What Are My Treatment Options With Advanced Prostate Cancer
The treatments your doctor recommends will depend on factors specific to you, from your overall health to how advanced your cancer was when it was first diagnosed.
Many men receive ADT, a type of hormone therapy, which deprives the body of the male hormones that the cancer needs to keep growing.
For most men, however, hormone therapy stops working at some point. Alternatives to hormone therapy were approved by the Food and Drug Administration in 2018, and Tagawa often starts men on these therapies as soon as theyre diagnosed with bone metastases. Other treatment options may be available through clinical trials.
In addition, chemotherapy, surgery, and immunotherapy as well as radiation treatments, like external beam radiation, which directly target bone problems may be considered. Major cancer centers, such as Memorial Sloan Kettering Cancer Center in New York City and MD Anderson Cancer Center in Houston, have teams of prostate cancer specialists, as well as sophisticated radiation and other treatment equipment consolidated in one place, which can help with the coordination of care.
The Definition Of Cancer
Cancer is a disease in which some of the bodys cells grow uncontrollably and spread to other parts of the body.
Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and multiply to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.
Sometimes this orderly process breaks down, and abnormal or damaged cells grow and multiply when they shouldnt. These cells may form tumors, which are lumps of tissue. Tumors can be cancerous or not cancerous .
Cancerous tumors spread into, or invade, nearby tissues and can travel to distant places in the body to form new tumors . Cancerous tumors may also be called malignant tumors. Many cancers form solid tumors, but cancers of the blood, such as leukemias, generally do not.
Benign tumors do not spread into, or invade, nearby tissues. When removed, benign tumors usually dont grow back, whereas cancerous tumors sometimes do. Benign tumors can sometimes be quite large, however. Some can cause serious symptoms or be life threatening, such as benign tumors in the brain.
Risk Factors For Prostate Cancer
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn’t mean that you will get prostate cancer. It just means that your risk of the disease is greater.
- Age. Men who are 50 or older have a higher risk of prostate cancer.
- Race. African-American men have the highest risk of prostate cancerâthe disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.
- Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a man’s relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
- Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.
Treatment For Locally Advanced Prostate Cancer
Prostate cancer that has spread to tissue around the prostate may be treated with radiation therapy, surgery, or hormone therapy. Sometimes two of these treatments are combined.
Radiation therapy uses high-energy X-rays or protons to destroy the cancer. This treatment has improved with newer technologies, so there are fewer side effects and complications than in the past. Radiation therapy usually is combined with hormone therapy.
External beam radiotherapy, or EBRT, uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may cause your symptoms to get worse.
Two common forms of external radiation are:
- Conformal radiotherapy . This uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
- Intensity modulated radiation therapy . This uses newer 3D-CRT technology to target the cancer.
The two most common surgeries are:
In some cases, men will have radiation therapy after a prostatectomy, especially if the tumour could not be completely removed by surgery.
Does It Matter Where Treatment Is Performed
A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We don’t have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.
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Can I Survive Advanced Prostate Cancer Whats The Prognosis
Prostate cancer is the second leading cause of death from cancer in men, according to the National Cancer Institute. While theres no cure, men can live with it for years if they get the right treatment. Each man with advanced prostate cancer is different, of course. You and your cancer have unique qualities that your doctor takes into consideration when planning the best treatment strategy for you.
According to Harvard Medical School, the prognosis for men with advanced prostate cancer is improving because of newer medications that help them get past a resistance to androgen-deprivation therapy that typically develops after a few years of treatment. With these medications, many men are living longer, and a number of men diagnosed with advanced prostate cancer are dying with the cancer, not from it.
Promptly treating prostate cancer bone metastases with the newest medication can help change a mans prognosis dramatically, Tagawa says. There are men who do well for decades, he says. Some men can even stop treatment, go on to live many years, and actually die of something unrelated.
Tagawa says that cancer specialists who use sophisticated imaging technologies, like positron-emission tomography scans, have gotten very good at finding even tiny bone metastases, which is valuable in diagnosing and removing early stage metastases.
Experimental Treatments For Advanced Prostate Cancer
Researchers are currently testing many new approaches and treatments for prostate cancer, including new medications. These include the following:
Immune checkpoint inhibitors
The immune system uses âcheckpointsâ to stop it from attacking the bodyâs healthy cells. These checkpoints are proteins on immune cells.
Cancer cells often use these checkpoints to keep the immune system from attacking them.
Immune checkpoint inhibitors are drugs that can these checkpoints on cancer cells. Inhibiting these checkpoints can allow a personâs immune system to attack the cancer cells.
Chimeric antigen receptor T cell therapy
This treatment involves taking immune cells from the personâs blood. A scientist then alters these cells in a lab to have receptors called chimeric antigen receptors on their surface.
These receptors help the cells attach to proteins on the surface of prostate cells. A scientist then multiplies these altered T cells in a lab before putting them back into the personâs blood.
Scientists hope these T cells can then find prostate cancer cells and launch a targeted immune attack.
However, this treatment is complicated and may have some serious side effects. This means it is currently only available as part of clinical trials.
Targeted drug therapies
Targeted drug therapies can act on specific parts of cancer cells and the environments surrounding them.
Two possible targeted therapy treatments are:
Treating prostate cancer that has spread to the bones
Take Time To Make A Treatment Decision
Most prostate cancers grow relatively slowly, so immediate treatment is rarely necessary. Many men can safely take months to decide what to do. The decision process can be complicated. The chosen treatment can significantly affect your life, which makes it especially important to take time to educate yourself and confidently choose the approach that is most appropriate for you.
Tissue Ablation And Focal Therapy
Tissue ablation treatments destroy the prostate cancer through freezing or heating. These treatments can be applied to all or just part of the prostate . Whereas whole gland ablation has largely fallen out of favor, focal ablation has gained popularity. The two most commonly used energy sources are as follows:
Cryosurgery kills cancer cells in the prostate by freezing them through special needles that are inserted into the gland. The needles are placed under ultrasound guidance. This method is effective in curing cancer but can’t treat lymph nodes and commonly causes erectile dysfunction if the entire prostate is treated. Urinary incontinence is a rare but possible side effect.
High-intensity focused ultrasound uses the high temperatures created by focused sound wave energy to kill cancer cells. While HIFU results over the years have been mixed, modern systems such the one used at UCSF allow real-time monitoring of tissue temperatures during treatment, improving outcomes.
Less commonly used ablation methods include interstitial laser ablation, electroporation , vascular targeted photodynamic therapy, gold nanoparticle therapy, and others under development. Focal radiation is used occasionally as well. Currently, there is little data comparing these technologies.
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What Does Watchful Waiting Mean
In men who are older or have serious illnesses, the risks and distress associated with surgery or radiotherapy can outweigh the possible benefits of this treatment. Some men also say that they dont want to have a distressing treatment. Watchful waiting is then an option. In this approach, the cancer isnt treated with the aim of curing it. Instead, you may have treatment to control the cancer and manage the symptoms if you start to get symptoms.
One big difference to active surveillance is that you dont need to have distressing check-ups in the watchful waiting approach. Watchful waiting is mainly considered in men whose prostate cancer isnt likely to shorten their life in the next ten years. Their prostate cancer isnt likely to grow much during that time.
Side Effects Of Radical Prostatectomy
The most common side effects of the procedure are incontinence and erectile dysfunction . The incontinence, though common early after surgery, usually goes away. Whether erectile function returns depends on whether the nerves surrounding the prostate can be spared at surgery, patient age and baseline function. Men who are older or already have erection problems are most likely to have erectile dysfunction afterward.
For more information on erectile dysfunction and treatment, see Managing Erectile Dysfunction A Patient Guide.
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Options For Dealing With Recurrence
With a persistently increasing PSA, the suspicion for recurrence increases. The most important factor in assessing your long-term outcome is determining the location of the prostate cancer cells producing the PSA. Advanced imaging techniques, such as MRI and PSMA PET/CT, are often helpful in learning where the cancer is located, and in the case of post-radiation recurrence, repeat biopsy may be required.
If a man underwent surgery as an initial treatment, revisiting the post-operative pathology report may help to identify what contributed to the recurrence. If there was still cancer present , the cancer was aggressive , or genomic profiling of the tumor showed high-risk features, several options are available:
- EBRT to the prostate bed with or without the pelvis.
- EBRT accompanied by hormone therapy. The duration of hormone therapy will depend on the PSA level just prior to radiation and to a lesser extent on the Gleason score and staging of the cancer.
- Systemic treatment using hormone therapy, other treatments for those at risk for metastatic disease, or a combination.
- Active surveillance if the remaining cancer appears insignificant. You and your doctor can decide whether to intervene more aggressively and, if so, when.
If you’re seeking additional or different approaches, you may be eligible to participate in an appropriate clinical trial . You can research this with the help of your doctor.
Surgery For Bladder Cancer
Surgery is done for most bladder cancers. The type you have depends on the stage of the cancer.
Removing the tumor from the inside bladder is the most common surgery for early bladder cancer. This can be done during a cystoscopy. A a cystoscope with a looped wire on the end is used to remove the tumor.
When the cancer is more invasive, the cancer is removed along with part of the bladder or the entire bladder.
If only part of the bladder is removed, youll still be able to hold and release urine as normal, though in smaller amounts. If the entire bladder is removed, youll need another way to store and pass urine. Your doctor can explain the options for this.
Side effects of surgery
Any type of surgery can have some risks and side effects. For instance, removing the bladder not only changes how your body passes urine, but it can also cause sexual side effects. If you have these or any other problems, let your doctors know. There are ways to help deal with many side effects.
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How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
Medicines For Treating Side Effects
Hormone therapy can cause loss of sexual desire, hot flashes, enlarged and painful breasts, and erection problems.
- For men who have erection problems after surgery, medicines such as sildenafil , tadalafil , or vardenafil may be helpful. Using medicines soon after surgery may help men regain sexual function. Talk with your doctor about your situation.
- Taking a temporary break from hormone therapy can make some side effects go away.
- To relieve breast pain, the anti-estrogen breast cancer medicine called tamoxifen or radiation treatment is commonly used. Tamoxifen can also help reverse breast growth. Also, it causes hot flashes.
- For hot flashes, taking a certain kind of antidepressant may help. Paroxetine or venlafaxine may help with hot flashes. But they have different side effects. So if you are having a problem with hot flashes, talk with your doctor.
- In some cases, cyproterone may be used to treat hot flashes.
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How The Prostate Changes As You Age
Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren’t noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.
Tell your doctor if you have these urinary symptoms:
- Are passing urine more during the day
- Have an urgent need to pass urine
- Have less urine flow
- Feel burning when you pass urine
- Need to get up many times during the night to pass urine
Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation , enlarged prostate , and prostate cancer.
One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.
Growth Rate Of Aggressive Prostate Cancer
The Gleason score is used to classify different stages of prostate cancer. This score reflects the growth rate of cancer cells. It is divided into localized, regional, and distant stages. Localized prostate cancer has not spread to nearby structures and lymph nodes. Distant stage prostate cancer has spread to other parts of the body and has metastasized. Men diagnosed with localized prostate cancer will live an average of five years after diagnosis.
The researchers tested this computational method using large-scale data. They accessed 33 million PSA test results from 14 million men in the Veterans Affairs Health System. They then analyzed data from 58,523 men ranging in age from 50 to 75. They used an exponential plus constant trend to calculate the cancer-derived PSA over time. As PSA grew, the investigators found that the risk of dying from prostate cancer increased by 2 points.
The growth rate of aggressive prostate cancer is determined by analyzing the size of the tumor under the microscope. While a lower Gleason score indicates a less aggressive tumor, the higher Gleason score means a more aggressive tumor with greater potential for growth and spread. Ultimately, these numbers will help determine the most appropriate treatment for each patient. But if there is no specific test to predict a persons risk of developing aggressive prostate cancer, there is no certainty yet.
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