Thursday, April 18, 2024

Hormone Therapy For Prostate Cancer Stage 4

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What Are Prostate Cancer Survival Rates By Stage

Gleason 4+4=8 & Hormone Therapy | Ask a Prostate Cancer Expert, Mark Scholz, MD

Staging evaluation is essential for the planning of treatment for prostate cancer.

  • A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
  • Further testing and calculations may be performed to best estimate a patientâs prognosis and help the doctor and patient decide upon treatment options.

Prognosis refers to the likelihood that the cancer can be cured by treatment, and what the patientâs life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.

If a cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If the cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival based again on group statistics for people who have been in the same situation.

Nomograms are charts or computer-based tools that use complex math from analysis of many patientsâ treatment results.

The prognosis for prostate cancer varies widely, and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and the cancerâs responsiveness to treatment, among other factors.

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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.

Metastatic Prostate Cancer Treatment

If a patient has been diagnosed with prostate cancer and he or she is concerned about prostate cancer metastasis, they should talk with a doctor about the risk of prostate cancer metastasis and corresponding treatment options.

Treatments for stage 4 prostate cancer may depend on where in the body the disease has spread. Options include:

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Prostate Cancer Risk Groups

Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .

Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.

The risk group of the cancer will help determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

What Is The Life Expectancy For Stage 4 Prostate Cancer

Hormone Therapy For Stage 4 Prostate Cancer

Prostate cancer life expectancy is determined using five-year survival rates. This is the percentage of people who may still be alive five years after being diagnosed.

The five-year survival rate for men with localized prostate cancer, where there is no evidence of cancer spreading outside the prostate, and regional prostate cancer, when cancer has migrated outside the prostate to adjacent structures or lymph nodes exclusively, is approximately 100 percent.

When prostate cancer reaches stage 4 and has spread to other organs such as the lungs, liver, or bones, the five-year survival rate falls below 30%. At stage 4, prostate cancer is unlikely to be cured, although with effective therapy, many people can live for several years. The patients life expectancy is determined by the precise characteristics of his cancer.

However, thanks to routine screening procedures, prostate cancer is often discovered early, before it has spread to other organs, and it is usually not fatal. When diagnosed early, there are several treatment options available, as well as a good likelihood of a cure.

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Stage 3 Prostate Cancer

In stage 3, cancer has now spread beyond the prostate and may have potentially spread into the nearby seminal vesicles.

  • Stage IIIA The tumor may involve both lobes of the prostate or less than that . There is no regional lymph node metastasis and no distant metastasis. . The PSA level is below or equal to 20 ng/ml. The Grade Group is 1-4.
  • Stage IIIB The tumor extended through the prostatic capsule to the seminal vesicles or the adjacent structures, such as the bladder, muscles or the pelvic floor . There is no regional lymph node metastasis and no distant metastasis. . There can be any PSA level. The Grade Group is 1-4.
  • Stage IIIC The tumor may or may not be extended through the prostatic capsule but has not spread to the regional lymph nodes or to other distant areas . There can be any PSA level. The Grade Group is 5.

Metastatic Stage Iv Or D2 Prostate Cancer

Prostate cancer that has spread to distant organs and bones is treatable, but not usually curable with current standard therapies. Treatment has evolved significantly over the past decade from hormone or androgen deprivation therapy alone to newer combination treatment regimens incorporating ADT plus chemotherapy and targeted therapies.1,20

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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 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.

Life Expectancy And Survival Rates

Intermittent Hormone Therapy for Prostate Cancer 101 | Ask a Prostate Expert, Mark Scholz, MD

Generally speaking, the earlier prostate cancer is detected, the more likely treatment will be successful. Once the cancer has begun to spread outside the prostate, treatment is likely to shift away from attempts to cure the disease and toward methods to help reduce the rate of spread, lengthen life and keep the symptoms under control, according to UCLA Health.

Unlike most prostate cancer diagnoses, for which the five-year survival rate is nearly 100 percent, the five-year survival rate for prostate cancer in the advanced stages may be less, depending on where the cancer has metastasized to. For instance, with regional metastasis , the five year survival rate is nearly 100 percent, but distant metastasis , has a five-year survival rate of just 30 percent, according to the National Cancer Institutes Surveillance, Epidemiology and End Results database.

The stage of the disease at diagnosis is a better predictor of survival than age is. Studies of age as a predictor of survivability have been inconsistent. An analysis of data, published in the journal Urology in December 2014, noted that some research has shown higher rates of survival among younger patients while other research has indicated that younger men typically develop prostate cancer that is aggressive, advanced and quickly fatal.

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What Is Stage 4 Prostate Cancer

The fourth stage of prostate cancerdefines a tumor that has progressed to other regions of the body, such as the lymph nodes, lungs, liver, bones, or bladder. The 5-year survival rate for these tumors is 29 percent.

Keep in mind that each case is unique, and figures like these are merely suggestions. As advances in prostate cancer treatment become more common, your odds of surviving this disease improve.

In general, prostate cancer has a very good survival rate one of the greatest of any cancer type. Because prostate cancer is frequently a slow-moving disease, the majority of men diagnosed with it will die from an unrelated reason.

Stage 4 prostate cancer means the cancer has spread to lymph nodes or to other parts of the body. It is further divided into two substages:

  • Prostate Cancer Stage 4A Stage 4A: The cancer has spread to nearby lymph nodes but may or may not have spread to nearby tissues.
  • Prostate Cancer Stage 4B Stage 4B: The cancer has spread to another area of the body, such as the bones or distant lymph nodes.

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Hormone Therapy For Prostate Cancer

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Hormone therapy is also called androgen suppression therapy. The goal of this treatment is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cell growth.

Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone . Most androgens are made by the testicles, but the adrenal glands as well as the prostate cancer cells themselves, can also make androgens.

Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.

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Stage 4 Pancreatic Cancer Symptoms

One reason that pancreatic cancer gets diagnosed late is that it can be easy to miss the signs. A person may not know that they have cancer because they do not feel sick. Even if they do have symptoms, they might not bother them much.

The symptoms of pancreatic cancer usually do not start until the cancer cells have gotten into other organs. The intestines are often one of the first places cancer goes. It can also go to the liver, lungs, bones, and even the brain.

Once cancer goes to other parts of the body, a person can start to feel very sick. They can also have serious medical conditions, such as:

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Surgery And Hormonal Therapy

Stage Iv Prostate Cancer Photograph by Gunilla Elam/science Photo Library

In theory, NHT, as demonstrated in the radiation literature, should improve survival of patients undergoing prostatectomy in a locally advanced setting. Putatively, the same proposed mechanisms of benefit should apply to surgical therapy, i.e. that preoperative NHT can potentially downstage locally advanced tumors, thus making them more amenable achieving negative margins at the time of surgical resection, and therefore improve patient outcomes. In 1944, Vallet first described the concept of combining systemic therapy in the form of bilateral orchiectomy with perineal prostatectomy . However, this combination therapy did not receive much attention until the 1980s, when reversible and less toxic forms of ADT became available. As summarized in Table 2, patients who have received NHT have shown a significant decrease in positive surgical margins and lymph node metastasis, as well as reductions in tumor size and PSA levels . However, long-term follow-up has not indicated any difference in disease-free survival as determined on the basis of PSA level or biochemical disease-free survival .

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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:

Cancer grade
grade group 5 910

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.

What Is Prostate Cancer

Prostate cancer is cancer that affects the prostate gland in men. Prostate cancer is the second-leading cause of cancer deaths for men in the US.

Growth in the prostate can be of two types

  • Benign growths: These are noncancerous growths and are rarely a threat to life. For example, benign prostatic hyperplasia.
  • Malignant growths: These are cancerous growths that can sometimes be life-threatening.
  • Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.

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    Treatment To Lower Testicular Androgen Levels

    Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.

    Orchiectomy

    Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens are made. This causes most prostate cancers to stop growing or shrink for a time.

    This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Because of this, they may choose treatment with drugs that lower hormone levels instead.

    Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.

    LHRH agonists

    Luteinizing hormone-releasing hormone agonists are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy.

    With these drugs, the testicles stay in place, but they will shrink over time, and they may even become too small to feel.

    • Leuprolide mesylate

    LHRH antagonists

    Possible side effects

    Many side effects of hormone therapy can be prevented or treated. For example:

    Stage 4 Prostate Cancer: Survival Rates Treatment And Support

    Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

    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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    Checking Your Hormone Therapy Is Working

    You have regular blood tests to check the level of a protein called prostate specific antigen . PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless you have had the prostate gland completely removed.

    While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer starts to grow and develop, the level of PSA may go up. This is hormone resistant prostate cancer or castrate resistant prostate cancer. Then your doctor may need to change your treatment. They will discuss this with you

    Radiation Therapy For Metastatic Prostate Cancer

    Radiation therapy may be used to treat men with high-risk prostate cancer or stage 4A cancer .

    In these instances, external beam radiation therapy is commonly used, also known as EBRT. Using an external machine, a doctor sends targeted beams of radiation to the cancer site. Its administered five days a week in an outpatient facility throughout several weeks.

    Radiation may be targeted to cancer that has spread to the bones as well, helping reduce pain.

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    Bone Pain In Prostate Cancer

    Many advanced prostate cancer patients often suffer from bone pain that adversely affect quality of life. The management of pain or other cancer related functional impairment is integral part of palliative care. Palliative management can include analgesics, glucocorticoids, palliative chemotherapy, radioisotopes or radiotherapy.

    Radioisotopes that selectively concentrate in bone lesions are approved for the palliative treatment of painful bone metastases. The treatment is of more value in patients with multiple metastases . The radioisotopes have been found to reduce the need for opioid painkillers in such patients.

    EBRT is effective in painful bone lesions in advanced prostate cancer patients but not an ideal option if there are multiple lesions at different sites. The lesions in multiple sites will progress after EBRT in one site and pain will reappear in a short time afterwards, unless other systemic therapies are initiated to control the disease process. Read more on EBRT under prostate cancer treatments.

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