Watchful Waiting Or Active Surveillance
Prostate cancer treatments can have side effects. If you’re worried about these risks, you can decide to hold off on these treatments and see if your tumor grows. Waiting is also an option if youâre older, your cancer is growing slowly, or you don’t have symptoms that bother you.
Waiting does not mean that you do nothing about your cancer. Your doctor will keep a close eye on the tumor and watch for any signs that itâs getting worse.
Watchful waiting means you and your doctor will look out for symptoms. The doctor may do tests from time to time to make sure the cancer hasn’t grown.
Active surveillance means your doctor will do tests, including PSA blood tests and rectal exams, usually about every 3-6 months to check on it. You may also have a biopsy, when a doctor takes a small piece of tissue from your prostate and checks it for cancer.
Prostate Cancer Risk Groups
Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .
Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.
The risk group of the cancer will help determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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.
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What Can I Expect If I Have Metastatic Cancer
Your healthcare provider will work closely with you. Theyll monitor your symptoms and find treatments to ease them. Youll probably have many medical visits and will need to make important decisions regarding your overall health.
Is metastatic cancer curable?
In most cases, metastatic cancer is not curable. However, treatment can slow growth and ease many of the associated symptoms. Its possible to live for several years with some types of cancer, even after it has metastasized. Some types of metastatic cancer are potentially curable, including melanoma and colon cancer.
What is the metastatic cancer survival rate?
The five-year survival rate of metastatic cancer depends on the type of cancer you have. For example, the five-year survival rate for metastatic lung cancer is 7%. This means that 7% of people diagnosed with metastatic lung cancer are still alive five years later. Meanwhile, the five-year survival rate of metastatic breast cancer is 28% for women and 22% for men.
How Is A Recurrence Detected
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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Castrate Refractory Prostate Cancer: A Wider Range Of Options
In this section, we explain the treatments available at Birmingham Prostate Clinic for patients once their disease becomes resistant to hormone treatment, called castrate refractory prostate cancer. Two types of treatments are needed to:
- Control the cancer and preventing further spread of cancer
- Control or prevent the symptoms caused by the spread of prostate cancer to the bones
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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.
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Who Is At Risk Of Stage 4 Prostate Cancer
Each year almost 200,000 American men are diagnosed with prostate cancer. Obesity and smoking are linked to a higher risk of prostate cancer, but most prostate cancers happen to men over 55. The risk increases as you get older about 60% of prostate cancers are diagnosed in men over 65 years old.
Stage 4 prostate cancer happens when cancer becomes aggressive and spreads to other parts of your body. Some genetic mutations have been connected to an increased likelihood of developing aggressive prostate cancer, so men with family histories of the disease are at greater risk. Men with family members who have had pancreatic, breast, or ovarian cancers might also have a higher risk of prostate cancer.
Black or African-American men are also more likely to have aggressive forms of prostate cancer than men from other races.
The Truth About Stage 4 Metastatic Cancer
The most advanced stage of any types of cancers is stage 4 metastatic cancer. Stage 4 cancer of any kind is hard to treat. This still means that there is a chance for curing. There are many clinical trials that are improving that contribute in the increase of survival rates of patients.
Stage 4 Metastatic Cancer
However, the improvement of prognosis depends on the treatment. How a patient responds to the treatment matters a lot. Having the right treatment is very important for survival.
Stage 4 metastatic cancer life expectancy is not good at all. It has the lowest percentage when it comes to the five-year survival rate. This is because the cancerous cells have already spread to other parts of the body. Therefore, the stage 4 metastatic cancer prognosis of patient is poor and not progressive. Lets take an example such as in stage 4 metastatic cancer liver. This is the condition wherein the cancer has spread from the liver to others parts of the body. This cancer of the liver which is already in its most advanced stage has originated from the lungs that spread to breast, pancreas, large intestines and stomach. This is a condition that may be difficult to cure. Another example is the stage 4 metastatic cancer spine is the cancer in the spine that has widely spread the cancer cells to the whole spine and to other parts of the body too.Treating this stage cancer very extensively is needed for patients to survive.
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What Is The Treatment For Advanced Prostate Cancer
No matter where prostate cancer spreads, its still treated as prostate cancer. Its harder to treat when it reaches an advanced stage.
Treatment for advanced prostate cancer involves targeted and systemic therapies. Most men need a combination of treatments and they may have to be adjusted from time to time.
Cancer May Spread From Where It Began To Other Parts Of The Body
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.
Denosumab, a monoclonal antibody, may be used to preventbone metastases.
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Is Stage 4 Cancer Always Terminal
More severe cancers are more likely to be terminal. However, that is never a certainty. For example, the American Cancer Society say the 5-year survival rate for breast cancer that spreads to distant body parts is 27%, or 86% when it only spreads locally.
Determining the severity of cancer and its stage is a complex process. Doctors are still learning about all the factors that affect how cancer develops and affects the body.
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How The Study Was Performed
During the study, scientists randomized 1,071 men with intermediate- or high-risk localized prostate cancer into four groups. One group received radiation and six months of an anti-testosterone drug called leuporelin, and the second group received radiation plus 18 months of leuporelin therapy. Two other groups were treated with the same regimens of either radiation plus six or 18 months of leuporelin therapy, along with another drug called zoledronic acid, which helps to limit skeletal pain and related complications should cancer spread to the bones. Study enrollment occurred between 2003 and 2007 at 23 treatment centers across New Zealand and Australia.
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Chemotherapy For Metastatic Prostate Cancer
Chemotherapy may be used for patients with metastatic prostate cancer, with the aim of slowing any further spread of cancer and improving quality of life.
The most commonly used chemotherapy medications, typically given via an intravenous line, are docetaxel combined with prednisone. However, there are several chemotherapy drugs available, so ask a doctor which types may be most appropriate as an effective prostate cancer treatment.
In some cases, these treatments are considered palliative, intended to relieve difficult symptoms and improve quality of life.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
Sexuality And Feeling Good About Your Body
Prostate cancer treatment can often affect sexual function. Learning to be comfortable with your body during and after prostate cancer treatment is a personal journey, one that is different for everyone. Information and support can help you cope with these changes over time. Learn more in Sex and the Man With Cancer.
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Surgery For Metastatic Prostate Cancer
Unlike with localized prostate cancer, surgery isnt usually used to treat metastatic cancer. However, it may be used in some cases if it can help improve a patients quality of life, often to resolve urinary problems or stop bleeding.
If prostate cancer is locally advanced and hasnt spread far, a radical prostatectomy may still be an option. A radical prostatectomy is a surgical procedure in which the prostate is removed, along with any nearby tissue that contains prostate cancer cells.
Stage 4 Prostate Cancer Clinical Trials
Clinical trials provide cancer patients with life-extending and curative new medicines. Clinical drug trials are critical in getting new medicines to patients who need them the most, as well as securing data so that regulatory clearances may be secured, and new drugs can enter broad clinical practice. Patients who take part in clinical trials benefit both treatment science and their fellow patients.
There are currently 100 Phase III drug trials and more than 500 Phase I/II trials related to prostate cancer treatment in progress in the United States alone. Those that are approved will join the 12 new drugs that have been approved for men with advanced/metastatic disease since 2010 and further improve outcomes for patients:
Using our AI-powered approach, Massive Bio leads patients through the most extensive clinical trial matching process available.
We can assist you if you have been diagnosed with any of the following prostate cancer subtypes:
- Transitional Cell Carcinoma
- Small Cell Carcinoma
If you do not know which type of prostate cancer you have, that is okay. Additional testing can help you determine your exact diagnosis.
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Side Effects Of Targeted Therapy
Some men may experience side effects such as diarrhea, nausea and low red blood cell counts. Other possible side effects include:
Liver blood tests may also be abnormal.
One of the targeted therapies for prostate cancer, Lynparzaî , may increase the risk for blood clots in the lungs and legs. These drugs may also cause a blood cancer such as myelodysplastic syndrome or acute myeloid leukemia, but this is rare.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
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If The Cancer Comes Back
If your prostate cancer comes back at some point, your treatment options will depend on where the cancer is, what types of treatment youve already had, and your health. See Treating Prostate Cancer that Doesn’t Go Away or Comes Back After Treatment. For more general information on recurrence, see Understanding Recurrence.
What Happens During Treatment
A urinary catheter is inserted through your urethra and into your bladder. Then the BCG solution is injected into the catheter. The catheter is clamped off so the solution stays in your bladder. Some doctors may remove the catheter at this time.
You have to hold the medicine in your bladder. Youll be instructed to lie on your back and to roll from side to side to make sure the solution reaches your entire bladder.
After about two hours, the catheter is unclamped so the fluid can be drained. If the catheter was already removed, youll be asked to empty your bladder at this time.
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Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .