How Do You Treat Prostate Cancer

What Are The Symptoms Of Prostate Cancer

Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:

• Frequent, sometimes urgent, need to urinate, especially at night.
• Weak urine flow or flow that starts and stops.
• Painful urination .
• Painful ejaculation and erectile dysfunction .
• Blood in semen or urine.
• Lower back pain, hip pain and chest pain.
• Leg or feet numbness.

What Happens When Prostate Cancer Is Left Untreated

Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.

While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their doctors monitor their cancer.

Known as active surveillance, it is common when the cancer is expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. In active surveillance, doctors will initiate cancer treatment only if cancer starts growing.

Others men may choose to not undergo cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits.

This option is certainly OK and reasonable in the right circumstancesrequiring a careful and thoughtful discussion with your doctor and family.

Chemotherapy For Prostate Cancer

https://www.youtube.com/embed/O24t-bbE1k4 The decision on when to start chemotherapy is difficult and highly individualized based on several factors: What other treatment options or clinical trials are available. How well chemotherapy is likely to be tolerated. What prior therapies you have received. If radiation is needed prior to…

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Treatment Options Under Clinical Evaluation

Treatment options under clinical evaluation for patients with include the following:

Cryosurgery

Cryosurgery, or cryotherapy, is under evaluation for the treatment of localized prostate cancer. It is a surgical technique that involves destruction of prostate cancer cells by intermittent freezing of the prostate with cryoprobes, followed by thawing. There is limited evidence regarding its efficacy and safety compared with standard prostatectomy and radiation therapy, and the technique is evolving in an attempt to reduce local toxicity and normal tissue damage. The quality of evidence on efficacy is low, currently limited to case series of relatively small size, short follow-up, and surrogate outcomes of efficacy.

Serious toxic effects associated with cryosurgery include bladder outlet injury, urinary incontinence, sexual impotence, and rectal injury. Impotence is common, ranging from about 47% to 100%.

The frequency of other side effects and the probability of cancer control at 5 years’ follow-up have varied among reporting centers, and series are small compared with surgery and radiation therapy. Other major complications include urethral sloughing, urinary fistula or stricture, and bladder neck obstruction.

Proton-beam therapy

Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer.

Neoadjuvant hormonal therapy

The role of neoadjuvant hormonal therapy is not established.

Bicalutamide

Evidence :

Who Is More Likely To Have Prostate Cancer Recurrence

In general, the further your cancer has spread and the more aggressive it is, the more likely it is to recur. Specific factors include:

• Tumor size: In general, the larger the tumor, the more likely it is to recur.
• Gleason score: A higher Gleason score means a more aggressive cancer and a higher rate of recurrence.
• Cancer staging: Staging refers to how far the cancer has spread. Higher stage cancers have spread further at initial treatment and have higher rates of recurrence.
• Involvement of the lymph nodes: Prostate cancer that has entered the lymph nodes prior to treatment is more likely to recur.

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Watchful Waiting Or Active Surveillance/active Monitoring

Asymptomatic patients of advanced age or with concomitant illness may warrantconsideration 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.

Watchful waiting and active surveillance/active monitoring are the most commonly used terms, and the literature does not always clearly distinguish them, making the interpretation of results difficult. The general concept of watchful waiting is patient follow-up with the application of palliative care as needed to alleviate symptoms of tumor progression. There is no planned attempt at curative therapy at any point in follow-up. For example, transurethral resection of the prostate or hormonal therapy may be used to alleviate tumor-related urethral obstruction should there be local tumor growth hormonal therapy or bone radiation might be used to alleviate pain from metastases. Radical prostatectomy has been compared with watchful waiting or active surveillance/active monitoring in men with early-stage disease .

• Regular patient visits.
• Transrectal ultrasound .
• Transrectal needle biopsies .

Patient selection, testing intervals, and specific tests, as well as criteria for intervention, are arbitrary and not established in controlled trials.

Prostate Cancer Expertise At Scca

Data collected from cancer centers across the country show that men who begin their prostate cancer treatment at SCCA have higher survival rates on average than those who started treatment at other centers.

We have world-class urologic oncologists, medical oncologists, radiation oncologists and pathologists who specialize in prostate cancer the most advanced diagnostic, treatment and recovery programs and extensive support.

SCCA patients have access to advanced treatments being explored in ongoing prostate cancer clinical trials conducted at SCCA, Fred Hutch and UW Medicine. Our doctors and scientists are at the forefront of research to better prevent, diagnose and treat prostate cancer and to improve quality of life for survivors, including through the Institute for Prostate Cancer Research, a Fred HutchâUW Medicine collaboration.

Your SCCA doctors will explain all your options and recommend a treatment plan based on the grade and stage of your prostate cancer and several other factors, including your age, your general health, potential side effects and the probability of curing your disease, extending your life or relieving your symptoms.

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What About My Physical And Emotional Wellness

Eating a healthy diet including a variety of foods, will ensure you have what your body needs to cope with treatment and recovery. Regular physical activity can improve your cancer recovery and reduce side effects such as fatigue.

• Don’t be afraid to ask for professional and emotional support.
• Consider joining a cancer support group.
• Learn to ignore unwanted advice and “horror stories”.
• Live day-to-day and remember that every day is likely to be different.

Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life or reduce pain. There is no evidence that these therapies can cure or prevent cancer. Some have not been tested for side-effects, may work against other medical treatments and may be expensive. Talk to your doctor about using complementary therapies.

What Questions Should I Ask My Healthcare Provider

If you have prostate cancer, you may want to ask your healthcare provider:

• Why did I get prostate cancer?
• What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
• Has the cancer spread outside of the prostate gland?
• What is the best treatment for the stage of prostate cancer I have?
• If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
• What are the treatment risks and side effects?
• Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
• Am I at risk for other types of cancer?
• What type of follow-up care do I need after treatment?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.

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Standard Treatment Options For Stage Iii Prostate Cancer

Standard treatment options for patients with include the following:

External-beam radiation therapy with or without hormonal therapy

EBRT alone, luteinizing hormone-releasing hormone agonist, or orchiectomy, in addition to EBRT, should be considered. Definitive radiation therapy should be delayed until 4 to 6 weeks after transurethral resection to reduce the incidence of stricture.

Hormonal therapy should be considered in conjunction with radiation therapy especially in men who do not have underlying moderate or severe comorbidities. Several studies have investigated its utility in patients with locally advanced disease.

Evidence :

Evidence :

Radiation Therapy For Prostate Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

• As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
• As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
• If the cancer is not removed completely or comes back in the area of the prostate after surgery.
• If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

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Side Effects Of Radiation Therapy

Compared to earlier radiation methods, these modern techniques reduce the chance of urinary and bowel problems.

With several treatment options available, your doctor will work with you to develop and oversee a treatment plan that precisely addresses your prostate cancer while minimizing the risk to surrounding tissues.

This is why it is important to choose an experienced radiation oncologist who specializes in the management of prostate cancer. High volume centers where practitioners have significant experience and treat large numbers of patients with prostate cancer may be associated with good outcomes and fewer lasting problems related to treatment. The majority of patients who undergo radiation do not have permanent effects on bowel or urinary function, and patients who develop erectile difficulty after these therapies can often be treated successfully with medications such as sildenafil or tadalafil.

Radical Prostatectomy vs. Radiation: How to Compare the Results

Making a decision about prostate cancer treatment is not easy. When considering radiation therapy or radical prostatectomy, one of your top concerns is seeking reassurance that your cancer will be cured following treatment.

A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer

A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.

Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.

If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.

To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.

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Treatments For Prostate Cancer That Hasnt Spread

Prostate cancer that is contained within the prostate gland is called localised prostate cancer. Doctors look at different factors to divide men into different groups according to whether the cancer is likely to grow quickly or slowly, or whether it is likely to spread. They use this information to work out which treatments are best for each man. You can find information about low risk, intermediate risk and high risk localised prostate cancer in this section.

How Is Hormone Therapy Used To Treat Hormone

Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:

Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.

The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.

Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.

Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.

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How Far Your Prostate Cancer Has Grown And Spread

The stage refers to the size of the tumour in your prostate and how far it has grown- that is whether it is completely inside the prostate gland or if it has spread outside the prostate. The treatment the doctors choose will be different depending on the stage of the cancer. The diagram below shows a cancer contained within the prostate. There is detailed information about staging prostate cancer in this section.

Table 5 Definitions Of Tnm Stages Iva And Ivba

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Prostate Cancer: A Guide For Aging Men

Prostate cancer is one of the most frequently diagnosed cancers in the world, despite it only being diagnosed in males . In fact, more than 70 percent of men over the age of 80 have some quantity of cancer cells in their prostate.

Its so common that it sometimes doesnt go diagnosed until autopsies are performed, though that doesnt mean the cancer is the cause of death. On the contrary, the overall prognosis for men diagnosed with prostate cancer is as positive as you can get when talking about the dreaded c word. The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.

The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.

Nevertheless, prostate cancer is serious business, and the best way to handle a diagnosis is to be informed. Lets take a look at the frequency at which its diagnosed, how youre tested for it, how it can affect your daily life, and what we can do to try and prevent the disease.

Average Age of Prostate Cancer Diagnosis