Receiving Treatment For Prostate Cancer That Has Spread
At Moffitt Cancer Center, the experts within our Urologic Oncology Program treat patients with all stages of prostate cancer, including advanced-stage cancers that have metastasized to other areas of the body. Our multispecialty team collaborates as a tumor board, ensuring each patient receives a treatment plan tailored to his unique needs. For individuals with metastatic prostate cancer, treatment plans aim to alleviate symptoms, slow the rate of cancer growth and shrink tumors to help improve quality of life.
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Possible Cancer Protection From Prostate Drugs
Early research suggested that 5-alpha-reductase inhibitors , a class of drugs used to treat prostate enlargement, might increase the risk of developing more aggressive prostate cancer. However, newer studies have found that not only do the drugs appear to pose no extra risk, they may even protect against prostate cancer.
For instance, research from the Prostate Cancer Prevention Trial study in 2013 showed that taking the 5-ARI finasteride for seven years could lower the chance of getting low-grade prostate cancer by 25% among men ages 55 and older. A follow-up study of almost 9,500 men, published in the Nov. 1, 2018, issue of the Journal of the National Cancer Institute, also showed that finasteride lowered the risk by a similar amount , and found the protective effect lasted for at least 16 years.
Prostate Cancer And Your Sex Life: What You Should Know
While sex might not be the first thing in your mind when you are diagnosed with prostate cancer, it is something that you need to know about especially if you lead a sexually active life. You might feel awkward talking about your sex life with your doctor but it is important to do so.
When you get treated for prostate cancer, it can affect your sex life in various ways. You might lose interest in sex or you might just feel discomfort when you think of sex. Some men feel pain during ejaculation as well. All of these can hinder your ability to enjoy sex and this can affect your self-image and self-confidence.
You need to ask your doctor about the treatment that you will be receiving and how it will affect your sex life. You can ask questions such as the safety measures that you can take, which sex positions you should avoid, whether you can have sex with your partner daily, etc.
Whatever questions you have, just ask your doctor to be on the safe side. If you are unable to do that then you might want to speak to your counsellor first and then to your doctor so you dont feel awkward.
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Will Bph Affect My Sex Life
There is some evidence that older men with severe BPH symptoms may be more likely to have problems in the bedroom, compared to other men their age. Some of the medications commonly used to treat BPH have been associated with problems getting an erection and ejaculating. If you develop sexual issues, talk to your doctor. A change in medications may be enough to correct them.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someones risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.
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Risk Groups For Localised Prostate Cancer
Doctors divide localised prostate cancer into 3 risk groups depending on how likely it is that the cancer will grow quickly or spread.
Your risk group depends on:
- the size of your tumour
- how the cells look under the microscope and the pattern of the cells in the prostate tissue
- your prostate specific antigen blood test
What Are Prostate Cancer Treatment Side Effects
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.
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What Are Bone Metastases With Prostate Cancer
The ACS describes bone metastases as areas of bone containing cancer cells that have spread from another place in the body. In the case of prostate cancer, the cells have spread beyond the prostate gland. Since the cancer cells originated in the prostate gland, the cancer is referred to as metastatic prostate cancer.
The cancer cells spread to the bones by breaking away from the prostate gland and escaping attack from your immune system as they travel to your bones.
These cancer cells then grow new tumors in your bones. Cancer can spread to any bone in the body, but the spine is most often affected. Other areas cancer cells commonly travel to, according to the ACS, include the pelvis, upper legs and arms, and the ribs.
Advanced Genomic Testing For Prostate Cancer
The most common lab test for prostate cancer is advanced genomic testing, which examines a tumor to look for DNA alterations that may be driving the growth of the cancer. By identifying the mutations that occur in a cancer cells genome, doctors may get a clearer picture of the tumors behavior and be able to tailor a patients treatment based on the findings.
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How Active Surveillance Works
The Gleason score is just one way that doctors monitor prostate cancer during active surveillance. They also do periodic follow-up biopsies and measure PSA levels, which may rise if cancer starts to spread in the prostate. Doctors may recommend treatment sooner if PSA begins to rise quickly or if a follow up biopsy reveals a higher Gleason score or more widespread cancer within the prostate. Its an inexact science that depends on a doctors skill and experience and a mans willingness to wait for signs that a cancer poses a clear threat before opting for treatment and its potential for side effects.
Penney says she and her Harvard colleagues are among the many scientists now searching for better ways to predict which prostate cancers are likely to be lethal and which can be monitored and not treated. The answer may be found in genetic changes in prostate cancer cells that signal a higher threat. But finding a better way to predict which prostate cancers are likely to turn lethal is far from guaranteed.
Some believe its not possible, Penney says. After the cancer is diagnosed, so many things can change in unknown ways. Diet, exercise, and other lifestyle factors, for example, could affect whether low-risk prostate cancers become more aggressive or threatening over time.
To Treat Or Not To Treat
Up until now, with a few notable exceptions, doctors have myopically focused on treating prostate cancer, says Adami. They are willing to spend tens of thousands of dollars on chemotherapy that has minimal effects on cancer mortality, often with substantial side effects. But we ignore entirely the fact that large groups of prostate cancer patients die from other causes that actually are preventable.
Among older patients especially, that activity can take the form of vigorous walking. Recently, Mucci has spearheaded an intervention with Adami and other colleagues in Sweden, Iceland, and Ireland in which men walk in groups with a nurse three times a week. In a pilot study, researchers found improvements in just 12 weeks in body weight, blood pressure, sleep, urinary function, and mental health.
Scientists at HSPH are also searching for genetic and lifestyle markers that help predict how aggressive a patients prostate cancer will be. For example, an ongoing project led by Mucci and Adami draws on detailed cancer registries in Nordic countries, including an analysis of 300,000 twins, to tease out the relative contribution of different genes to prostate cancer incidence and survival.
is a Boston-based journalist and author of The Coke Machine: The Dirty Truth Behind the Worlds Favorite Soft Drink.
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Pearls And Other Issues
PSA Testing: The Pros and the Cons
Prostate Specific Antigen is a protein produced by the prostate and is abundant in semen. Its natural function is to divide seminogelin in the semen, which helps in liquefaction. The expression of PSA is androgen-regulated.
It was originally used as a prostatic tissue stain to help determine the etiology of tumors of unknown origin. Later, serum levels of PSA were used as a prostate cancer screening tool because serum PSA levels start to increase significantly about seven to nine years before the clinical diagnosis of malignancy. While a good indicator of prostatic disorders, PSA elevation is not specific for cancer as it is also elevated in benign prostatic hyperplasia, infection, infarction, inflammation , and after prostatic manipulation. It also cannot reliably distinguish between low risk/low grade disease and high risk/high grade cancers.
About 80% of the patients currently diagnosed with prostate cancer are initially investigated due to an elevated serum PSA.
While it unquestionably increases prostate cancer detection rates, the value of PSA testing is less clear in avoiding overtreatment, improving quality of life and lengthening overall survival which is why routine PSA screening for prostate cancer remains quite controversial.
PSA testing became widely available in the United States in 1992, and since then, prostate cancer detection rates have increased substantially.
The Current USPSTF Recommendation
Against PSA Screenings
What Can Cause Adenocarcinoma
Though the exact cause of adenocarcinoma is not fully understood, researchers have identified a variety of risk factors that are associated with this type of cancer:
Smoking is the most common risk factor associated with all types of cancers. It is important to note that these risk factors will not necessarily lead to lung cancer. Similarly, an individual may develop lung cancer without having any of these risk factors.
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Symptoms Of Advanced Prostate Cancer
The symptoms of advanced prostate cancer depend on where the cancer has spread to. Find out about the possible symptoms and when to see your doctor.
Advanced prostate cancer means that a cancer that began in the prostate gland has spread to another part of the body. If your cancer has spread you might:
- have bone pain
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Aggressive Versus Indolent Prostate Cancer
While there are many types of prostate cancers, urologists usually break them down into aggressive and indolent categories to make it easier to determine the right treatment and to treat various types of cancers effectively. Aggressive cancer is a high-risk prostate tumor that if not treated remains highly active and very likely to spread to areas outside the prostate gland. The cancer grows quickly, spreads early, rapidly and widely, and causes increased damage in the body. Because aggressive cancer spreads as secondary deposits and can quickly result in widespread damage, it progresses rapidly to advanced stage cancer and can be very difficult to treat. So for aggressive prostate cancers to be treated successfully, they should be diagnosed early and treatment should be started when the tumors are still in their early stages.
On the other hand, indolent prostate cancer is a low-risk, slow-growing and low-volume tumor that can sit in the prostate gland for many years without causing any problems. An indolent cancer is not likely to spread outside the prostate even if not treated. But if it does, the spread will be local and slow. In fact, patients with indolent prostate cancers can live for 10-20 years without the cancer causing any serious effects on their lives.
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High Risk Prostate Cancer
High risk cancers might grow or spread within a few years. Localised prostate cancer is high risk if you have one of the following:
- a T stage of T2c
- a Gleason score between 8 and 10
- a PSA level higher than 20 ng/ml
High risk localised prostate cancer is also a locally advanced prostate cancer. This means that even if your cancer is contained within the prostate gland, your doctor might describe it as locally advanced.
Your risk group helps your doctor decide which treatment you need. Treatment also depends on:
- your age and general health
- how you feel about the treatments and side effects
- your type of cancer
Looking For More Survivorship Resources
For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:
ASCO Answers Cancer Survivorship Guide:Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.
Cancer.Net Patient Education Video:View a short video led by an ASCO expert that provides information about what comes after finishing treatment.
Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.
The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.
This is the end of Cancer.Nets Guide to Prostate Cancer. Use the menu to choose a different section to read in this guide.
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How Likely Is It For Prostate Cancer To Spread
Heres our process. About 80 percent of the time prostate cancer cells metastasize, or spread, they will spread to bones, such as the hip, spine, and pelvis bones. It can be by direct invasion or by traveling through your blood or lymphatic system. Metastatic prostate cancer is considered advanced prostate cancer.
What Is Prostate Cancer
Cancer can start any place in the body. Prostate cancer starts in the prostate gland. It starts when cells in the prostate grow out of control.
Cancer cells can spread to other parts of the body. Cancer cells in the prostate can sometimes travel to the bones or other organs and grow there. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the prostate.
Cancer is always named for the place where it starts. So when prostate cancer spreads to the bones , its still called prostate cancer. Its not called bone cancer unless it starts from cells in the bone.
Ask your doctor to use this picture to show you where your cancer is.
The prostate is a gland found only in men, so only men can get prostate cancer.
The prostate is just below the bladder and in front of the rectum . The tube that carries pee goes through the prostate. The prostate makes some of the fluid that helps keep the sperm alive and healthy.
There are a few types of prostate cancer. Some are very rare. Most prostate cancers are a type called adenocarcinoma. This cancer starts from gland cells. Your doctor can tell you more about the type you have.
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Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
If You Dont Have Treatment Straight Away
Your doctors monitor your cancer closely if it is unlikely to grow or develop for many years. If it starts to grow, you have treatment. This is called active surveillance. You have active surveillance if you have either:
- low risk localised prostate cancer and surgery or radiotherapy are suitable treatments for you
- intermediate risk localised prostate cancer if you dont want treatment straight away
Another way to monitor prostate cancer is called watchful waiting. You have fewer tests than with active surveillance. You have watchful waiting if the doctor aims to control your cancer and:
- you don’t have any prostate cancer symptoms and you’re not suitable for treatments that aim to cure, such as radiotherapy or surgery
- you dont want active surveillance
You might also have cryotherapy or high frequency ultrasound therapy as part of a clinical trial.
Radiotherapy and surgery work equally well at curing prostate cancer but they have different side effects. Your doctor can explain these to you.
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