Tuesday, November 29, 2022

How Do You Know Prostate Cancer Has Spread

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Warning Signs Of Prostate Cancer

How to Know If Cancer Has Spread | Prostate Cancer

One of the challenges of prostate cancer is that it often doesnt present symptoms that alert men to its presence, particularly in the early stages. But the Urology Care Foundation notes that there may be some warning signs that you have problems related to your prostate, including the following:

  • Frequent urge to urinate
  • Hip, back or thigh pain
  • Reduced appetite
  • If you get screened for prostate cancer, there are additional warning signs based on how the prostate gland cells look under a microscope, notes the American Cancer Society. Cells that may be concerning will exhibit some level of what is known as prostatic intraepithelial neoplasia . These cells may exhibit low-grade PIN, in which something is slightly off with the cells, or high-grade PIN, when they show clear abnormalities.

    Under a microscope, prostate gland cells may also exhibit what is known as proliferative inflammatory atrophy . PIA indicates cells that are smaller than normal and show some signs of inflammation. These cells may be worth additional monitoring because they could develop high-grade PIN and ultimately prostate cancer.

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    Mechanisms Of Lymph Node Metastasis

    Tumor-associated lymphatic vessels serve as a route for lymph node metastasis

    Lymph node. Metastases of tumor cells through lymphatic vessels to lymph nodes.

    Local extension of tumor cells from the primary tumor into the surrounding lymphatics through a process called permeation is one means through which tumor cells can enter into the lymphatic vessels . In addition, tumor cells can be stimulated by cytokines produced by the lymphatic vessels, which promote chemotactic diffusion of tumor cells into the lymphatics . Finally, many tumors have the ability to secrete growth factors that induce the growth of new lymphatic vessels from a precursor, a process called lymphangiogenesis .

    Treatment For Advanced Prostate Cancer

    Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.

    A multidisciplinary team will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.

    The main treatments are:

    • Hormonal therapy

      Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.

    • Chemotherapy

      Chemotherapy uses anti-cancer drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.

    • Radiotherapy

      Radiotherapy is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. Its given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.

    • Surgery

      Surgery to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.

    Your doctor or nurse will usually ask you to sign a form giving your permission for them to give you the treatment. They cannot give treatment without your consent.

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    How We Treat Prostate Cancer

    The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.

    What Treatments Are Available

    How To Know If Prostate Cancer Has Spread To The Bones / Prostate ...

    If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.

    If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

    Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.

    If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.

    Before you start treatment

    Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.

    It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.

    If you have any questions, speak to our Specialist Nurses.

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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.

    How Prostate Cancer Spreads

    Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries tiny blood vessels at some distant location.

    The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.

    Most break-away cancer cells form new tumors. Many others dont survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.

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    Pathological Stage: A Look At The Actual Cancer Cells And Their Distribution Within The Pelvic Area

    This system assesses how pervasive the cancer cells are within and around the prostate. These stages begin at T2.

    T2: The tumor is located in the prostate only.T3: The tumor has breached the prostate border on 1 or more sides.T3b: The tumor has begun to grow in the seminal vesicles.T4: The tumor has grown into other neighboring structures, like the bladder, the rectum, or the pelvic wall.

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    What Should I Do If I Have Prostate Cancer Symptoms

    Is Prostate Cancer Fatal? | Ask A Prostate Expert, Mark Scholz, MD

    If you are displaying one or more signs of prostate cancer, be sure to promptly consult with a physician. Even benign prostate conditions like prostate enlargement warrant timely medical attention, so dont delay seeking treatment. And, like most other malignancies, prostate cancer is usually more easily treated when it is detected at an early stage.

    Medically reviewed by Monica Chatwal, MD.

    At Moffitt Cancer Center, we provide a full range of diagnostic testing for prostate cancer. If you have received a prostate cancer diagnosis, we understand that every day counts, and we want to support you every step of the way. Our Urologic Oncology Program includes a multispecialty team that focuses exclusively on evaluating and treating prostate cancer.

    Contact Moffitt at or complete a new patient registration form online to speak with one of our specialized oncologists about your symptoms. As Floridas top cancer hospital, were committed to providing all new patients rapid access to a cancer expert within a day of their reaching out.

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    What Stages Have To Do With Cancer Spread

    Cancers are staged according to tumor size and how far it has spread at the time of diagnosis. Stages help doctors decide which treatments are most likely to work and give a general outlook.

    There are different types of staging systems and some are specific to certain types of cancer. The following are the basic stages of cancer:

    • In situ. Precancerous cells have been found, but they havent spread to surrounding tissue.
    • Localized. Cancerous cells havent spread beyond where they started.
    • Regional. Cancer has spread to nearby lymph nodes, tissues, or organs.
    • Distant. Cancer has reached distant organs or tissues.
    • Unknown. Theres not enough information to determine the stage.
    • Stage 0 or CIS. Abnormal cells have been found but have not spread into surrounding tissue. This is also called precancer.
    • Stages 1, 2, and 3. The diagnosis of cancer is confirmed. The numbers represent how large the primary tumor has grown and how far the cancer has spread.
    • Stage 4. Cancer has metastasized to distant parts of the body.

    Your pathology report may use the TNM staging system, which provides more detailed information as follows:

    T: Size of primary tumor

    • TX: primary tumor cant be measured
    • T0: primary tumor cant be located
    • T1, T2, T3, T4: describes the size of the primary tumor and how far it may have grown into surrounding tissue

    N: Number of regional lymph nodes affected by cancer

    M: Whether cancer has metastasized or not

    Risk Factors You Can Control

    Diet seems to play a role in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. The reason for this link is unclear. Dietary fat, particularly animal fat from red meat, may boost male hormone levels. And this may fuel the growth of cancerous prostate cells. A diet too low in fruits and vegetables may also play a role.

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    Screening For Prostate Cancer

    There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.

    The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.

    There are no proven measures to prevent prostate cancer.

    What Are The Stages Of Prostate Cancer

    What Happens If You Have Prostate Cancer

    Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:

    • Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
    • Adds together the two most common grades to get your Gleason score .
    • Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.

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    Hormone Therapy With Radiation

    Prostate cancer cells need testosterone to grow. Hormone therapy aims to drastically lower testosterone levels to slow the cancer’s progression. Although it does not cure the cancer on its own, hormone therapy improves the effectiveness of radiation for high-risk disease and is often recommended in conjunction with radiation therapy for men with intermediate- or high-risk localized disease. However, hormone therapy may have significant side effects. These include loss of libido , hot flashes , changes in mood or memory, loss of bone and muscle density, body fat gain, and adverse effects on sugar or cholesterol metabolism. When offered as short-term therapy in conjunction with radiation, it is often well tolerated. How long a patient should receive hormone therapy remains controversial and depends on how aggressive his cancer is.

    Learn more about hormone therapy.

    What Are Prostate Tests And How Is Prostate Cancer Diagnosed

    Tests which check for prostate cancer include:

    • A digital rectal exam . In this exam, your provider feels your prostate for lumps or anything unusual by inserting a lubricated, gloved finger into your rectum.
    • A prostate-specific antigen blood test. A high PSA blood level may be a sign of prostate cancer. But many other things can cause high PSA levels, too.
    • Imaging tests. These tests may use ultrasound or MRI to make pictures of your prostate.

    If these tests show that you might have prostate cancer, the next step is usually a prostate biopsy. A biopsy is the only way to diagnose prostate cancer.

    During a biopsy, a doctor uses a hollow needle to remove some prostate tissue. The tissue is studied under a microscope to look for cancer cells.

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    What Are The Side Effects Of Hormone Therapy For Prostate Cancer

    Testosterone is the primary male hormone and plays an important role in establishing and maintaining the male sex characteristics, such as body hair, muscle mass, sexual desire, and erectile function. Most men who are on hormone therapy experience at least some effects related to the loss of testosterone, but the degree to which you will be affected by any one drug regimen is impossible to predict. Side effects from testosterone-lowering therapies include hot flashes, breast enlargement or tenderness, loss of bone mineral density and fractures, increased weight gain , higher cholesterol, a higher risk of diabetes, and a slightly higher risk of heart problems like heart attacks and chest pains. Some men complain of mood problems and depression during this time as well. Dont be afraid to discuss these issues with your doctors. For all of these reasons, maintaining a healthy overall lifestyle is vital to doing well with hormonal therapies over time.

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    Enlarged Prostate Or Prostate Cancer

    10 Warning Signs of 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 . Its 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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    Why Cancer Spreads

    Cancer cells dont respond to signals telling them its time to die, so they continue rapidly dividing and multiplying. And theyre very good at hiding from the immune system.

    When cancer cells are still contained in the tissue where they developed, its called carcinoma in situ . Once those cells break outside the tissues membrane, its called invasive cancer.

    The spread of cancer from where it started to another place is called metastasis. No matter where else in the body it spreads, a cancer is still named for the place it originated. For instance, prostate cancer that has spread to the liver is still prostate cancer, not liver cancer, and treatment will reflect that.

    While solid tumors are a feature of many types of cancer, thats not always the case. For example, leukemias are cancers of the blood that doctors refer to as liquid tumors.

    Exactly where cancer cells will spread next is dependent on their location in the body, but its likely to spread nearby first. Cancer can spread through:

    Cancer cells that have more genetic damage usually grow faster than cancer cells with less genetic damage . Based on how abnormal they appear under a microscope, tumors are graded as follows:

    • GX: undetermined
    • rare prostate cancers such as small-cell carcinomas or lymphomas

    What Is My Outlook

    If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.

    While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.

    No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.

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