Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
How Will I Know That The Treatment Has Been Successful
As with any other prostate cancer treatment option, the postoperative PSA blood test will be the primary indicator of a successful treatment. We will obtain a PSA level three months after the procedure, and then every six months for five years. After five years PSA monitoring is generally done annually. We expect to see the PSA come down to a level well below 0.5 ng/dl and remain at the lowest level achieved. Three successive rises in the PSA after reaching the lowest point would raise concern about residual or recurrent prostate cancer.
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Enlarged Prostate Or Prostate Cancer
The prostate can grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms similar to prostate cancer. This is called benign prostatic hyperplasia . It’s not cancer and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis. This inflammation or infection may also cause a fever and in many cases is treated with medication.
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How Can I Lower My Testosterone With Surgery
The majority of the testosterone in your body is made by your testicles. You can lower your testosterone with an operation called an orchiectomy. An orchiectomy is a simple and effective way to lower the amount of testosterone in your body. However, it is a permanent form of hormone therapy.
Your surgery
Some men are concerned about how their body will look after their testicles are removed. There are testicular prostheses , or artificial testicles, that can be placed in your scrotum to replace the testicles removed during your surgery. The prostheses make your scrotum look like it did before surgery. If youare concerned about how your body will look, speak with your doctor or health care team about artificial testicles.
After surgery
Your scrotum may feel a little bit sore and may be swollen. You will be given medicines to relieve the soreness. You may use ice packs for the first day or two after your orchiectomy to help with the swelling. Remember, do not put the ice pack directly on your scrotum. Put a towel or piece of clothing over your scrotum, then place the ice pack on top of it. You will need to keep your incision clean and dry. Your doctor and health care team will tell you how to clean your incision. You will need to avoid heavy lifting or hard activity for one to two weeks following your surgery.
Follow-up tests
Possible side effects
More hormone treatment
About Hormonal Therapy For Prostate Cancer
Testosterone is a male hormone. Its made when hormones from your pituitary gland cause your testes to make sperm. Testosterone can cause prostate cancer cells to grow.
Hormonal therapy prevents prostate cancer cells from growing by:
- Blocking the action of testosterone and other male hormones.
Your doctor may recommend hormonal therapy in order to:
- Make it easier for radiation to kill prostate cancer cells.
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What Will I Learn By Reading This
You and your doctor may be talking about using hormone therapy to control your prostate cancer. It is important for you to learn about hormone therapy so that you will know what to expect and how best to take care of yourself before, during, and after treatment. You will learn:
It is important to think about how you will work these things into your everyday life if you and your doctor decide that hormone therapy is the best way for you to control your prostate cancer..
What Types Of Hormone Therapy Are There
There are three main ways to have hormone therapy for prostate cancer. These are:
- injections or implants
- surgery to remove the testicles .
The type of hormone therapy you have will depend on whether your cancer has spread, any other treatments youre having, and your own personal choice. You may have more than one type of hormone therapy at the same time.
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How The Study Was Performed
During the study, scientists randomized 1,071 men with intermediate- or high-risk localized prostate cancer into four groups. One group received radiation and six months of an anti-testosterone drug called leuporelin, and the second group received radiation plus 18 months of leuporelin therapy. Two other groups were treated with the same regimens of either radiation plus six or 18 months of leuporelin therapy, along with another drug called zoledronic acid, which helps to limit skeletal pain and related complications should cancer spread to the bones. Study enrollment occurred between 2003 and 2007 at 23 treatment centers across New Zealand and Australia.
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.
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Hormone Therapy Can Cause Side Effects
Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.
Some common side effects for men who receive hormone therapy for prostate cancer include
How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
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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.
What Is Hormone Therapy
Hormones occur naturally in your body. They control the growth and activity of normal cells. Testosterone is a male hormone mainly made by the testicles.
Prostate cancer usually depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body.
Hormone therapy on its own doesn’t cure prostate cancer. But it can lower the risk of an early prostate cancer coming back when you have it with other treatments. Or it can shrink an advanced prostate cancer or slow its growth.
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While Youre Taking Hormonal Therapy
- Tell your doctor or nurse if youre taking any medications, including patches and creams, or if youve changed medications. Some medications may change the way hormonal therapy works. Tell your doctor if youre taking:
- Medications that require a prescription
- Medications that dont require a prescription
- Any herbal remedies, vitamins, or dietary supplements
Establishing Candidacy For Treatment Intensification
Although mHSPC is generally considered an aggressive prostate cancer, it is still a heterogeneous disease that requires an individualized treatment approach to optimize outcomes. Patients who tend to do worse are those with high-volume, de novo metastatic disease, which is different from those who also have metastatic disease but happen to years later and theyve finished treatment, Pedro C. Barata, MD, MSc, said. He noted that patients who tend to do worse have been shown to benefit from treatment intensification approaches, such as a triplet regimen that adds docetaxel and an AR-targeted therapy to ADT, as well as strategies such as concomitant radiotherapy of the primary tumor.
To ensure he identifies patients who would benefit from treatment intensification, Barata said he sequences all patients up front. When I have an aggressive molecular profile, it makes me think about treatment intensification at that point, he said. Another trigger he noted is a low PSA level. Its not concurrent with the amount of disease that you see, he said.
Barata noted that the next step will be identifying all the patient subgroups who would benefit from treatment intensification approaches such as triplet therapy, as well as which intensification approach may be best suited to each subgroup. Ongoing studies are anticipated to help shed light on these areas.
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Coping With Erectile Dysfunction
Erectile dysfunction is a common side effect of prostate cancer treatments. Generally, erectile function improves within two years after surgery. Improvement may be better for younger men than for those over age 70. You also may benefit from ED medications. Other treatments, such as injection therapy and vacuum devices, may help.
Surgery To Remove The Testicles
You may be offered an operation to remove the testicles, or the parts of the testicles that make testosterone. This is called an orchidectomy . Its not used as often as other types of hormone therapy.
Surgery is very effective at reducing testosterone levels, which should drop to their lowest level very quickly usually in less than 12 hours. It also means that you wont need to have regular injections, so theres no risk that youll miss an injection.
Surgery cant be reversed, so its usually only offered to men who need long-term hormone therapy.
If youre thinking about having surgery, your doctor may suggest trying injections or implants for a while first. This will give you and your doctor a chance to see how you deal with the side effects of low testosterone.
Short-term side effects of an orchidectomy include swelling and bruising of the scrotum .
Some men find the thought of having an orchidectomy upsetting and worry about how theyll feel once their testicles are removed. Speak to your doctor if you have any concerns.
If you dont want an orchidectomy, you can usually have a different type of hormone therapy instead.
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Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.
Now, newly published results from a phase 3 clinical trial are providing some needed guidance.
Preparation Isolation And Culture Of Adipose Tissue
In this in vitro study, 10 g of abdominal adipose tissue was used to isolate mesenchymal stem cells from a referred patient for liposuction after signing the written informed consent. The research was run under the Tehran University of Medical Sciences ethical committee . The fat sample taken in saline buffer phosphate solution containing the antibiotic penicillinstreptomycin was transferred to a cell culture laboratory under sterile conditions. After several washing steps with saline buffer phosphate and the physiological serum, the tissue was cut into small pieces. By collagenase I, adipose tissue was digested, and mesenchymal stem cells were extracted from this tissue.
First, 1.5 mg of collagenase I enzyme was added for each gram of fat and incubated for 60 min at 37 °C. Then, it was centrifuged for 10 min at 2000 rpm. Finally, the cell sediment in DMEM culture medium with 1% penicillin and streptomycin, 10% F.B.S. was moved to a T75 cell culture flask and incubated at 37 °C with 5% carbon dioxide and 90% humidity. The cell culture medium was changed every four days. The trypsin cells were then isolated from the flask and ready for use when they reached the third or fourth passage stage.
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A Genetic Biomarker Test For Newly Diagnosed Prostate Cancer
Results from a study of a different genetic biomarker test suggest that it could one day help inform treatment decisions for men newly diagnosed with localized prostate cancer.
According to findings published February 24 in JCO Precision Oncology, a biomarker test called the Oncotype DX Genomic Prostate Score accurately predicted the long-term risk of metastasis and death from prostate cancer in men with localized disease. The test needs to be validated in larger forward-looking studies before it can be used to guide treatment, the study researchers noted.
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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Prostate Cancer Survival Rates
The good news about prostate cancer is that it usually grows slowly, and 9 out of 10 cases are found in the early stages. Overall, the 5-year relative survival rate is 100% for men with disease confined to the prostate or nearby tissues. Many men live much longer. When the disease has spread to distant areas, that figure drops to 31%. But these numbers are based on men diagnosed at least 5 years ago. The outlook may be better for men diagnosed and treated today.
How Will I Know If My Treatment Is Working
You will have regular appointments to check how well your treatment is working and monitor any side effects. These will involve regular prostate specific antigen blood tests to measure the amount of PSA in your blood.
PSA is a protein produced by cells in your prostate and also by prostate cancer cells, even if they have spread to other parts of your body. The PSA test is a good way to check how well your treatment is working.
How your treatment is monitored will depend on whether youre having hormone therapy as part of treatment that aims to cure your prostate cancer, or having life-long hormone therapy to keep advanced prostate cancer under control.
You can contact your nurse at the hospital, or our Specialist Nurses, between appointments if you have any side effects or symptoms that youd like to talk about.
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