Treatment Options Under Clinical Evaluation For Stage I Prostate Cancer
Treatment options under clinical evaluation for patients with stage I prostate cancer include the following:
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer. In the CLIN1001 PCM301 randomized trial, 413 men with low-risk cancer were randomly assigned in an open-label trial to receive either the photosensitizing agent, padeliporfin , or active surveillance. Median time to local disease progression was 28.3 months for patients receiving padeliporfin and 14.1 months for patients who were assigned to active surveillance . However, the appropriate population for photodynamic therapy may be quite narrow, as it may overtreat men with very low-risk disease and undertreat men with higher-risk disease.
Myth: Psa Tests Are Bad For You
Fact: Some prostate cancer experts recommend against regular PSA testing, but not necessarily because of the test itself which is just a simple blood test. PSA screening certainly isnt perfect, but it doesnt pose any actual danger to your health. The real hazard is anxiety and sometimes faulty decision-making when it comes to interpreting and acting on PSA results. According to the ACS, PSA levels usually go above 4 when prostate cancer develops. However, a PSA level between 4 and 10 results in a prostate cancer diagnosis only about 25 percent of the time.
Causes of a high PSA can range from things like bicycling to ejaculation. As a result, some men are given invasive biopsies that arent needed. Or, if they do have cancer, they may be treated aggressively for slow-growing tumors that might never have caused any issues.
Which is not to say that PSA tests arent valuable or that they cant save lives. In the years since theyve been widely used, says Dr. Wei, prostate cancer diagnoses have gone up but the death rate is going down. This is at least in part because PSA tests lead to more investigation, which can find cancer early when its more receptive to treatment. Talk with your doctor about whether and how often you should be screened for prostate cancer.
Standard Treatment Options For Stage I Prostate Cancer
Standard treatment options for patients with stage I prostate cancer include the following:
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Evidence :
Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radicalprostatectomy may be difficult after a transurethral resection of the prostate .
Because about 40% to 50% of men with clinically organ-confined disease are found to have pathologic extension beyond the prostate capsule or surgical margins, the role of postprostatectomy adjuvant radiation therapy has been studied.
Evidence :
Evidence :
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Study Finds New Way To Pinpoint Dangerous Prostate Cancer
Researchers say theyve found a new way to tell if a mans prostate cancer will come back and kill him after treatment.
If a blood test called a PSA doesnt fall to low enough levels after treatment, it means the cancers not all gone and will likely come back and spread, the team at Brigham and Women’s Hospital and Harvard Medical School reported.
PSA tests look for prostate specific antigen, a protein made only by prostate cells. Higher PSA levels suggest that prostate cells are growing often because of cancer, but sometimes if the prostate is inflamed or because of the harmless enlargement of the prostate that comes with aging.
The important number to know: PSA should fall to 0.5 nanograms or lower.
That gives doctors a chance to act right away, said Dr. Anthony DAmico, the senior oncologist on the study.
Instead of waiting to see if PSA has gone up, this can tell you that somebody has not only failed treatment, but failed so badly that they are going to die of prostate cancer, DAmico told NBC News.
You should know what your PSA is after your treatment. You need to know once it stops going down if that low point is above half a point .”
“By identifying and enrolling these men in clinical trials immediately, the hope is to take a prostate cancer that appears to be incurable and make it curable” added Dr. Trevor Royce, who led the work on the study.
Its an important question.
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Quality Of Life With Advanced Stage Prostate Cancer
Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.
Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.
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What Have Researchers Found About How These Treatments Compare With Each Other
Researchers found that for some men:
- The risk of the cancer spreading to other parts of the body is much lower with surgery to remove the prostate gland than with watchful waiting.
- Surgery to remove the prostate gland appears to increase the chance of surviving the cancer more than external-beam radiation therapy.
- A combination of 3D-CRT and hormone therapy appears to increase the chance of surviving the cancer more than 3D-CRT alone.
Note
Research is only one source that helps guide doctors when they treat localized prostate cancer. Doctors also rely on their experience and on guidelines for treatment based on evidence and recommendations by experts.
When thinking about what treatment may be best for you, your doctor will consider several things, including:
- Your age
- Other health problems you may have
- How long you are expected to live
- Your preferences
Your doctor will also discuss possible side effects to help you decide about treatment. Talk with your doctor about your options and the trade-offs between possible benefits and side effects. Usually, you have time to think about your options before making a decision.
Note
What Is Localized Prostate Cancer
Localized prostate cancer is cancer that is only inside your prostate gland and has not spread to other parts of your body. The prostate is a gland in men about the size of a walnut. It makes and stores the liquid that carries sperm.
The prostate is near the bladder and rectum . It is just below the bladder and surrounds the upper part of the urethra .
Most men with localized prostate cancer have few or no symptoms. Possible symptoms can include:
- Problems when you urinate
- Pain in your lower back
- Pain when you ejaculate
- Blood in your urine
Note
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Prostate Cancer Treatment Health Professional Version
On This Page
The median age at diagnosis of carcinoma of the prostate is 66 years. Prostate cancer may be cured when localized, and it frequently responds to treatment when widespread. The rate of tumor growth varies from very slow to moderately rapid, and some patients may have prolonged survival even after the cancer has metastasized to distant sites, such as bone. The 5-year relative survival rate for men diagnosed in the United States from 2010 to 2016 with local or regional disease was greater than 99%, and the rate for distant disease was 30% a 98% survival rate was observed for all stages combined. The approach to treatment is influenced by age and coexisting medical problems. Side effects of various forms of treatment should be considered in selecting appropriate management.
Many patientsespecially those with localized tumorsmay die of other illnesses without ever having suffered disability from the cancer, even if managed conservatively without an attempt at curative therapy. In part, these favorable outcomes are likely the result of widespread screening with the prostate-specific antigen test, which can identify patients with asymptomatic tumors that have little or no lethal potential. There is a large number of these clinically indolent tumors, estimated from autopsy series of men dying of causes unrelated to prostate cancer to range from 30% to 70% of men older than 60 years.
Hormonal Therapy For Recurring Disease
Continuous versus intermittent hormonal therapy
Most men who are treated for recurrence after initial local therapy are asymptomatic, and the recurrence is detected by a rising PSA. It is possible that intermittent androgen deprivation therapy can be used as an alternative to continuous ADT to improve QOL and decrease the amount of time during which the patient experiences the side effects of hormonal therapy, without decreasing the survival rate.
Hormonal approaches
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What We Dont Know
While research is promising, thereâs still a lot scientists need to learn. Some things to consider:
- Thereâs no proof that ejaculating more actually causes lower chances of prostate cancer. For now, doctors just know theyâre connected. It may be that men who do it more tend to have other healthy habits that are lowering their odds.
- Ejaculation doesnât seem to protect against the most deadly or advanced types of prostate cancer. Experts donât know why.
- Scientists donât know if ejaculation during sex vs. masturbation has the same benefits. Some research has found that the makeup of semen is different for each. For example, semen during sex has higher levels of sperm and some chemicals. Itâs possible that these could make a difference in a manâs odds of having prostate cancer.
- Not all studies have found a benefit. The 2016 study got attention because of its size and length . But some smaller studies have not shown the same good results. A few even found that some men, specifically younger men, who masturbated more had slightly higher chances of prostate cancer. Some researchers wonder if a manâs age may affect whether more ejaculation helps.
How Serious Is My Cancer
If you have prostate cancer, the doctor will want to find out how far it has spread. This is called the stage of the cancer. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of the cancer through the prostate, and if it has spread to other parts of your body. It also includes your blood PSA level and the grade of the cancer. The prostate cancer cells are given a grade, based on how they look under a microscope. Those that look very different from normal cells are given a higher grade and are likely to grow faster. The grade of your cancer might be given as a Gleason score or a Grade Group . Ask your doctor to explain the grade of your cancer. The grade also can helpdecide which treatments might be best for you.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate.
If your cancer hasn’t spread to other parts of the body, it might also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help tell if other tests should be done, and what the best treatment options might be.
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Symptoms Of Prostate Cancer
Symptoms of prostate cancer do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder out of the penis .
When this happens, you may notice things like:
- an increased need to pee
- straining while you pee
- a feeling that your bladder has not fully emptied
These symptoms should not be ignored, but they do not mean you have prostate cancer.
It’s more likely they’re caused by something else, such as prostate enlargement.
What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
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Tips For Talking With Your Partner
Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:
- Bring your partner with you to doctors visits. Being part of the conversation may help them understand what youre experiencing.
- Listen to your partners concerns, too. Remember that this issue affects both of you.
- See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
- If sex is a problem right now, its possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.
How Will Treatment Affect My Libido
Prostate cancer may dampen your sex drive. Knowing that you have cancer and going through treatment can both cause you to feel too anxious to have sex.
Hormone therapy used to treat prostate cancer can also affect your libido. This treatment slows prostate cancer growth by lowering testosterone levels in your body. You need testosterone to have a healthy sex drive. Hormone therapy can also affect your self-esteem and sex drive by making you gain weight or causing your breast tissue to enlarge. If your hormone levels are low, your doctor may be able to prescribe testosterone replacement therapy to bring them back up to normal. This depends on your overall cancer treatment plan.
2013 study , about 3 percent of participants reported that they had a reduced penis size after radical prostatectomy or radiation plus hormone therapy. The men said their smaller penis affected their relationships and their satisfaction with life.
For men who do experience this, the change in size is generally half an inch or less. This decrease in size may be due to tissues shrinking in the penis. These tissues may shrink because of nerve and blood vessel damage.
If youre concerned about this side effect, ask your doctor about taking a drug for an erectile dysfunction , such as Cialis or Viagra. The increased blood flow from these drugs may help prevent your penis from getting smaller. Theyll also help with acquiring and maintaining an erection.
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Immediate Versus Deferred Hormonal Therapy
Refer to the Treatment Option Overview for Prostate Cancer section for information on the use of immediate hormonal therapy plus radiation in the setting of locally recurrent prostate cancer after radical prostatectomy.
PSA is often used to monitor patients after initial therapy with curative intent, and elevated or rising PSA is a common trigger for additional therapy even in asymptomatic men. Despite how common the situation is, it is not clear whether additional treatments given because of rising PSA in asymptomatic men with prostate cancer increase OS. The quality of evidence is limited.