer cells need male sex hormones to help them grow. This therapy blocks them from getting or using those hormones. This is called androgen deprivation therapy. Some treatments lower the bodyâs levels of testosterone and other male hormones. Other types of therapy block the way those hormones work.
Cancer vaccine. One of the newer ways to treat advanced prostate cancer is to get the body’s immune system to attack the cancer cells. Doctors do this with a vaccine called sipuleucel-T . Itâs an option for men when hormone therapy isn’t working anymore. The vaccine is custom-made for each man. Scientists donât know if it slows or stops the cancerâs growth, but it does seem to help you live longer.
Chemotherapy. Chemo is another option when hormone therapy no longer works. It can slow cancer cellsâ growth, and shrink tumors. You usually go to a clinic to get the drugs through an IV. You may need to get a few rounds of treatment, called cycles, with some time in between for your body to recover.
What Happens If My Cancer Starts To Grow Again
Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.
You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:
Which treatments are suitable for me?
Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.
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Where Can I Get Support
Being diagnosed with any kind of prostate cancer can be frightening and overwhelming. No matter what youre feeling or thinking, there is support available if you want it. You can speak to our Specialist Nurses, in confidence or chat with them online. Our Dealing with prostate cancer page looks at things you can do to help yourself and people who can help.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
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 Happens If You Stop Hormone Therapy For Prostate Cancer
If you stop your hormone therapy, your testosterone levels will gradually rise again and some side effects will reduce. Your side effects won’t stop as soon as you finish hormone therapy it may take several months. Surgery to remove the testicles can’t be reversed, so the side effects are permanent.
What Is Locally Advanced Prostate Cancer And How Is It Treated
The spread of cancer is described here. When cancer has spread through the capsule of the prostate or the seminal vesicles or into the surrounding structures , it is called locally advanced prostate cancer. Men with locally advanced prostate cancer have a higher risk that cancer cells may have already spread.
You may be offered other treatment to kill any cells that could have spread beyond the prostate. You may be offered radiotherapy treatment to include the surrounding structures , usually in combination with two to three years of hormone therapy. Hormone treatment can delay or prevent the cancer coming back in other places and is given by tablets or injections.
Some men with locally advanced prostate cancer are treated with hormone therapy alone. The choice depends on factors that you will discuss with your doctor.
There are two types of hormone treatments that can be used to treat locally advanced prostate cancer:
- Luteinising hormone-releasing hormone agonists or Gonadotropin-releasing hormone antagonists given by injection
- Anti-androgens given by tablet
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