The Best Care For Prostate Cancer
When it comes to prostate cancer, there are no easy answers. We strive make it easier. We confirm a prostate diagnosis, even when prostate cancer is hard to find because the tumors are very small. We are experts at diagnosing these challenging cases.
Our specialized team develops a personalized treatment plan for you that aims to preserve your urinary and sexual function. We explore all minimally invasive options, including active monitoring before recommending surgical removal of your prostate or external radiation therapy. We offer minimally invasive treatments such as cryosurgery — a type of focal therapy that targets a section of the prostate gland containing the cancer rather than the whole prostate — and high-dose brachytherapy radiation, which kills cancer cells in your prostate while potentially preserving healthy tissue.
We are also strong advocates of active surveillance or watchful waiting for small, nonaggressive prostate cancer. We believe active surveillance is a safe and important course for certain men with prostate cancer who may be candidates to avoid treatment altogether.
When Can Prostate Cancer Kill You
Prostate cancer can be a deadly disease when discovered at an advanced stage. Advanced prostate cancer is cancer that has already spread from the prostate to other distant parts of the body. It is also called metastatic prostate cancer. However, there are rare cases when prostate cancer is diagnosed at such a late stage. Usually, it develops to this stage after the first diagnosis. That is why choosing the best treatment for prostate cancer is crucial. Finally, it can make the difference between life and death. Read more about the most efficient prostate cancer treatment.
How Is Chemotherapy Given
You can get chemotherapy in two different ways. Some of the anticancer medicines are given to you intravenously which is also known as an I.V. This means that the medicines go into your body through a needle in your vein. Other chemotherapy medicines can be taken by mouth or orally. Sometimes two or more chemotherapy medicines will be given to you at the same time. This treatment may work better at killing your prostate cancer cells. You may need many blood tests before, during, and after getting chemotherapy. These blood tests tell your doctor how your body is doing. When you have a blood test, a nurse or technician will take a small amount of blood from your arm with a needle. The tests can tell your doctor how the healthy cells in your body are doing. This is important for your doctor to know in deciding on your chemotherapy dose . Blood tests may also tell the doctor how well the chemotherapy is controlling your cancer.
Getting Ready For Chemotherapy
- What tests has your doctor told you that you need to have before you start your chemotherapy?
- When are your appointments for these tests?
- Where do you need to go to have these tests?
- What transportation plans will you make to get to these places? If you need help, speak with your doctor or health care team.
Getting Chemotherapy By Mouth Or Orally
If you are taking chemotherapy by mouth the medicine is given to you in a pill, capsule or liquid form. You will swallow the medicine just like many other medicines you may take. If you are taking chemotherapy by mouth, make sure that you take them exactly as you are told. It is important that you do not skip a time when you are supposed to take your medicine. Also, do not stop taking your medicine unless you speak with your doctor. It may help you to keep track of when you need to take your medicine by using a calendar with the dates marked to show when you need to take it. If you are taking pills or capsules, some men find it helpful to use a pillbox that has spaces in it with different times of the day. You can fill the pillbox with your chemotherapy medicine so that you are reminded to take it at the right time. If you vomit right after taking your chemotherapy medicine, let your doctor know.
External Beam Radiation Therapy
This is the most common type of radiation therapy, and it is painless. Before treatment, your radiation team will use computerized tomography scans and magnetic resonance imaging scans to map out the location of the prostate and tumor cells.
During each treatment session, X-ray beams are focused on the targeted cancer areas. Oncologists can change the intensity of doses and radiation beams to better deliver high doses of radiation to tumor cells while delivering lower doses to surrounding healthy tissues.
Will Chemotherapy Cure My Prostate Cancer
No, chemotherapy will not cure your prostate cancer, because it does not kill all of your prostate cancer cells. But chemotherapy helps control your prostate cancer. It may:
When To Talk With A Doctor
Prostate cancer is the most common type of cancer among men in the United States and should therefore be a subject that men learn about and address with their doctors once they reach adulthood.
Because prostate cancer is slow growing, regular prostate screenings can often catch the disease in its early stages. The American Cancer Society recommends the following timeframe for initial prostate screenings:
- age 40 for men with more than one first-degree relative who had prostate cancer at an early age
- age 45 for men at high risk of developing prostate cancer, including African Americans and anyone with a first-degree relative who was diagnosed with cancer younger than 65 years of age
- age 55 to 69 for men who are of average risk of prostate cancer
The issue of prostate cancer screenings is a somewhat controversial one, so talk with a primary care physician or urologist about the pros and cons of getting a screening at your age.
Other Prostate Cancer Detection Methods
The DRE exam may also complement the diagnosis process. In a digital rectal exam, the doctor places a lubricated gloved finger into the rectum to check for prostate abnormalities. The DRE test is performed in order to complement the PSA test and provides a more accurate diagnosis.
Following these procedures, a prostate biopsy is usually recommended if there are any signs of prostate problems. However, biopsies are usually very uncomfortable and, most often, results are negative. Therefore, other non-invasive prostate cancer detection methods are being used. The MRI scan is used in radiology to recreate images of the prostate gland and nearby tissues. MRI scans are used to check for cancerous cells in the prostate. MRI guided biopsies are more precise due to the fact that the doctor knows the exact location of the affected tissue. CT scans and PET scans are also other non-invasive methods of prostate cancer detection.
Questions To Ask Your Doctor
These questions may be useful to you when you talk to your doctor about your chemotherapy treatment:
About Chemotherapy
- Why do I need chemotherapy?
- How can chemotherapy help me?
- What are the risks of chemotherapy?
- Are there any other possible treatments for my prostate cancer?
About Your treatment
- How many chemotherapy treatments will I get?
- What medicine or medicines will I take?
- How will the medicines be given to me?
- How long will each treatment I get last?
About Side Effects
- What side effects may I get from my chemotherapy medicine?
- When will these side effects happen?
- Are there any side effects I should tell you about right away?
- What can I do to manage my side effects?
About Contacting Your Doctor
- How do I get in touch with you or my health care team after your office is closed?
Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy
Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.
If This Uncertainty Would Bother You So Much That It Would Affect Your Quality Of Life Surgery May Be A Better Option For You Phuoc Tran Md Phd
However, if youre okay with waiting for the PSA nadir, and if you dont mind getting treatment over the course of a few weeks instead of in one operation, then radiation may be ideal for you.
What are my options?
Conventional external-beam radiation therapy is given in little doses, a few minutes a day, five days a week, for seven or eight weeks. These small doses minimize the injury risk for the healthy tissue near the tumor. Scientists measure radiation in units called Gy . Most men get a minimum total dose of 75.6 Gy, but could get as much as 81 Gy; this works out to 2 Gy or less per day.
The treatment itself is painless just like getting an x-ray at the dentists office. But one big challenge with getting repeated treatments is making sure youre always in the exact same position, so the radiation can hit the target the way its supposed to. Thus, you will be custom-fitted with your own pelvic immobilization device, which will not only keep you from fidgeting, but will make sure youre not slightly higher and to the right on the table one day, and slightly lower and to the left the next.
When you get fitted for your device, you will have a CT scan, so doctors can get a 3D look at your prostate. Then, when you get the radiation, you wont just get it from one side, but from multiple directions, and each beam of radiation will be individually shaped to target the cancer and a 5- to 10-millimeter margin of healthy tissue around the prostate.
Stem Cell Or Bone Marrow Transplant
A stem cell transplant, sometimes called bone marrow transplant, replaces damaged blood-forming cells with healthy ones. The procedure takes place following large-dose chemotherapy or radiation therapy to kill cancer cells and to stop your stem cells from producing cancerous cells.
Stem cell transplants can be used for several types of cancer, including multiple myeloma and some kinds of leukemia.
Talk To Your Radiation Oncologist About Respiratory Gating
If you have left sided breast cancer, some radiation will likely make its way to your heart, and heart disease related to radiation for breast cancer is a significant concern. Radiation has been linked with a number of different forms of heart disease ranging from valve disease, to rhythm disturbances, to coronary artery disease.
Fortunately, the technique of respiratory gating or “breath hold” can reduce the amount of radiation that hits your heart significantly. With this technique, your technician will have you hold your breath for short periods of time during each session. It is important to ask about this before beginning your treatments, as special measurements will need to be taken to be sure that inhaling air into your lungs will move your heart away from the field of radiation.
Even though research has found benefit in these techniques, not everyone is informed of this option. Make sure to be your own advocate, so that you either receive this heart-sparing technique, or at least clearly understand why it may not be needed.
What Happens If I Decide Not To Treat My Prostate Cancer
Should I treat my prostate cancer or leave it alone? The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present. But let’s take a look at the natural history of prostate cancer if it is not treated…
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, especially if it’s expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. This is called active surveillance, meaning doctors will initiate cancer treatment only if the cancer starts growing.
Others choose no 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 circumstances — requiring a careful and thoughtful discussion with your doctor and family.
What happens if prostate cancer is ultimately left untreated?
Where does prostate cancer spread?
Most cases of diagnosed prostate cancer, however, if left untreated, will grow and possibly spread outside of the prostate to local tissues or distantly to other sites in the body. The first sites of spread are typically to the nearby tissues.
Proton Beam Radiation Therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
Find Or Purchase Comfortable Clothes
Your skin can become tender as radiation goes on, and loose-fitting camisoles and tops will be most comfortable. If you must wear a bra, make it a comfortable one and place a soft cloth between your bra strap and skin.
Don’t starch your blouses or shirts, and use a mild laundry detergent when washing your clothes.
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.
It’s 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.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
Use The Weekends To Recuperate Not Catch Up
Many people try to delegate to the weekends what doesn’t get done during the week, but this can lead to exhaustion. Make your number one weekend priority be to rest and heal, rather than trying to complete your to-do list.
A Word From Verywell
Taking the time to prepare not only physically but mentally for radiation can pay off when the fatigue hits full force. While the treatments may seem to go on forever, in reality it is just a short hiatus from life. Let yourself rest and pamper yourself as you would a good friend.
What To Think About
Antiandrogen hormone therapy also may cause diarrhea, breast tenderness, and nausea. Cases of liver problems, some serious, have been reported.
Hormone therapy can also affect the bones, making them thin and brittle and more likely to break. Medicines such as bisphosphonates and denosumab may help prevent bone loss during long-term hormone therapy.
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
- chemotherapy
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
What Are The Symptoms
Sometimes there are no symptoms of either locally advanced or metastatic prostate cancer.
When they do appear, symptoms of locally advanced prostate cancer include:
- Waking up many times during the night to urinate.
- Having trouble starting or stopping your urine stream, having a weaker-than-normal stream, or not being able to urinate at all.
- Having pain or a burning feeling when you urinate.
- Having blood in your urine or semen.
- Painful ejaculation.
- Having a deep pain or stiffness in your lower back, upper thighs, or hips.
Symptoms of metastatic prostate cancer may include:
- Bone pain.
- Swelling in your legs and feet.
What Kind Of Treatment Will I Need
There are many ways to treat prostate cancer. The main kinds of treatment are observation, active surveillance, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.
The treatment thats best for you will depend on:
- Your age
- Any other health problems you might have
- The stage and grade of the cancer
- Your feelings about the need to treat the cancer
- The chance that treatment will cure the cancer or help in some way
- Your feelings about the side effects that might come with treatment
Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
How Is Prostate Cancer Diagnosed
A blood test called a prostate-specific antigen test is the most common way to check for prostate cancer. A higher level of PSA may mean that you have prostate cancer or that your prostate cancer has come back.
Your doctor also may do a biopsy. In this test, your doctor takes samples of tissue from your prostate gland or from the area where the cancer may have spread and sends the samples to a lab for testing. A biopsy is the only way to know for sure that you have prostate cancer.
If you have had prostate cancer before, your doctor may also order a bone scan, CT scan, or to see if it has come back or spread.
How Can Cancer Kill You
Many people have questions about how cancer can kill you. Its something that most people worry about it at some point.
We know that talking about this can be difficult. You can save to read this information another time when you feel ready. And its ok if you dont want to read this information at all.
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.
Treatment For Metastatic Prostate Cancer
Treatment for prostate cancer that has spread to the bones and/or other organs in the body is aimed at relieving symptoms and slowing the cancer’s growth. Treatment may include:
- Hormone therapy to slow cancer growth.
- Radiation therapy to shrink tumours and ease pain.
- Chemotherapy to stop the growth of cancer cells.
- Surgery to remove blockages that are causing problems .
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.
Talk To Your Radiation Oncologist About What To Expect
While many people seem to have an idea what to expect with surgery and chemotherapy, it is common for people to be surprised at how radiation affects them. Unlike scars with surgery and hair loss with chemotherapy, the effects of radiation are less visible.
Talk about what to do if you develop skin redness and rashes, and ideally how to prevent this. There are some personal care products that you will need to avoid, and your radiation oncologist help you to understand what products to use and what to avoid.
If you had a mastectomy and reconstruction, talk about how the radiation may affect your healing, as well as the risk of infection if you develop open sores. Many people are unaware of the risk of reconstruction failure related to radiation. Make sure to talk about not only the risk that reconstruction may be more challenging following radiation, but complications that may occur during or shortly after reconstruction if you have tissue expanders in place.
It’s also important to be sure you understand not only the short term side effects, but the potential long term effects of radiation therapy.
How Is It Treated
Your treatment choices depend on your overall health, how fast the cancer is growing, and how far it has spread.
Locally advanced prostate cancer may be treated with surgery, radiation therapy, hormone therapy, or a combination of these.
Treatment of metastatic cancer focuses on slowing the spread of the cancer and relieving symptoms, such as bone pain. It also can help you feel better and live longer. Treatment may include hormone therapy, radiation therapy, chemotherapy, or immunotherapy.
Men over age 80 or those with other serious health problems may decide not to have treatment except for what is needed to treat any symptoms .