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How Likely Is Prostate Cancer To Spread

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The Top 7 Signs Of Advanced Prostate Cancer

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In the early stages, you may not notice any symptoms related to prostate cancer. This is why screenings are important. Symptoms can sometimes be noticed for the first time when the cancer advances.

Advanced prostate cancer, also called metastatic cancer, means the cancer has spread to other areas of your body beyond your prostate gland. The most common areas for prostate cancer to spread are your bladder, rectum, and bones. It can also spread to your lymph nodes, liver, lungs, and other body tissues.

Whether youve just been diagnosed or youre in treatment, its also important to know the signs of advanced cancer. Cancer can behave differently depending on your genetics, so not every person will experience the same symptoms in the same way.

Read on to learn more about the seven top symptoms of advanced prostate cancer and how to spot them.

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.

What Are The Signs Of Prostate Cancer

Most early prostate cancers are detected with PSA tests or digital rectal exams before they cause any symptoms. However, more advanced prostate cancers can cause a variety of symptoms including:

  • Trouble starting to urinate .
  • Urinating much more often than usual.
  • The feeling that you can’t release all of your urine.
  • Pain with urination or ejaculation.
  • Blood in your urine or semen.
  • Impotence/erectile dysfunction.
  • Numbness in the lower extremities.
  • Loss of bladder or bowel control.

All of these symptoms can be caused by things other than prostate cancer, so experiencing them doesn’t necessarily mean you have prostate cancer. When older men have problems urinating, it is usually caused by a problem called benign prostatic hyperplasia , which is not prostate cancer. If you have any of these symptoms, you need to see your provider for testing.

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What If My Biopsy Shows Cancer

If the biopsy shows prostate cancer, your doctor will determine how likely your cancer is to grow quickly and spread. Sometimes, prostate cancer grows slowly over many years. But other times, it grows quickly.

Your doctor can use your PSA level, Gleason score, and tumor score to determine your risk level. The following pages give more information about Gleason score, T-score, and prostate cancer risk levels.

Gleason Score

The Gleason score is a common scale used to determine how fast your prostate cancer is likely to grow. Gleason scores can range from 2 to 10, but most often range from 6 to 10. The higher the Gleason score, the more likely your cancer is to grow and spread.

Tumor Score

The T-score tells how far your prostate cancer has grown.

  • T1: The cancer is too small to be felt during a digital rectal exam or seen in an imaging test . The cancer is found from a biopsy done after a man has a high PSA level or has surgery for problems urinating. The cancer is only in the prostate gland.
  • T2: The cancer can be felt during a digital rectal exam and may be seen in an imaging test. The cancer is still only in the prostate gland.
  • T2a: The cancer is in one-fourth of the prostate gland .
  • T2b: The cancer is in more than one-fourth of the prostate gland , but has not grown into the other side of the prostate gland.
  • T2c: The cancer has grown into both sides of the prostate gland.

Risk Level

Table 1. Determining risk level

Risk Level*
  • Hormone therapy

What Is The Prognosis For People Who Have Prostate Cancer

Prostate Cancer

Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.

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What Are Possible Side Effects Of Treatments For Localized Prostate Cancer

All treatments can cause side effects. The most common side effects are urinary, bowel, and sexual problems. Some problems happen soon after treatment, but others develop over time. Some side effects may get better, but some may last a long time or may never go away. Talk with your doctor if you have any side effects. There may be ways to help manage them.

Table 2. Possible side effects of treatments

Treatment
  • Weakened bones that may break more easily
Some types of hormone therapy may increase the risk of a heart attack or stroke.

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.

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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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Stage Iv Prostate Cancer Prognosis

Prostate Cancer and Bone Metastasis

Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.

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.

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Watchful Waiting And Active Surveillance

Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.

Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.

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How Will My Cancer Be Monitored

Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.

You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.

You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.

Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.

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Are Prostate Problems Always A Sign Of Prostate Cancer

Not all growths in the prostate are cancerous, and not all prostate problems indicate cancer. Other conditions that cause similar prostate cancer symptoms include:

  • Benign prostatic hyperplasia : At some point, almost every man will develop benign prostatic hyperplasia . This condition enlarges the prostate gland but doesnt increase cancer risk. The swollen gland squeezes the urethra and blocks the flow of semen and urine. Medications, and sometimes surgery, can help.
  • Prostatitis: Men younger than 50 are more prone to prostatitis, inflammation and swelling of the prostate gland. Bacterial infections are often the cause. Treatments include antibiotics or other medications.

Symptoms Of Advanced Prostate Cancer

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
  • have weight loss for no known reason

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Who Gets This Cancer

Prostate cancer occurs only in men, and it is more common in older men than younger men. It is more likely to occur in men with a family history of prostate cancer and men of African American descent. The rate of new cases of prostate cancer was 111.3 per 100,000 men per year based on 20142018 cases, age-adjusted.

Rate of New Cases per 100,000 Persons by Race/Ethnicity: Prostate Cancer

Males

SEER 21 20142018, All Races, Males

Distant Metastatic Prostate Cancer

Distant metastatic prostate cancer is more advanced, having spread to areas outside the pelvic region. The most common distant places where prostate cancer spreads include the:

  • Bones
  • Lungs
  • Liver

Less commonly, prostate cancer may spread to the adrenal glands, kidneys, brain, pancreas or another organ. It is important to note that it is still considered prostate cancer when it spreads to other regions, as the cancer cells in distant areas are the same as the original cancer cells in the prostate gland, even if the prostate gland was previously removed. A biopsy may be recommended to confirm this.

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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.

Faqs About Prostate Cancer That Has Spread To The Bones

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The prostate is a gland the size of a golf ball that sits below the bladder and in front of the rectum. Its responsible for making the fluid that forms semen. Many men develop cancer of the prostate gland its the second most common cancer among men in the United States. There are several stages of prostate cancer the earliest, when the cancer is still limited to the prostate gland itself, is the easiest to treat.

When the cancer has spread, or metastasized, beyond the prostate gland, its considered advanced, according to the American Cancer Society . When it spreads, its common for cancer cells to reach the bones first. Nine out of 10 men with advanced prostate cancer also have it in their bones.

At this advanced stage, the cancer cant be cured, says Scott T. Tagawa, MD, a medical oncologist at Weill Cornell Medicine and New York-Presbyterian Hospital in New York City. But with treatment, many men can live a long time. There are men Ive been treating for advanced prostate cancer for 10 or 20 years.

Arm yourself with the facts about what happens when prostate cancer spreads to the bones and what you can do to help manage it.

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What Are Prostate Cancer Survival Rates By Stage

Staging evaluation is essential for the planning of treatment for prostate cancer.

  • A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
  • Further testing and calculations may be performed to best estimate a patients prognosis and help the doctor and patient decide upon treatment options.

Prognosis refers to the likelihood that the cancer can be cured by treatment, and what the patients life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.

If a cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If the cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival based again on group statistics for people who have been in the same situation.

Nomograms are charts or computer-based tools that use complex math from analysis of many patients treatment results.

The prognosis for prostate cancer varies widely, and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and the cancers responsiveness to treatment, among other factors.

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Risks For Prostate Cancer

    Certain behaviours, substances or conditions can affect your risk, or chance, of developing cancer. Some things increase your risk and some things decrease it. Most cancers are the result of many risks. But sometimes cancer develops in people who don’t have any risks.

    The risk for prostate cancer increases as men get older. The chance of being diagnosed with prostate cancer is greater after age 50. Prostate cancer is most often diagnosed in men in their 60s.

    Prostate cancer occurs in Black men of African or Caribbean ancestry more often than in men of other ethnicities. Black men are also more likely to have more aggressive prostate tumours and die from prostate cancer when compared to other men. The reason for this is not clear.

    The following can increase your risk for prostate cancer. Most of these risks cannot be changed.

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    How Prostate Cancer Develops

    However, sometimes something goes wrong within prostate cells, and cancer develops.

    In general, cancer is a condition in which a normal cell becomes abnormal and starts to grow and/or reproduce uncontrollably without having the signals or brakes that stop typical cell growth. Prostate cancer occurs when a normal prostate cell begins to grow out of control. In many cases, prostate cancer is a slow-growing cancer that does not spread beyond the prostate gland before the time of diagnosis.

    Once prostate cancer forms, it feeds on androgens and uses them as fuel for growth. This is why one of the backbones of treatment for men, especially with advanced prostate cancer, is to lower a mans androgen levels with drugs collectively termed hormone therapy.

    Not all prostate cancer cells are alike. Prostate cancers that are composed of very abnormal cells are much more likely to both divide quickly and spread, or metastasize, from the prostate to other regions of the body. Often, prostate cancer spreads first to tissues that are near the prostate, including the seminal vesicles and nearby lymph nodes.

    Researchers have identified various biological and genetic subtypes of prostate cancer. Although these subtypes are typically not yet used to guide treatment recommendations, they are the subject of active research funded by the Prostate Cancer Foundation.

    Help support PCFs research into causes and treatments of prostate cancer: Donate Today!

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