Medical Research Council Study
Two recent studies provide convincing clinical evidence supporting the early treatment of advanced prostate cancer: the randomized trial reported by the Medical Research Council 29 and the Eastern Cooperative Oncology Group /SWOG Stage D1 study.30 The MRC study randomized 934 patients with locally advanced prostate cancer or asymptomatic metastasis to either immediate treatment or to the same treatment deferred until an indication occurred. This study showed that there was a more rapid local and distant disease progression in the deferred treatment group, as evidenced by an earlier onset of pain and an increased need for transurethral resection of the prostate. There was also a 2-fold increase in serious complications, such as pathologic fractures, spinal cord compression, and extraskeletal metastasis, in the deferred treatment group compared with those who received immediate treatment .29
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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.
Stage 3 Prostate Cancer
Prostate cancer can spread to nearby areas , including the seminal vesicles. Following a diagnosis of locally advanced prostate cancer, there a range of therapeutic options to treat the disease.
Hormone therapy, surgery, and radiation therapy are the primary treatments offered to men with stage III prostate cancer. In some cases, a combination of these therapies is required for an optimal outcome or to manage treatment resistance.
Here, we discuss the characteristics of stage III prostate cancer, the associated risk factors, its diagnosis, and treatment. We make significant contrasts with other prostate cancer stages to highlight the current challenges in the treatment of this stage of prostate cancer.
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Using Complementary Or Traditional Healing
Sometimes people with cancer might think about using complementary therapies or traditional healing.
Some alternative, complementary and traditional healing methods may react with the treatment you receive and cause harmful side-effects.
It is important to talk to your treatment team about any other therapies youre using or thinking about because they may interfere with hospital treatment.
Combined Androgen Blockade: Pro And Con
Crawford ED, Eisenberger MA, McLeod DG, et al. A Controlled Trial of Leuprolide With and Without Flutamide in Prostatic Carcinoma. New England Journal of Medicine 1989 321:41924. PMID: 2503724.
Eisenberger MA, Blumenstein BA, Crawford ED, et al. Bilateral Orchiectomy With or Without Flutamide for Metastatic Prostate Cancer. New England Journal of Medicine 1998 339:103642. PMID: 9761805.
Two large meta-analyses that reviewed many studies comparing combined androgen blockade to monotherapy concluded that the combination offered only a small survival advantage and even that finding was inconsistent between the two analyses. One analysis, which reviewed 27 randomized studies involving 8,275 men, estimated that combined androgen blockade improved five-year survival by only 2% to 3%, at most. However, an advantage of only 2% to 3%, when applied to thousands of men undergoing treatment, translates into hundreds of lives extended obviously an important benefit to the men who gain months and even years of life as a result. That is why I use combined therapy for all of my patients who undergo hormone treatments.
Why Do We Need Hormone Therapy For Breast Cancer
Hormone therapy for breast cancer is often used after surgery to reduce the risk that the cancer will return. Hormone therapy for breast cancer may also be used to shrink a tumor before surgery, making it more likely the cancer will be removed completely. If your cancer has spread to other parts of your body, hormone therapy for breast cancer may
Intermittent Or Continuous Therapy
Once prescribed, hormone therapy used to continue for life, but scientists are now reevaluating that strategy and investigating whether hormone therapy can be taken intermittently, with so-called holidays from treatment. The thinking is that this may not only help restore quality of life as, for example, returning libido and sexual health but also delay the hormone resistance that eventually develops in men taking hormone therapy.
Clinical trials evaluating whether intermittent therapy is as effective or more effective than continuous therapy are now under way, so it is too early to say for sure.
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What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
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.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
Its 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.
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What The Researchers Did
Dr. Crawfords team reviewed clinical data from nearly 23,000 men who were given ADT injections between 2007 and 2016. Each mans treatment varied by how their ADT was formulated. Some types of ADT are given once a month, and others are given at three-, four-, or six-month intervals. The researchers wanted to know how many men were late on their ADT treatments, and how that would affect the amounts of testosterone in their blood.
During this research, the investigators defined month in two ways: either as one lasting 28 days, which is how months were defined during the clinical trials that set dosing schedules for ADT, or as a calendar month lasting 31 days. ADT was deemed late if it was given after day 28 by the first definition or after day 32 by the second definition.
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How Many Times Can You Have Hormone Treatment For Prostate Cancer
ADT is usually the first type of hormone therapy people will receive for prostate cancer.
If ADT stops working, people may receive further hormone therapy with different types of treatment, such as androgen receptor blockers or androgen synthesis inhibitors.
People may have hormone therapy in combination with other treatments, such as chemotherapy. Doctors will monitor how they respond to treatment and decide whether to continue hormone therapy or try a different treatment.
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Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each persons individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
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Looking At Cure Rates
If you, or somebody you love has recently been diagnosed with prostate cancer, survival rates are likely one of the first things that you will want to understand. Of course, it is equally important to understand the specific risks posed to individuals so that they can detect cancer in the earliest stages.
Prostate cancer detection is closely linked with mens age. According to the Prostate Cancer Foundation, only 1 in 451 men has a prostate diagnosis before the age of 50. This continues to increase as men age. Between 50-59 years of age, the rate increases to 1 in 55 , 1 in 20 for ages 60-69 , and 1 in 12 between the ages of 70-79. In fact, almost 60% of all prostate cancer diagnoses occur in men over the age of 65.
Because so many men are diagnosed with prostate cancer later in life, many professionals only worry about the short-term survival rates. The five year prostate cancer survival rate is frequently cited as one of the most important statistics . However, for many people, a five year approach seems short-sighted, and you may wish to know your long-term prognosis. For these individuals, we thought it was important to look at a 15-year prostate cancer survival rate.
Surgery For Prostate Cancer
If the cancer has not spread in your body, the whole prostate gland can be surgically removed. This is called a radical prostatectomy.
During the surgery, your surgeon will try to save the two bundles of nerves attached to the prostate that help you get erections. This is only possible if the cancer is not in or close to these nerves.
Sometimes lymph nodes are also removed during the surgery if the cancer has a higher risk of spreading.
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Hormone Therapy And Radiation Therapy In Treating Patients With Prostate Cancer
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
|First Posted : January 27, 2003Results First Posted : October 31, 2017Last Update Posted : June 15, 2022
RATIONALE: Hormones can stimulate the growth of prostate cancer cells. Hormone therapy may fight prostate cancer by reducing the production of androgens. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known which regimen of hormone therapy and radiation therapy is more effective for prostate cancer.
PURPOSE: Randomized phase III trial to compare the effectiveness of two different regimens of hormone therapy and radiation therapy in treating patients who have prostate cancer.
|Drug: CasodexDrug: EulexinDrug: LHRH agonistRadiation: radiation therapy
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prostate-specific antigen level , tumor stage , Gleason score , and prior hormonal therapy . Patients are randomized to one of two treatment arms.
Patients are followed every 3 months for 1 year, every 6 months for 4 years, and then annually thereafter.
Hormonal Therapy On Its Own
Doctors do not usually advise having hormonal therapy instead of a prostatectomy or radiotherapy. Hormonal therapy alone cannot cure early or locally-advanced prostate cancer.
Depending on your general health and preferences, you may decide to have hormonal therapy on its own. For example, if you:
- are not well enough to have a prostatectomy or radiotherapy
- do not want to have a prostatectomy or radiotherapy
- are monitoring prostate cancer, for example having watchful waiting and the cancer starts to grow.
Hormonal therapy can slow down or stop the cancer cells growing for many years. It can also improve any symptoms. Not having surgery or radiotherapy means you avoid the side effects of these treatments. But hormonal therapy also causes side effects. It is important to talk to your doctor or nurse before you decide.
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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 persons 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.
Stage 4 Prostate Cancer: Survival Rates Treatment And Support
Prostate cancer is in stage 4 when the cancer spreads beyond the lymph nodes and into other areas of the body. While the vast majority of prostate cancer cases are caught before this happens, when the cancer is treatable, stage 4 is far more difficult to treat. Therefore, the survival rate among men with stage 4 prostate cancer is much lower.
There are two types of stage 4 prostate cancer: 4A and 4B, according to the American Cancer Society. The type assigned to a persons diagnosis is based on whether the cancer has spread and to what degree, and the value assigned to two additional factors called the Grade Group and the prostate-specific antigen . The Grade Group is a measure of how likely the cancer is to spread quickly, and the PSA is a measure of a protein in the blood produced by cells in the prostate.
With stage 4A, the tumor has already spread into the lymph nodes and may be spreading into tissues adjacent to the prostate, but has not spread to other areas of the body. The Grade Group can be of any value, as can the PSA.
With stage 4B, the tumor may have spread into the lymph nodes, may be spreading into nearby tissues and has spread to other areas of the body like the bones, certain organs and distant lymph nodes. The Grade Group and PSA can be of any value.
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How To Treat Hormone Sensitive Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer: Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
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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Learn More About Prostate Cancer Care At Rcca
If youve been diagnosed with prostate cancer or are concerned about potential symptoms, contact RCCA today. Our team of cancer care specialists will assess the stage of your cancer using the latest diagnostic methods and work with you to design a fully individualized care plan that includes advanced treatment options, the potential for clinical trials, and support that addresses physical and emotional well-being. To speak with a representative right away, please call 844-474-6866.
Initial Treatment Of Prostate Cancer By Stage
The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.
For prostate cancers that havent spread , doctors also use risk groups to help determine treatment options. Risk groups range from very low risk to very high risk, with lower risk group cancers having a smaller chance of growing and spreading compared to those in higher risk groups.
Other factors, such as your age, overall health, life expectancy, and personal preferences are also taken into account when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.
You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here.
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