How Do I Know That My Cancer Has Come Back
Recurrent prostate cancer usually doesn’t cause symptoms unless it has spread to other parts of your body. Then you might have:
- Trouble urinating
Often, the first sign that your cancer has returned is rising levels of prostate specific antigen, or PSA, in a blood test. Regular PSA testing is one way your doctor monitors you for a recurrence.
This test can’t show for sure that your cancer is back. Your doctor can do a biopsy to confirm that your cancer has returned, or a CT or MRI scan to see if it has spread.
Doctors also have an imaging test called positron emission tomography, or a PET scan, that may be better than other scans. It uses a radioactive tracer to find out where the cancer has spread and predict which treatment might work best against it.
How Is Prostate Cancer Treated
Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.
Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are
- Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
- Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
- Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
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Is Prostate Cancer Curable
Prostate cancer is the most common type of cancer among men, second only to skin cancer. Learning that one has any type of cancer isnt easy, but the first question on most patients minds after diagnosis is, is prostate cancer curable?
The short answer is yes, prostate cancer can be cured, when detected and treated early. The vast majority of prostate cancer cases are discovered in the early stages, making the tumors more likely to respond to treatment. Treatment doesnt always have to mean surgery or chemotherapy, either. Non-invasive radiation therapy can effectively treat prostate cancer in the case of Pasadena CyberKnife, radiosurgery treatment generally takes less than a week, and you can typically resume your normal activities the same day you receive treatment.
After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
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What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
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Figure 1 Location Of The Prostate Gland
This location creates challenges in both diagnosis and treatment. During a digital rectal exam, for example, a doctor is able to feel only the back portion of the prostate. If cancer has developed in the apex, base, or deep inside the prostate, it may not be palpable.
As you evaluate treatment options, Id suggest that you think not only about your situation today, but also about where you expect to be in five or 10 years because chances are, youll still be alive. And you need to be sure that you would make the same treatment decision five or 10 years from now as you will right now.
Will you be able to deal with impotence if it occurs? What about incontinence ? How will the possible side effects of treatment affect your relationship with your wife or significant other and your very sense of self? Its vital to really think about these issues: In my experience, truly informed patients are much better able to deal with adverse consequences than patients who are uninformed or rush into making a decision.
Its also important to understand the limits of current medical knowledge about prostate cancer.
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There Are Different Types Of Treatment For Patients With Prostate Cancer
Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The patients age.
- Whether the cancer has just been diagnosed or has recurred .
Treatment options also may depend on the following:
- Whether the patient has other health problems.
- The expected side effects of treatment.
- Past treatment for prostate cancer.
- The wishes of the patient.
Most men diagnosed with prostate cancer do not die of it.
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How Can You Get Cbd And Medical Marijuana
You may also have heard of CBD oil. Itâs sold everywhere from your grocery store to vitamin shops. It doesnât contain THC, the ingredient in marijuana that gets you high. CBD is usually sold as an oil, but you can also find it as an extract, a vaporized liquid, edibles like gummies, in foods, in drinks, and in beauty products. Remember, CBD is not regulated by the FDA, so itâs also hard to know how much CBD youâre getting. One study of 84 CBD products found that more than a quarter contained more CBD than was on the label, and some products even contained THC.
The only medical marijuana product approved by the FDA is a prescription oil called Epidiolex to treat epilepsy. Thereâs no research to suggest it can treat prostate cancer or relieve cancer treatment-related symptoms. It also may cause side effects like:
- Loss of appetite
It may also interact with other medications you take, like blood thinners. Talk to your doctor to make sure you donât have any medical conditions that make using it unsafe.
If youâre considering using medical marijuana, check your state regulations. If itâs legal, you should be able to purchase it at a medical dispensary.
Show Sources
Harvard Health Publishing: âPot for the Prostate,â âCBD Products Are Everywhere, but Do They Work?â
International Journal of Molecular Sciences: âCannabinoids and Prostate Cancer: A Systematic Review of Animal Studies.â
American Cancer Society: âMarijuana and Cancer.â
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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How Does My Doctor Choose A Treatment
Once you know that your cancer has returned, you and your doctor will choose a treatment. A few factors go into making the decision, including:
- Which type of treatment you had before
- How aggressive your cancer is
- Whether, and where, it has spread
- How much time has passed since your first treatment
- How quickly your PSA level is rising
- Your overall health
Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment
If your prostate-specific antigen blood level or another test 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.
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What Happens When Prostate Cancer Is Left Untreated
While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their healthcare providers monitor their cancer.
Known as active surveillance, it is common when the cancer is expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. In active surveillance, healthcare providers will initiate cancer treatment only if cancer starts growing.
Others men may choose to not undergo cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits.
This option is certainly OK and reasonable in the right circumstancesrequiring a careful and thoughtful discussion with your healthcare provider and family.
Expert Review And References
- American Cancer Society. Treating Prostate Cancer. 2019: .
- American Society of Clinical Oncology. Prostate Cancer. 2020: .
- Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
- Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
- Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatmentand follow-up. Annals of Oncology. 2020: 31: 1119-1134. .
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Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
What Is The Prognosis For Surgery
Its important to know that the prognosis for surgery is often very good. Your doctor may be able to cure your prostate cancer with surgery alone, or they may recommend a combination of radiation therapy and hormone therapy. Surgery is typically followed by regular checkups over several years to ensure that the cancer hasnt returned or spread anywhere else in the body.
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What Is Active Surveillance For Prostate Cancer
Active surveillance means monitoring a low-grade and non-aggressive prostate cancer instead of pursuing immediate treatment. Many prostate cancers that are diagnosed early with PSA screening can be watched safely. With careful monitoring, they will not cause the patient any pain or impact his quality of life before the conclusion of his natural lifespan. Essentially, the patient has prostate cancer but undergoes no treatment for it. This allows them to forgo side effects from treatment while not reducing their life span.
Before opting for active surveillance, the most important consideration is that you have undergone the best testing to ensure that your prostate cancer is in fact safe to track. As a direct result of research that Siteman urologists have led, we know that many patients with low-risk prostate cancers are safe for active surveillance.
If you and your physician choose active surveillance, you will check in with your medical team on a regular basis to make sure the prostate cancer has not changed. Some active surveillance patients at Siteman are eligible to join clinical trials for immunotherapies as an extra safeguard against rapid or sudden cancer growth. Ask your physician if this could be an option for you.
Prostate Cancer Caregiver Podcast Series
We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.
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What Surgical Procedures Are Used To Treat Prostate Cancer
Two main procedures are used in the treatment of prostate cancer:
- Radical prostatectomy
- Transurethral resection of the prostate
A prostatectomy is a procedure to remove the prostate gland. This is performed to cure the prostate cancer.
During a transurethral resection of the prostate, the surgeon does not take out the entire prostate, but instead removes a portion of prostate tissue. Patients might undergo this procedure as part of a broader treatment program.
Read more about prostate cancer surgery at Siteman.
What Does It Mean To Have A Gleason Score Of 6 7 8 Or 9
Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6. These cancers may be called well differentiated or low-grade and are likely to be less aggressive that is, they tend to grow and spread slowly.
Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.
Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:
- Gleason score 3+4=7 tumors still have a good prognosis , although not as good as a Gleason score 6 tumor.
- A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.
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Swelling Bruising Or Tenderness Of The Scrotum
Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.