Prognostic Nomogram For Css
Compared with the nomogram for OS, the nomogram for CSS integrating all the significant independent factors including AJCC stage based on the training cohort is shown in Figure 6B. The C-index for nomogram of CSS prediction was 0.838 , and 0.852 in the training and validation cohort, respectively. The calibration plots indicated an excellent accuracy in prediction for CSS probability at 5 and 10 year in the training cohort and testing cohort .
What Are Stage 4 Prostate Cancer Treatments
After prostate cancer has spread to other parts of your body and reached the final stage it is often incurable. Some treatments may be able to shrink tumors or slow the cancers spread.
Hormone blocking therapy
Prostate cancer needs the male hormone testosterone to grow. Blocking or preventing your body from making testosterone can potentially slow the cancers spread or even shrink tumors. Testosterone can be blocked with many different types of medications or surgery to remove your testicles.
In late-stage prostate cancer, hormone therapy is usually used alone but can also be combined with other treatments.
Radiation therapy may be recommended in stage 4 prostate cancer for men with very large tumors or cancer that has spread to the lymph nodes and other areas. It is often combined with hormone therapy or used after surgery to kill off any remaining cancer cells.
Chemotherapy might be recommended for people with stage 4 prostate cancer in combination with hormone therapy or other treatments. It can help relieve some of your prostate cancer symptoms and potentially prolong your life expectancy.
Pain relief and supportive care
What Are Next Steps
Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But its important to remember that the numbers are only statistics.
The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.
Everyones cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.
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Loss Of Libido And Erectile Dysfunction
The hormones that are often used to treat advanced prostate cancer can decrease libido and cause erectile dysfunction , which occurs when a man isnt able to have or keep an erection to have sex, according to the University of Rochester Medical Center in Rochester, New York.
As a result, for couples, theres a real struggle to recover that sense of life together how to be intimate without having sex, says Michael J. Morris, MD, an oncologist at Memorial Sloan Kettering Cancer Center in New York City.
Depending on the type of treatment that caused the ED, the ability to have an erection may improve over time, according to the University of Rochester Medical Center. You and your partner may want to explore other ways to be intimate in your relationship. A sex therapist or couples counselor may be able to help. There are also treatments available for erectile dysfunction, such as medications and implants.
Gleason Score Vs Grade Groups
The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.
One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:
- 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
- 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.
So, although both situations give a Gleason score of 7, they actually have very different prognoses.
Heres an overview of how the two grading systems compare:
|grade group 5
Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.
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Treatment Options Under Clinical Evaluation
Treatment options under clinical evaluation for patients with prostate cancer include the following:
Cryosurgery, or cryotherapy, is under evaluation for the treatment of localized prostate cancer. It is a surgical technique that involves destruction of prostate cancer cells by intermittent freezing of the prostate with cryoprobes, followed by thawing. There is limited evidence regarding its efficacy and safety compared with standard prostatectomy and radiation therapy, and the technique is evolving in an attempt to reduce local toxicity and normal tissue damage. The quality of evidence on efficacy is low, currently limited to case series of relatively small size, short follow-up, and surrogate outcomes of efficacy.
Serious toxic effects associated with cryosurgery include bladder outlet injury, urinary incontinence, sexual impotence, and rectal injury. Impotence is common, ranging from about 47% to 100%.
The frequency of other side effects and the probability of cancer control at 5 years follow-up have varied among reporting centers, and series are small compared with surgery and radiation therapy. Other major complications include urethral sloughing, urinary fistula or stricture, and bladder neck obstruction.
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer.
Neoadjuvant hormonal therapy
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Experimental Treatments For Advanced Prostate Cancer
Researchers are currently testing many new approaches and treatments for prostate cancer, including new medications. These include the following:
Immune checkpoint inhibitors
The immune system uses Ã¢checkpointsÃ¢ to stop it from attacking the bodyÃ¢s healthy cells. These checkpoints are proteins on immune cells.
Cancer cells often use these checkpoints to keep the immune system from attacking them.
Immune checkpoint inhibitors are drugs that can these checkpoints on cancer cells. Inhibiting these checkpoints can allow a personÃ¢s immune system to attack the cancer cells.
Chimeric antigen receptor T cell therapy
This treatment involves taking immune cells from the personÃ¢s blood. A scientist then alters these cells in a lab to have receptors called chimeric antigen receptors on their surface.
These receptors help the cells attach to proteins on the surface of prostate cells. A scientist then multiplies these altered T cells in a lab before putting them back into the personÃ¢s blood.
Scientists hope these T cells can then find prostate cancer cells and launch a targeted immune attack.
However, this treatment is complicated and may have some serious side effects. This means it is currently only available as part of clinical trials.
Targeted drug therapies
Targeted drug therapies can act on specific parts of cancer cells and the environments surrounding them.
Two possible targeted therapy treatments are:
Treating prostate cancer that has spread to the bones
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Patients And Their Families May Have Cultural Or Religious Beliefs And Customs That Are Important At The Time Of Death
After the patient dies, family members and caregivers may wish to stay with the patient a while. There may be certain customs or rituals that are important to the patient and family at this time. These might include rituals for coping with death, handling the patients body, making final arrangements for the body, and honoring the death. The patient and family members should let the healthcare team know about any customs or rituals they want performed after the patients death.
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 prevent further spread of cancer
- Control or prevent the symptoms caused by the spread of prostate cancer to the bones
Signs Of Prostate Cancer Include A Weak Flow Of Urine Or Frequent Urination
- Weak or interrupted flow of urine.
- Sudden urge to urinate.
- Trouble starting the flow of urine.
- Trouble emptying the bladder completely.
- Pain or burning while urinating.
- Blood in the urine or semen.
- A pain in the back, hips, orpelvis that doesnât go away.
- Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia.
Other conditions may cause the same symptoms. As men age, the prostate may get bigger and block the urethra or bladder. This may cause trouble urinating or sexual problems. The condition is called benign prostatic hyperplasia, and although it is not cancer, surgery may be needed. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be like symptoms of prostate cancer.
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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.
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Treatments To Control And Prevent Symptoms Caused By The Spread Of Prostate Cancer To The Bones
Palliative External beam radiotherapy
Radiopharmaceuticals: Strontium-89 , samarium-153
Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment.
Zolidronic acid is a bisphosphonate given by a 15-minute intravenous infusion every 34 weeks. It reduces the risk of bone complications, including pain and fractures.
Xgeva : this is a newly licensed drug available at BPC.
Surgery may be undertaken to treat bone fractures or to relieve the pressure on the spinal cord by bone metastases.
What Are The Final Stages Of Prostate Cancer
The progression of prostate cancer is divided into four distinct stages by the fourth stage the cancer will have spread to other parts of the body. In this final stage, the Gleason score can range from 2 to 10, and the cancer may have spread to nearby tissue such as the rectum, bladder or pelvic wall. It may also have spread to nearby lymph nodes, and often spreads to the bones.
The stages of prostate cancer represent the degree to which the cancer has spread. In early stages, the cancer is more contained.
- Stage IThe cancer is only in the prostate.
- Stage IIThe cancer is more advanced but is still contained within the prostate.
- Stage IIIThe cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles.
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First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
How Would I Treat Stage 4 Prostate Cancer
- I would stop all the foods that cause cancer, and stop using all the household and bodycare products that leach toxins into the body.
- I would change to those foods that resonate with my body through personal testing as I describe in my book.
- I would only eat fresh organic foods, grains, nuts and seeds properly prepared and soaked to reduce the phytic acid cooked nourishing broths and meats from grass-fed and pastured animals and eat raw, unpasteurized dairy and eggs which have a completely different profile than conventional cancer-causing, factory-farmed and produced foods which are loaded with toxins.
- I would stop all harmful foods listed on this site and in my book. For end stage prostate cancer, I would stop all sugar and its substitutes. Why? They feed the cancer.
- I would undergo cleansing short fasts with freshly made vegetable juices if personally tested “Yes.” I would do a liver flush, or many, to rid the body of major toxins quickly and easily.
- I would ensure that if couldn’t get adequate sun on my skin, I would at least take an adequate dosage of Vitamin D3 levels.
- I would take aloe vera juice each day and test for which supplements my body needed like zinc and magnesium.
End stage prostate cancer could then no longer find a host in my body for I would have changed the conditions that I either knowingly or unknowingly created that led to it.
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Frequently Asked Questions About Metastatic Prostate Cancer
If you have been diagnosed with late-stage prostate cancer, you likely have a number of questions about this malignancy and what you can expect moving forward. To help answer some of your initial questions, you may find it useful to browse the following articles:
While these articles may help provide general information about metastatic prostate cancer, it is best to discuss your individual condition and specific questions with a physician to receive medical advice that is tailored to your unique circumstances. At Moffitt Cancer Center, the multispecialty team that makes up our Urologic Oncology Program collaborates in regular tumor board meetings to provide our patients with individualized treatment plans that lead to better outcomes and an improved quality of life.
Medically reviewed by Monica Chatwal, MD.
Moffitt welcomes patients with or without a referral to learn more about their metastatic prostate cancer diagnosis and treatment options. To schedule an appointment, call or fill out a new patient registration form online.
Religious And Spiritual Beliefs
Awareness of the importance of religious beliefs and spiritual concerns within medical care has increased substantially over the last decade. National consensus guidelines, published in 2018, recommended the following:
- That all patients receive a screening assessment for religious and spiritual concerns, followed by a more complete spiritual history.
- That all patients receive a formal assessment by a certified chaplain.
- That such information is placed in patient records, with follow-up at all appropriate times, including hospitalization at the EOL.
An interprofessional approach is recommended: medical personnel, including physicians, nurses, and other professionals such as social workers and psychologists, are trained to address these issues and link with chaplains, as available, to evaluate and engage patients. A survey of nurses and physicians revealed that most nurses and physicians desire to provide spiritual care, which was defined as care that supports a patients spiritual health. The more commonly cited barriers associated with the estimated amount of spiritual care provided to patients included inadequate training and the belief that providing spiritual care is not part of the medical professionals role. Most nurses desired training in spiritual care fewer physicians did.
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What Will Happen In The Last Few Days
It can help to know what is normal in the last few days of life so that you know what to expect. You might not be aware of these changes when they happen because you may be drowsy or unconscious.
If you’re supporting someone who is dying, read about what you can do to help and how you can get support.
Many people worry about being in pain when they are dying. Some people do get pain if their prostate cancer presses on their nerves or makes their bones weak. But not everyone dying from prostate cancer has pain. And if you are in pain, there are things that can help to reduce and manage pain.
You should tell your doctor or nurse if youre in pain or if your pain gets worse. They can talk with you about how best to manage your pain and can help keep it under control.
You may find sitting or lying in some positions more comfortable than others, so ask if you need help getting into a different position.
Your doctor can give you medicines to help manage pain. The type of medicines they give you will depend on what is causing the pain and which medicines are suitable.
Your doctor will monitor how the pain medicines are working and may change the type of medicine or the dose. If youre still in pain or get pain in between taking medicines, its important to tell your doctor or nurse.
Sleeping and feeling drowsy
Not recognising people
Feeling restless or agitated
Changes in skin temperature or colour
Changes in breathing
Loss of appetite
Changes in urinating or bowel movements