Watchful Waiting And Active Surveillance
Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.
Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.
Future Predictors Of Prostate Cancer
Researchers are seeking more accurate ways of diagnosing, monitoring, and treating prostate cancer. Many of the studies focus on genes and genetic abnormalities of a cancer. Scientists have found that the product of a certain gene appears more often in advanced prostate cancers than in early stage prostate cancers. Now the goal is to determine if the presence of this gene product means that a cancer is more aggressive. Knowing this information can help doctors decide which patients may benefit from immediate treatment, and of what type. This and other genetic research will pave the way for earlier, more accurate predictors of cancer growth.
Grade And Risk Category
The biopsy results will show the grade of the cancer. This is a score that describes how quickly the cancer may grow or spread.
For many years, the Gleason scoring system has been used to grade the tissue taken during a biopsy. If you have prostate cancer, youll have a Gleason score between 6 and 10. A new system has been introduced to replace the Gleason system. Known as the International Society of Urological Pathologists Grade Group system, this grades prostate cancer from 1 to 5 .
Risk of progression
Based on the stage, grade and your PSA level before the biopsy, localised prostate cancer will be classified as having a low, intermediate or high risk of growing and spreading. This is known as the risk of progression. The risk category helps guide management and treatment.
Grading prostate cancer
|High risk. The cancer is likely to grow aggressive.|
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As Screening Falls Will More Men Die From Prostate Cancer
In active monitoring, men with localized prostate cancer do not get surgery or radiation right after theyre diagnosed. Instead, they have regular biopsies, blood tests, and MRIs to see if their cancer is progressing. If it is, they can receive treatment.
Although some oncologists advise men with early, low-grade prostate cancer to choose active surveillance and professional groups such as the American Society of Clinical Oncology recommend it; many patients recoil at;what sounds like lets just wait for your cancer to become really advanced.;A decade ago fewer than 10 percent of;men diagnosed with prostate cancer chose monitoring, UCLA researchers found. But that is changing. Now at least half;of men do.
That made sense to Garth Callaghan, author of the best-selling Napkin Notes, a book;of missives he tucked into his daughters lunch box. Diagnosed with early prostate cancer in 2012, he said, none of the choices seemed particularly attractive to a 43-year-old man who dreaded the possibility of side effects of surgery or radiation, including incontinence and impotence. I was completely torn. My previous experience was, just get it out of my body. But after his doctor explained that prostate cancer is grossly overtreated in the United States, I did a complete 180 and chose active monitoring.
Surgery For Aggressive Prostate Cancer Gives 92% 10
Patients with the most aggressive form of prostate cancer who have surgery radical prostatectomy 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. This compares to an 88% 10-year cancer specific survival rate and 52% overall survival rate for those who underwent radiotherapy without surgery. The findings were presented at the American Urological Associations 84th Annual Meeting, Chicago.
Stephen Boorjian, M.D., a urologist at the Mayo Clinic, said:
Its long been believed that patients with aggressive prostate cancer are not candidates for surgery. We found that surgery does provide excellent long-term cancer control for this type of prostate cancer. In addition, by allowing the targeted use of secondary therapies such as androgen deprivation, surgery offers the opportunity to avoid or at least delay the potentially adverse health consequences of these treatments.
Their study included 1,847 individuals with aggressive prostate cancer. Between 1988 and 2004 1,238 of them underwent a surgical procedure to have their prostate taken out at the Mayo Clinic, while 609 received radiotherapy at the Fox Chase Cancer Center. 344 of the patients who received radiotherapy were also given androgen deprivation therapy.
The investigators worked out their overall and cancer-specific survival rates:
Dr. Boorjian said:
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Ask Your Doctor For A Survivorship Care Plan
Talk with your doctor about developing a survivorship care plan for you. This plan might include:
- A summary of the treatment you received
- A suggested schedule for follow-up exams and tests
- A schedule for other tests you might need in the future, such as early detection tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
- A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
- Suggestions for things you can do that might improve your health, including possibly lowering your chances of the cancer coming back
Outlook For Men With Localised Prostate Cancer
Most;localised prostate cancer;is slow-growing and may not need treatment or shorten a mans life. For many men who have treatment for localised prostate cancer, the treatment will get rid of the cancer. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.
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Quality Of Life With Advanced Stage Prostate Cancer
Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.
Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.
Small Cell Prostate Cancer
Small cell prostate cancer is a subset of neuroendocrine;cancer. It is made up of small round cells.
It is a high-grade malignant neoplasm, which is rare and affects less than 1% of the population. It is extremely lethal.
It is one of the most aggressive malignancies of the;prostate with a survival rate of 1-2 years from the time it is diagnosed.
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Communicate With Your Doctor
The most critical recommendation to reduce your risk is to keep in communication with your doctor. Your case is different from any other, and you deserve personalized treatment. These recommendations should adapt to your case, too. Thus, talk to your doctor and follow recommendations. If your doctor considers it appropriate to screen with PSA testing, talk about the pros and cons with him. And if you need treatment, discuss the benefits and drawbacks of your treatment options. Ask questions and inform yourself about prostate cancer and what to do about it.
How To Make The Right Treatment Decision
Current expert guidelines for treatment of localized prostate carcinoma recommend potentially curative therapy for patients whose life expectancy is at least 10 years., Patients with limited life expectancy are more likely to die from health conditions other than prostate cancer. Men with a life expectancy of more than 10 years are more likely to die from progressive prostate cancer. This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.,
Conservative management proved to be an acceptable treatment option for men with low-grade Gleason scores, clinically localized disease, and life expectancies of less than 10 years. Increasing age was described as a risk factor for receiving inadequate treatment for prostate cancer. Thus, older men have been shown to receive potentially curative therapy less often than younger men., Radical prostatectomy is preferred treatment in men younger than 70 years, whereas radiation therapy is applied predominantly in patients older than 70 years. Conservative therapy such as watchful waiting or androgen deprivation by luteinizing hormone-releasing hormone analogs is preferentially applied in men older than 80 years. Watchful waiting or hormonal therapy is used to treat 82% of men older than 80 years.
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Managing Bone Pain And Weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
What Can Affect My Outlook
No one can tell you exactly what will happen. How prostate cancer affects you will depend on many things.
- Your stage; Whether your cancer is localised, locally advanced, or advanced.
- Your Gleason score or grade group; The higher your;Gleason score, the more aggressive the cancer, and the more likely it is to spread.
- Your treatment options; You may be able to have treatment aimed at getting rid of the cancer. Or you may be able to have treatment to keep the cancer under control. Read more about;choosing your treatment.
- Your health; If you have other health problems, you may have fewer treatment options. And you may be more likely to die from another condition, such as heart disease.
- Your PSA level; After youve been diagnosed,;PSA tests;are a good way of monitoring your prostate cancer and seeing how youre responding to treatment.
- How successful your treatment is; Your treatment may be successful at getting rid of your cancer or keeping it under control. But for some men, treatment may not work as well as expected.
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Getting Regular Physical Activity
Some research has suggested that men who exercise regularly after treatment might be less likely to die from their prostate cancer than those who dont. Its not clear exactly how much activity might be needed, but more seems to be better. More vigorous activity might also be more helpful than less vigorous activity. Further studies are needed to follow up on these findings.
What Is Prostate Cancer
Prostate cancer only affects men. Cancer begins to develop in the prostate a gland in a mans reproductive system. The word prostate comes from Medieval Latin prostate and Medieval French prostate. The ancient Greek word prostates means one standing in front, from proistanai meaning set before. The prostate is so called because of where it is at the base of the bladder.
The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.
The urethra a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body goes through the prostate.
There are thousands of very small glands in the prostate they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.
It is a myth to think that a high blood-PSA level is harmful to you it is not. High blood PSA levels are however an indication that something may be wrong in the prostate.
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Keeping Health Insurance And Copies Of Your Medical Records
Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and although no one wants to think of their cancer coming back, this could happen.
At some point after your cancer treatment, you might find yourself seeing a new doctor who doesnt know your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.;
Is Red Wine Good For Prostate
A new study shows men who drink four or more glasses of red wine per week have a nearly 50% lower risk of prostate cancer than non-drinkers. In addition, researchers found that red wine’s protective effects appear to be even stronger against the most dangerous and aggressive forms of prostate cancer.
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Stage 2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still near 100 percent.
The PSA score for stage 2 is less than 20 ng/mL.
Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:
- Grade group: 1
- Gleason score: 6 or less
Reducing Your Risk Of Prostatecancer
Some people would prefer not to know when they are going to die. Thus, talking about 5-year or 10-year survival might not be the answer that youre looking for. Maybe you do not want to know how many years you have left. But even people who prefer not to know feel interested to learn how to reduce their risk.
Prevention is how doctors describe this process of reducing your risk. There are two types of prevention:
- Primary prevention: It starts before a prostate cancer diagnosis. Primary prevention is recommended to patients at risk of prostate cancer. For example, in African Americans and males with prostate cancer history in first-degree relatives.
- Secondary prevention: It starts after a prostate cancer diagnosis. Secondary prevention aims to reduce the risk of complications and spread of cancer. It reduces the patients mortality rate and the aggressiveness of cancer.
Primary and secondary prevention have similarities and differences. But most recommendations are the same. They include lifestyle modifications and dietary habits that you can adopt from now on. For example :
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Obesity And Dietary Habits
High-fat intake, the Western diet, obesity, and sedentary behavior are all associated with a higher incidence of prostate cancer. High calcium intake and a diet high in milk products can increase the risk. After being diagnosed with prostate cancer, calcium can increase the risk of aggressive types. On the other hand, whole milk increases the risk of recurrence of prostate cancer. Obese and overweight men are particularly prone to this increase in recurrence. Another dietary risk factor is vitamin D insufficiency. Meat consumption increases cancer risk, while fish consumption lowers the mortality rate.
How Is Advanced Prostate Cancer Diagnosed
If youve previously been diagnosed with prostate cancer, be sure to tell your doctor if you have any new symptoms, even if youve completed treatment.
To determine if prostate cancer has returned or has spread, your doctor will likely order some imaging tests, which may include:
- PET scans
- bone scans
You probably wont need all of these tests. Your doctor will choose the tests based on your symptoms and physical exam.
If any of the images reveal abnormalities, it doesnt necessarily mean that you have cancer. Additional testing may be necessary. If they find a mass, your doctor will probably order a biopsy.
For a biopsy, your doctor will use a needle to remove samples from the suspicious area. A pathologist will then analyze the removed cells under a microscope to see if theyre cancerous. The pathologist can also determine if you have an aggressive form of prostate cancer.
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