Monday, October 3, 2022

Can Metastatic Prostate Cancer Go Into Remission

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What Is Bone Metastasis

Stories of Advanced Prostate Cancer Remissions | Ask a Prostate Cancer Expert, Mark Scholz, MD

The bone is a common site for metastasis. Bone metastasis or “bone mets” occurs when cancer cells from the primary tumor relocate to the bone. Prostate, breast, and lung cancers are most likely to spread to the bone. However, other cancers are not excluded. Bone metastases do not begin from the bones but move there from the primary tumor site. On the other hand, primary bone cancers are rare cancers where the primary tumor actually starts in the bone. Therefore, bone cancer and bone metastases are not the same.

As an example, consider a patient with prostate cancer. Prostate cancer cells from the primary tumor can break away and get into the bloodstream. Once in the blood, the cancer cell can travel to the bone and form a new tumor. It is important to remember that this secondary tumor is made up of abnormal prostate cancer cells, not abnormal bone cells. The result of this process is referred to as prostate cancer that has metastasized to the bone or metastatic prostate cancer. This is otherwise known as bone metastasis.

When cancer cells metastasize to the bone, they can cause changes to the bone. The process by which portions of the bone are damaged is called osteolysis. Oftentimes, small holes result from osteolysis. These holes in the bone are referred to as osteolytic lesions or lytic lesions. Lytic lesions can weaken the bones and increase the risk of breakage or other problems. It is also common for bone metastasis patients to experience pain with lesions.

Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Support For Living With Secondary Breast Cancer

Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.

For many people, uncertainty can be the hardest part of living with secondary breast cancer.

You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.

  • Chat to other people living with secondary breast cancer on our online Forum.
  • Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
  • Live Chat is a weekly private chat room where you can talk about whatever is on your mind.

You can also call Breast Cancer Nows Helpline free on 0808 800 6000.

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How Do I Know If I Should Keep Getting Treatment

How much is treatment helping?

For some people, getting cancer treatment helps them feel better and stronger. It also helps control the cancer so they can live longer. But for others, being in treatment works the opposite way they may reach a point where it only makes them feel worse. Side effects might keep you from enjoying the life you have left. Only you can decide how you want to live your life. Of course, youll want to know how your family feels about it, too. Their feelings are important since they are living through the cancer with you. But keep in mind, the final decision is yours.

Do the benefits outweigh the side effects?

When a person has had many different treatments that didnt help stop the cancer, it may mean that its become resistant to all treatment. At this time you might want to weigh the possible limited benefit of a new treatment against the possible downsides, including the stress of getting treatment and the side effects that go with it. Everyone has a different way of looking at this. Talk to your cancer care team about what you can expect from treatment. They can help you make the best decision for yourself and your family.

How Do I Know If Treatment Worked

Stage 3 Lung Cancer Survival Rate

If treatment is successful, levels of PSA in the blood will decrease. PSA levels can rise substantially when an individual is battling prostate cancer, and these levels are used as an early indicator of potential cancer.

When prostate cancer is successfully treated using radiation therapies, PSA levels will drop to lower levels and stabilize. When prostate cancer is successfully treated by surgically removing the prostate, PSA levels will decrease to the point of being virtually undetectable. When monitoring for recurrence of prostate cancer, one common method is to monitor PSA levels in the blood. If the prostate cancer returns, it is likely that PSA levels will rise again.

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Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment

If your prostate-specific antigen blood level shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment you’ve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.

Stage 4 Prostate Cancer Treatments And Prognosis

Stage 4 prostate cancer is the most advanced stage of the disease. It means that cancer has spread beyond the prostate to distant areas of the body. Learn more about this stae, what treatments are available, and the prognosis.

Brianna Gilmartin / Verywell

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Why You May Need Treatment While In Remission

Because there are still cancer cells in your body even when youre in remission, you might have treatment during remission. This reduces the risk that the remaining cancer cells will start growing again.

Whether or not you have treatment during remission, youll be watched closely to make sure that your cancer doesnt become active again.

The most common type of treatment during remission is maintenance chemotherapy. This is chemo thats given regularly to stop the cancer from spreading.

Maintenance therapy shouldnt make you feel worse. If you find that the side effects start to become too much for you, talk to your doctor. They may take you off maintenance therapy.

Maintenance therapy may also become less effective over time, in which case your doctor may stop the therapy to help ensure your cancer doesnt become resistant to chemo.

For some people, cancer remission can last a lifetime. Others may have their cancer come back, which is called a recurrence.

types of cancer recurrence

  • Local. The cancer comes back in the place it was originally found.
  • Regional. The cancer comes back in lymph nodes and tissues near the original cancer site.
  • Distant. The cancer comes back in other places throughout the body .

The chance of recurrence depends on many things, including the type of cancer you had, what stage the cancer was found in, and your overall health.

The outlook for the five most common types of cancers is:

How Is A Recurrence Detected

Clinical Case Discussion: Metastatic Prostate Cancer and Evidence for More Precision Therapy

After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.

When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.

Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.

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Prostate Cancer Survival Rates

Answering the question of how curable is prostate cancer? first requires understanding what doctors mean when they refer to curability. Regardless of the type of cancer, doctors consider cancer cured when a patient remains cancer-free for a specified period after treatment. The higher the number of patients who stay cancer-free for five years or longer, the higher the curability of that particular disease.

Prostate cancer, therefore, has one of the highest curability rates of all types of cancer, thanks in large part to early detection standards and advances in treatment, such as the stereotactic body radiation therapy offered by Pasadena CyberKnife. When the cancer is detected in the early local or regional stages that is, before the cancer has spread or when it has only spread to limited areas in the pelvic regions the five-year survival rate is nearly 100 percent.

Survival rates decline significantly when cancer is detected at later stages however, the good news is that only about five percent of men are diagnosed after the cancer has become widespread throughout the body. In short, more than 90 percent of men who are diagnosed with prostate cancer live for five years or longer after treatment, making it one of the most curable forms of cancer.

Understanding Statistics About Survival

Doctors estimate prognosis by using statistics that researchers have collected over many years about people with the same type of cancer. Several types of statistics may be used to estimate prognosis. The most commonly used statistics include:

  • Cancer-specific survivalThis is the percentage of patients with a specific type and stage of cancer who have not died from their cancer during a certain period of time after diagnosis. The period of time may be 1 year, 2 years, 5 years, etc., with 5 years being the time period most often used. Cancer-specific survival is also called disease-specific survival. In most cases, cancer-specific survival is based on causes of death listed in medical records.
  • Relative survivalThis statistic is another method used to estimate cancer-specific survival that does not use information about the cause of death. It is the percentage of cancer patients who have survived for a certain period of time after diagnosis compared to people who do not have cancer.
  • Disease-free survivalThis statistic is the percentage of patients who have no signs of cancer during a certain period of time after treatment. Other names for this statistic are recurrence-free or progression-free survival.

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What Does Cancer Remission Mean

Cancer remission is when the signs and symptoms of cancer have lessened or are undetectable.

In blood-related cancers like leukemia, this means youll have a decrease in the number of cancer cells. For solid tumors, that means that the tumor size has decreased. The decrease must last for at least one month to be considered remission.

types of cancer remission

There different types of remission:

  • Partial. A reduction of at least 50 percent in measurable tumor size or cancer cells
  • Complete. All detectable evidence of cancer is gone.
  • Spontaneous. When cancer goes into remission without therapy considered adequate to otherwise lead to remission. This usually happens after a fever or infection, and is rare.

Remission is not a cure, and it doesnt mean that youre totally cancer-free. Even in complete remission, there can still be some cancer cells in your body, and these can start growing again.

Paying For Cancer Treatment

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Finances are often a very real concern for people with cancer. Treatment costs a lot. Hopefully, you have been able to keep your health insurance. Sometimes there are insurance options that people with cancer may not be aware of. Talk to your cancer care team, your facilitys financial counselors, or a social worker. You can also call us for help finding possible sources of financial assistance.

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Staging Spread And Survival Rates

As with all cancers, doctors use the term stage to describe the characteristics of the primary tumor itself, such as its size and how far prostate cancer has spread when it is found.

Staging systems are complicated. The staging system for most cancers, including prostate cancer, uses three different aspects of tumor growth and spread. It’s called the TNM system, for tumor, nodes, and metastasis:

  • T, for tumor describes the size of the main area of prostate cancer.
  • N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
  • M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.

Using the TNM system, each man’s prostate cancer can be described in detail and compared to other men’s prostate cancer. Doctors use this information for studies and to decide on treatments.

As far as survival rates for prostate cancer go, however, the staging system is pretty simple. As we’ve mentioned, in terms of survival rates, men with prostate cancer can be divided into two groups:

Treatment Of Metastatic Stage Iv Or D2 Prostate Cancer

Prostate cancer that has spread to distant organs and bones is treatable, but not curable with current standard therapies. Hormone therapy has been the standard treatment of metastatic prostate cancer for many years. Metastatic prostate cancer can be controlled with hormone therapy for many years and new treatment options continue to become available.

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Infection And The Immune System

Looking at people who have had a spontaneous remission of their cancers, it’s quickly noted that most of these regressions are associated with an acute infection. Infections often result in a fever and stimulation of the immune system.

We know that our immune systems have the ability to fight off cancer. That is, in fact, the logic behind immunotherapy. Immunotherapy medications, while still in their infancy, have resulted in dramatic remissions of cancer for some people, even in the advanced stages of cancer. These drugs work in different ways, but a common theme is that they essentially enhance the ability of our own immune systems to fight cancer.

Infections which have been associated with spontaneous remission include diphtheria, measles, hepatitis, gonorrhea, malaria, smallpox, syphilis, and tuberculosis.

Many Factors Can Affect Your Prognosis

What are the Treatment Options for Stage 4 Prostate Cancer?

Some of the factors that affect prognosis include:

  • The type of cancer and where it is in your body
  • The stage of the cancer, which refers to the size of the cancer and if it has spread to other parts of your body
  • The cancers grade, which refers to how abnormal the cancer cells look under a microscope. Grade provides clues about how quickly the cancer is likely to grow and spread.
  • Certain traits of the cancer cells
  • Your age and how healthy you were before cancer
  • How you respond to treatment

Learn more about Cancer Staging and Tumor Grade.

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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.

What Is Hospice Care

If at some point treatment can no longer control the cancer or the benefits no longer outweigh the side effects, you may feel better with hospice care. The hospice philosophy accepts death as the final stage of life and does not try to stop it or speed it up. The goal of hospice is to help patients live as alertly and comfortably as possible during their last days. Most of the time, hospice care is given at home. It can also be given in hospitals, nursing homes, and hospice houses. Your cancer may cause symptoms or problems that need attention, and hospice focuses on your comfort. If youd like to learn more about this, see Hospice Care.

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