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.
What Is The Prostate
The prostate is a small gland in the pelvis and is part of the male reproductive system.
About the size of a walnut, it’s located between the penis and the bladder, and surrounds the urethra.
The main function of the prostate is to produce a thick white fluid that creates semen when mixed with the sperm produced by the testicles.
Us Preventive Services Task Force Issues New Prostate Cancer Screening Guidelines
Prostate cancer is usually though not always a very slow-growing cancer that takes a long time to start affecting the body.
Most often, it only causes symptoms when it grows to pinch the urethra or invade the sphincter or other body parts.
In fact, some men with prostate cancer don’t show any signs or symptoms of their illness, the CDC notes.
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Early Stage Prostate Cancer
If the cancer is small and localized, a doctor may recommend:
Watchful waiting or monitoring
The doctor may check PSA blood levels regularly but take no immediate action. Prostate cancer grows slowly, and the risk of treatment side effects may outweigh the need for immediate treatment.
A surgeon may carry out a radical prostatectomy to remove the tumor. In addition to removing the prostate, the procedure may also involve the removal of the surrounding tissue, seminal vesicles, and nearby lymph nodes. A doctor can perform this procedure using either open, laparoscopic, or robot-assisted laparoscopic surgery.
This uses radiation to kill cancer cells or prevent them from growing. Options for early stage prostate cancer may include :
External radiation therapy: This method uses a machine outside the body to send radiation toward the cancer cells. Conformal radiation therapy is a type of external radiation that uses a computer to help guide and target a specific area, minimizing the risk to healthy tissue and allowing a high dose of radiation to reach the prostate tumor.
Internal radiation therapy: Also known as brachytherapy, this method uses radioactive seeds that a doctor implants near the prostate. A surgeon uses imaging scans, such as ultrasound or computed tomography to help guide the placement of the radioactive substance.
Treatment will depend on various factors. A doctor will discuss the best option for the individual.
Towards A Meaningful Definition Of High
In the United States, approximately 238,590 men were expected to be diagnosed with prostate cancer in 2013, and 29,720 prostate cancer patients were anticipated to die of their disease in 2013.2 Many of the patients who die of prostate cancer present initially with tumours seemingly confined to the gland this arguably represents true high-risk disease and new approaches are needed for these patients. By current estimates, high-risk disease accounts for 15% of all prostate cancer diagnoses3. The limitations of determining risk based on the T, N, M classification, which does not include Gleason score or PSA, have long been recognized. An important first step toward a more reliable schema was first proposed by D’Amico et al.,4 using an endpoint of PSA failure and defining high-risk as a clinical T stage cT2c, a Gleason score 8, or a PSA > 20 ng/mL this definition has been adopted by the American Urological Association .5 The Radiation Therapy Oncology Group developed the first classification which associated specific baseline factors with overall survival and cause-specific survival, arguably more relevant measures. High risk in the RTOG classification includes 1) Gleason 8, or 2) Gleason =7 plus either cT3 or node-positive PSA adds little to this model for the prediction of cause-specific survival or overall survival.6 When combining the RTOG model with the Kattan nomogram, the ability to predict prostate cancerspecific survival is improved.7
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Recurrent Prostate Cancer Symptoms
Prostate cancer that returns after treatment is considered recurrent. When it returns to the area around the prostate, the disease is classified as a local recurrence. If the cancer is found in another part of the body, the recurrent cancer is considered metastatic. If the cancer metastasizes outside the prostate, it most likely develops in bones first. Metastatic prostate cancer most often spreads to the liver, bones and lungs.
After initial treatment for prostate cancer, PSA levels are expected to drop dramatically. The first sign of recurrent prostate cancer may be a rise in the PSA level. Other symptoms of recurrent cancer may depend on whether and where the cancer has spread. Symptoms include:
- Blood in the urine
- Difficulty breathing
Patients should discuss any symptoms with their doctor and ask about scheduling regular PSA tests after treatment.
Whos At Risk For Prostate Cancer
All men are at risk of having prostate cancer. About one man in nine will be diagnosed with it during their lifetime, but only one in 39 will die of this disease. About 80% of men who reach age 80 have cancer cells in their prostate. Besides being male, there are other things that contribute to the risk.
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How Common Is Prostate Cancer And Who Is At Risk
Prostate cancer most often affects men between ages 55 and 69. There is a huge gap between the proportion of men diagnosed with prostate cancer and those whose health and lifespan are affected by the disease. American men have a 16 percent lifetime risk of developing prostate cancer, but only 2.9 percent of men die from it.
In fact, many prostate cancers are believed to be slow growing, with men dying from causes other than prostate cancer. Autopsy studies support this, finding that 30 percent of 55-year-old men and 60 percent of men reaching age 80 on whom an autopsy is performed have autopsy-discovered prostate cancer.
There are some factors that increase risk for prostate cancer, including:
Race Race seems to play a role in the frequency and severity of the disease. African-American men are far more likely to develop prostate cancer than white men 203.5 vs. 121.9 cases per 100,000 men. They are also more than twice as likely as white men to die of prostate cancer 44.1 vs. 19.1 deaths per 100,000 men.
Family History Positive family history of prostate cancer is another risk factor.
Elevated Body Mass Index Elevated BMI is another risk factor, linked to an increased risk of prostate-cancer-specific mortality and biochemical recurrence in men with prostate cancer.
Prognostic Groups For Localised Prostate Cancer
Doctors may divide localised prostate cancer into groups depending on how likely it is that the cancer will grow quickly or spread. In the UK, doctors now divide prostate cancer into 5 risk groups. This is the Cambridge Prognostic Group . The 5 risk groups are from CPG 1 to CPG 5.
Your group depends on:
- your Grade Group or Gleason score
- the prostate specific antigen level
- the size of your cancer. This is the T stage
Ask your doctor or specialist nurse if you have any questions about this.
Some doctors may use an older system that divides prostate cancer into 3 risk groups. These are:
- low risk prostate cancer. This is the same similar to CPG 1
- medium or intermediate risk prostate cancer. This is the similar to CPG 2 and CPG 3
- high risk prostate cancer. This is the same as CPG 4 and CPG 5
Treatment for localised prostate cancer depends on your risk group. It also depends on:
- your age and general health
- how you feel about the treatments and side effects
You might not have treatment straight away if its unlikely that your cancer will grow or develop for many years. Your doctor monitors your cancer closely and you have treatment if it starts to grow. This is active surveillance. Your doctor may recommend you have active surveillance if your cancer is in the CPG 1, 2 or 3.
If you decide to have treatment, it might include:
- surgery to remove your prostate or
- external radiotherapy
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What Age Should You Check For Prostate Cancer
Different organizations or healthcare organizations have varying answers, but, on average, screening should begin at age 50. If a man has increased risk factors such as strong family history, is Afro-American, or consumes a lot of red meat, he should be screened in his mid-40s. There is evidence that if the PSA is very low in the mid-40s, it does not have to be checked again for a number of years. If, however, the PSA is elevated, it should result in more careful screening in the subsequent years.
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.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
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 .
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Prostate Cancer Stages: What You Need To Know
There are four prostate cancer stages, which refer to how quickly and how far the cancer has spread.
The stages are based on guidelines set by the American Joint Committee on Cancer .
To determine your prostate cancer stage, your doctor will perform a number of tests, including:
- Digital rectal exam, in which your prostate is felt for abnormalities
- A blood test to measure the amount of PSA that’s circulating in your body
- A biopsy to extract cancerous tissue and grade how likely it will spread based on its appearance compared with normal prostate tissue
- Various imaging tests, such as computerized tomography and magnetic resonance imaging scans
- Bone scans to look for cancerous cells in bone
Risk Factors In Aggressive Vs Slow
In the past few years, weve learned that prostate cancer really is several diseases with different causes. More aggressive and fatal cancers likely have different underlying causes than slow-growing tumors.
For example, while smoking does not appear to be a risk factor for low-risk prostate cancer, it may be a risk factor for aggressive prostate cancer. Likewise, lack of vegetables in the diet is linked to a higher risk of aggressive prostate cancer, but not to low-risk prostate cancer.
Body mass index, a measure of obesity, is not linked to being diagnosed with prostate cancer overall. In fact, obese men may have a relatively lower PSA levels than non-obese men due to dilution of the PSA in a larger blood volume. However, obese men are more likely to be diagnosed with aggressive disease.
Other factors that have been linked to aggressive prostate cancer include:
- Tall height
- Lack of exercise and a sedentary lifestyle
- Very high calcium intake
- Agent Orange exposure
Research in the past few years has shown that dietary factors might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease. Get practical tips on dietary and lifestyle changes in PCFs guide, The Science of Living Well, Beyond Cancer.
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Radiation Therapy And Androgen Deprivation Therapy
A recent publication demonstrates an increasing trend of under treatment of high-risk prostate cancer, with many high-risk patients receiving ADT alone rather than curative treatment consisting of radiotherapy or radical prostatectomy.3 A Scandinavian randomised phase III trial, SPCG-7/SFUO-3 , showed that the addition of radiotherapy to total androgen blockade improved rates of survival and disease-free survival for high-risk patients .35 The National Cancer Institute of Canada and the United Kingdom Medical Research Council together randomized 1,057 patients with high-risk prostate cancer receiving lifelong ADT to pelvic radiotherapy or no further treatment . Similar to the results of the SPCG-7/SFUO-3 study, the addition of radiotherapy improved overall survival and prostate cancerspecific survival .36 This corresponds to very favorable number-needed-to-treat to prevent one prostate cancerspecific death .
Advanced Prostate Cancer Symptoms
Men with advanced prostate cancer may experience additional symptoms. Thats because the cancer has spread from the prostate to other parts of the body, such as the bones or lymph nodes.
Signs of metastatic prostate cancer may include:
- Swelling in legs or pelvic area
- Numbness or pain in the hips, legs or feet
- Bone pain that persists or leads to fractures
A wide range of treatment options are available for managing advanced cancer. These treatments kill cancer cells, but they may also help patients manage pain.
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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.
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What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
External Bream Radiation Therapy
External beam radiation therapy involves a series of daily treatments to accurately deliver radiation to the prostate. Treatment planning and delivery techniques such as intensity modulated radiation therapy can be utilized to control the dose of radiation to the desired treatment area in the prostate, allowing for optimal treatment while reducing the risk of exposure to the surrounding healthy tissue. Successful treatment requires coordination between the UCLA physicians, medical physicists, and therapists.
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Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- having blood in your urine or semen
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
- stomach pain
What Is The Outlook
No cure is available for stage 4 prostate cancer. Your healthcare team will work with you to help control the cancer for as long as possible while maintaining a good quality of life.
Your outlook will depend on how fast the cancer is spreading and how well you respond to therapies.
With treatment, you can live for many years with metastatic prostate cancer.
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Focused Care For Men At High Risk For Prostate Cancer And Those With Advanced Disease
Prostate cancer is one of the most common and deadly cancers for American men. To better assist men at risk for the disease, we created the University of Chicago Medicine High-Risk and Advanced Prostate Cancer Clinic . The program provides a comprehensive genetic evaluation and multifaceted screening plan for men with an increased prostate cancer risk. If youve been recently diagnosed with aggressive forms of prostate cancer, our team also offers novel treatment strategies as well as access to leading-edge clinical trials.
Favorite Online Support Networks And Advocacy
PHEN is an organization geared toward African-American men a group that has the nations highest prostate cancer incidence and mortality rates. It offers support groups, survivor networks, and a monthly newsletter that features new treatments and clinical trials. Their annual Fathers Day Rally event takes place at churches nationwide.
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Who Is At Risk For Prostate Cancer
All men are at risk for prostate cancer, but African-American men are more likely to get prostate cancer than other men.
All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.
The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.
Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.