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
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.
Biochemical Recurrence Without Metastatic Disease After Exhaustion Of Local Treatment Options
Biochemical recurrence is defined as a rise in PSA to 0.2 ng/mL and a confirmatory value of 0.2 ng/mL or greater following radical prostatectomy, or a rise of 2ng/mL or more above the nadir PSA after radiation therapy. Not all men who have a rising PSA will develop metastases, and for that reason not all such men require treatment. The risk of metastases and death depend on the patients Gleason score, the length of time between the nadir PSA and the onset of the PSAs rise, and the PSA doubling time.
Patients who have PSA failure following radical prostatectomy and have no evidence of metastatic disease have the options of watchful waiting, radiation therapy, or hormone ablation as salvage therapy. Similarly, patients who have PSA failure following radiation therapy have the following options:
- Watchful waiting
- Hormone ablation
The pretreatment Gleason score, clinical stage, PSA level, and percentage of positive core biopsy results have been found to be reliable predictors of failure following local therapy. Unfortunately, no means of identifying recurrences limited to the pelvis is reliable. Although a Gleason grade of 7 or less is associated with a better prognosis than a grade of 8 or more, the survival likelihood associated with a rise in the PSA level is greater if the rise occurs more than 2 years after local treatment than if it occurs less than 2 years afterward.
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Most Commonly Used Treatment For Prostate Cancer Is Radiotherapy
Radiation therapy is the most common treatment for prostate cancer regardless of cancer stage, prostate-specific antigen level, and prognosis and risk rating, according to a study published online by JAMA Oncology .
Prostate cancer remains the most commonly diagnosed solid organ tumor among US men with an estimated 233,000 new cases and 29,480 deaths in 2014. Earlier diagnosis and treatment advances have meant increased use of aggressive local treatments, particularly radical prostatectomy and radiation therapy, which can result in adverse effects.
Patients must often consider the recommendations of physicians, the aggressiveness of their cancer, whether active surveillance is preferred over treatment, and health care costs, according to the study background.
Jim C. Hu, MD, MPH, formerly of the David Geffen School of Medicine at UCLA, Los Angeles, California, and now of the Weill Cornell Medical College, New York, New York, and coauthors examined predictors for treatment and use of watchful waiting or active surveillancedescribed as monitoring the disease with the expectation to begin treatment if the cancer progressesfor indolent prostate cancer. The research, conducted at UCLA, analyzed Surveillance, Epidemiology and End Results -Medicare linked data for a total of 37,621 men with a prostate cancer diagnosis from 2004 to 2007.
Adverse Effects Of Androgen Suppression
Surgical and medical castration lead to a number of adverse effects, including the following, that can have a significant impact on a mans quality of life:
- Psychological changes
- Weight gain
In addition, in men with prostate cancer receiving ADT, lean body mass decreases significantly after 12-36 months of treatment.
Uncertainty remains about the impact of androgen ablation on cardiovascular morbidity and mortality. However, the combination of weight gain and anemia in men with asymptomatic cardiovascular disease could adversely affect survival in some cases.
The FDA has advised that manufacturers of gonadotropin-releasing hormone agonists, which are approved for palliative treatment of advanced prostate cancer, must add safety warnings about the increased risk of diabetes and certain cardiovascular diseases in men receiving these medications. The FDA notes that although the risk for these complications appears to be low, physicians should evaluate patients for risk factors for these diseases before prescribing these agents.
Patients receiving GnRH agonists should be actively monitored for diabetes and cardiovascular disease and treated when possible. Periodic measurement of fasting glucose, cholesterol, triglycerides, and blood counts should be performed. In addition, the package inserts for all LHRH medications recommend periodically measuring serum testosterone, because levels above 50 ng/dL do occur and may adversely affect long-term survival.
Acute kidney injury
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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.
Treatment For Prostate Cancer
Your treatment depends on a number of factors including how big the cancer is, whether it has spread anywhere else in your body and your general health. A team of doctors and other professionals discuss the best treatment and care for you.
This section is about treatment for prostate cancer that hasn’t spread to another part of your body.
We have separate information about treatment for cancer that began in the prostate and has spread to another part of the body. This is metastatic or advanced prostate cancer.
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What Affects My Treatment Options
Your treatment options will depend on whether your cancer is contained within the prostate gland , has spread just outside of the prostate or had spread to other parts of the body .
You may have a choice of treatments. Your doctor or specialist nurse will explain all your treatment options, and help you to choose the right treatment for you.
Your treatment options and which treatment you choose may depend on several things, including:
- how far your cancer has spread
- how quickly your cancer may be growing
- the advantages and disadvantages of each treatment
- what each treatment involves
- the possible side effects of each treatment
- practical things, such as how often you would need to go to hospital, or how far away your nearest hospital is
- your own thoughts about different treatments
- how the treatment you choose now could affect your treatment options later if your cancer comes back or spreads
- your general health
- how long youre expected to live for.
The first treatment you have may affect which treatments you can have in the future, if you need further treatment. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. And to take someone to appointments, such as your partner, friend or family member.
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Clinical Trials For Prostate Cancer
Major pharmaceutical companies continually research and develop medications and treatments, which must be shown to be safe and effective before the FDA approves them and doctors can prescribe them to patients. Through prostate cancerclinical trials, researchers test the effects of new medications on a group of volunteers with prostate cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the drugs under development and measure how well they treat prostate cancer, their safety, and any possible side effects.
Some people with prostate cancer are reluctant to join clinical trials for fear of getting no treatment at all. This is not true. Youâll get the most effective therapy available for your condition, or you might receive prostate cancer treatments that are being evaluated for future use. These drugs may be even more effective than the current treatment.
These websites offer information and services to help you find a prostate cancer clinical trial that is right for you:
TrialCheck. This website, developed by the nonprofit Coalition of Cancer Cooperative Groups, is an unbiased cancer clinical trial matching and navigation service that lets you search for cancer trials based on disease and location.
National Cancer Institute. This website lists more than 6,000 cancer clinical trials and explains what to do when you find one that you think is right for you.
CDC: “How is prostate cancer treated?”
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What Side Effects Can I Expect During Treatment And How Can I Manage Them
The range of side effects that you may notice depends on your treatment. Its important to ask your doctor what side effects to watch for and monitor.
At NYU Langone, Lepor said that patients receive a lot of information about possible side effects. We provide them with a very detailed day-by-day, week-by-week, month-by-month expectation and highlight when things may be more urgent.
If the cancer is localized or locally advanced, some potential side effects of the most common treatments include:
Laser Photodynamic Therapy Transforms Prostate Cancer Treatment
20 Dec 2016
Combination of near-infrared light and aquatic photosensitizer clears early-stage disease in half of men treated in major European trial.
A large clinical trial across 47 European hospitals has shown laser photodynamic therapy to be an effective treatment for early-stage prostate cancer, with no side effects.
Surgeons have just on more than 400 men in the journal Lancet Oncology. They found that, of the 206 patients to receive PDT, 101 had a negative biopsy result when tested two years after the treatment, while in 58 the disease had progressed.
At the same time, of the 207 men in the active surveillance group who did not receive PDT only 28 showed a negative biopsy at the two-year follow-up, while 120 tested positive for disease progression.
Destructive interactionSpeaking to the BBCs Today radio program the papers lead author Mark Pemberton, a professor at University College London, said: Interaction between the laser and photosensitizer destroys the cancer cells, and also importantly the blood vessels that supply the tumor.
Pemberton also highlighted how those treated with PDT were much less likely to require radical treatment after the two-year follow-up, and said that the lack of side effects was a key finding.
Weizmann licensed the drug to Steba via the Yeda Research and Development Company, the institutes technology transfer wing. Steba now manufactures a soluble version of Tookad.
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Choosing The Best Treatment
It can be difficult to choose the best treatment for you. Your doctor and specialist nurse will explain the different treatment options and help you make a decision. The Predict Prostate tool can also help you decide between monitoring and radical treatment. We have more information about this tool further down this page.
A UK trial showed that there can be very little difference in survival between the treatments especially if you are diagnosed with early prostate cancer.
Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
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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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Metastatic Prostate Cancer Treatment
If a patients prostate cancer has spread beyond the prostate and the surrounding area, he is given systemic therapies like hormone therapy and possibly chemotherapy. While cancer responds to hormone therapy, it is called castrate-sensitive disease. Over time, the disease may become less responsive to hormone therapy and start growing again. This is called castrate-resistant disease. Patients with castrate-resistant disease can be treated with a number of additional therapies. Many are eligible for clinical trials with newer drugs or drug combinations, including immunotherapy.
Some cases of prostate cancer can be passed down from one generation to the next. Learn more about genetic testing.
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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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.
Treatment Options For Prostate Cancer
There are a number of different treatments for prostate cancer. You may have a choice of treatments such as surgery or radiotherapy. Or your doctor might suggest that you have monitoring of your cancer instead of treatment straight away. Your doctor will recommend the best treatment for you.
This page is about treatment for people who have prostate cancer that hasnt spread to other parts of the body. We also have information about treatment for people who have prostate cancer that has spread to other parts of the body. This is metastatic or advanced prostate cancer.