Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the American Joint Committee on Cancers TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
- grade groups
What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy
Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .
Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.
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Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
Advanced And Metastatic Prostate Cancer What Is It
02 October 2020
Prostate cancer is the most commonly diagnosed cancer in Australian men, with about 17,000 men newly diagnosed each year. For most men the long-term outlook is very good – relative to the general population and considering other causes of death, 95% of men with prostate cancer will survive at least five years after diagnosis and 91% of men with prostate cancer will survive 10 years or more. Today there are around 220,000 Australian men alive after a diagnosis of prostate cancer.
Of concern to our mission, for men who develop advanced prostate cancer, the outlook is not as good. Prostate cancer kills more than 3,000 men in Australia every year, representing about 12% of all male deaths from cancer. So, what is advanced prostate cancer, how is it detected and how is it treated?
What is the prostate?
The prostate is a small gland located below the bladder and in front of the rectum in men. It surrounds the urethra, the passage that leads from the bladder, out through the penis through which urine and semen pass out of the body. The prostate gland is part of the male reproductive system .
The prostate produces some of the fluid that makes up semen, which enriches and protects sperm. The prostate needs the male hormone testosterone to grow and develop. Testosterone is made by the testicles.
What is prostate cancer?
Diagnosing advanced and metastatic prostate cancer
Further tests to determine where the cancer has spread to and the size of the cancers include:
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Swelling Bruising Or Tenderness Of The Scrotum
Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.
How Do I Know How Long I Have Left To Live
You might want to know how long you have left to live. This can help you prepare and plan the time you have left. There might be things you want to do or people you want to see. But some men dont want to know how long they have left. Everyone is different.
You can ask your doctor how long you have left to live. They wont be able to give you an exact answer. This can be frustrating and it may feel like your doctor is trying to avoid your questions. But no-one can know for certain how long you have left because everyone’s body and everyone’s cancer is different. However, your doctor will be able to give you some idea based on where the cancer has spread to, how you are responding to treatment, how quickly the cancer has spread, and what problems it is causing.;
It can be helpful to talk with your family about this. You may not want to upset them but they might have similar questions and thoughts to you.
If you have months or maybe years left to live, it can be difficult for your doctor to say exactly how long you have left. This is because they dont know how you will respond to;different treatments. If your treatment stops working so well, there may be other treatments available. Some men may not respond well to one treatment, but may respond better to another. Read more about;treatments for advanced prostate cancer.
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Why Its Important To Catch Cancer Early
For some cancers that are screened for on a regular basis, survival rates tend to be high. Thats because theyre often diagnosed early on, before symptoms develop.
But catching some cancers early is difficult. There are no regular screening guidelines for some cancers, and symptoms may not show up until the cancer is in its advanced stages.
To help protect yourself from these cancers:
- Be sure to keep up with your regular blood work and annual physicals.
- Report any new symptoms to your doctor, even if they seem minor.
- Talk with your doctor about testing if you have a family history of a particular type of cancer.
Complementary Therapies For Hot Flushes
There is limited scientific evidence that complementary therapies can help hot flushes in men with prostate cancer.
Small studies suggest people experience less extreme hot flushes whilst having acupuncture.
Cognitive behavioural therapy
This treatment suggests there is a link between your thoughts and actions. It focuses on calming your body and mind and keeping a positive outlook. This may help with hormonal symptoms such as hot flushes.
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About Rare Prostate Cancers
Although prostate cancer is a common cancer in men, there are different types of prostate cancer, and some of these are rare. Because they are rare, we dont know as much about them. If you are diagnosed with one of the cancers mentioned here, speak to your doctor or nurse about what that means and what treatments are suitable for you.
Like most things in our body, the prostate is made up of different types of cells . The type of cancer that develops depends on the cell it starts in.
The most common type of prostate cancer starts in some of the cells that line the prostate, called glandular epithelial cells. There are two types of gland cells basal cells and luminal cells . Prostate cancer can develop in either of these cells.
When we talk about common prostate cancer here, we mean this type of prostate cancer. You may hear it called adenocarcinoma or acinar adenocarcinoma or see this written in your biopsy results .
Rarer types of cancer can also develop from gland cells, or from other types of cells in the prostate.
Some men have more than one type of prostate cancer. For example, they may have some common prostate cancer as well as a rare cancer.
Some of the rare cancers may be more aggressive than common prostate cancer. This means they may grow faster and are more likely to spread outside the prostate.
Quality Of Life With Advanced Stage Prostate Cancer
Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.
Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.
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Coping With Prostate Cancer
Comparison of physical interventions, behavioural interventions, natural health products, and pharmacologics to manage hot flashes in patients with breast or prostate cancer : Protocol for systematic review incorporating network meta analysis B Hutton and othersSystematic reviews,;2015. Volume 4, Pages 1-7
Course and Moderators of Hot Flash Interference during androgen deprivation therapy for prostate cancer: A Matched ComparisonB Gonzalez and othersThe Journal of Urology, 2015. Volume 194, Pages 690-695
How long do the effects of acupuncture on hot flashes persist in cancer patients?J Frisk and othersSupportive care in cancer, 2014. Volume 22, Pages 1409-1415
Randomized trial to assess the impact of venlafaxine and soy protein on hot flashes and quality of life in men with prostate cancerM Vitolins and others
What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT;can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006; 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021; 79:150158.
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Loss Of Bladder And Bowel Control
The dying person might lose control of their bladder and bowel. This happens because the muscles in these areas relax and dont work as they did. This can be distressing to see and you might worry that they may feel embarrassed. The nursing staff will do all they can to protect the bed and keep your relative or friend as clean and comfortable as possible.;
If you are caring for the person at home, the district nurses and specialist nurses can arrange for you to have protective sheets or pads for the bed. They might also be able to arrange a laundry service for you, if necessary. As people become very close to death and are not eating or drinking, the amount of urine and stools they produce gets less and less.
Emotional And Spiritual Changes
Everyone will feel different emotions when they are dying. A lot depends on:
- the type of person they are
- their age
- how much support they have
- their religious and spiritual beliefs
- the experiences they have had in life
Someone dying in their 20s is likely to feel very differently from;someone who is 80. And someone leaving behind young children will have different worries from someone whose children are grown up and able to take care of themselves.
As death gets closer they might;begin to let go and seem more at peace with things. Others might;become very anxious, fearful or angry. Some people could;appear to withdraw, even from the people they love and care about. But this doesnt mean that they dont care anymore.
These events are all very normal and are a natural part of dying.
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External Beam Radiation Therapy
After completing external beam radiation therapy , urinary and bowel side effects may persist for two to six weeks, but they will improve over time. You may need to continue some medications.
Some patients report continued, though lessening fatigue for several weeks after treatment. Other minor problems may include dry itchy skin, a sensation of heaviness in the perineum, anal and rectal irritation, and flare-up of hemorrhoids. However, patients are usually well enough to continue with normal daily activities.
Prostate Cancer Caregiver Podcast Series
We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.
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What Should I Expect As My Cancer Progresses
How does prostate cancer spread?
Prostate cancer cells can move from the prostate to other parts of the body through the blood stream. Or they can spread to the lymph nodes near the prostate and then travel through the lymph vessels to other parts of your body. Lymph nodes and lymph vessels are part of your lymphatic system and are found throughout your body.
Prostate cancer most commonly spreads to the bones and lymph nodes. It can also spread to, or press on, the tube you urinate through , the bladder, the tubes that carry urine from the kidneys to the bladder and part of the bowel . Prostate cancer may spread to other parts of the body, including the lungs and liver. But this is less common.
If tests and scans show that your cancer is spreading, ask your doctor what will happen next. This can help you and your family prepare for what to expect. Find out more about;advanced prostate cancer and treatments.
Watch our;video about advanced prostate cancer.
How does prostate cancer cause problems?
Prostate cancer can cause problems if it is pressing on your bones or nerves. It can also cause problems by stopping your normal cells from working properly.;
What problems can advanced prostate cancer cause?
The symptoms and problems you have will depend on where the cancer has spread to. Even though your cancer is still growing, you will still be able to have treatment to help manage these problems.;
Advanced prostate cancer problems may include:
What should I look out for?
What Are The Potential Complications
Prostate cancer and treatment can lead to problems with urination as well as erectile dysfunction.
If stage 2 prostate cancer spreads outside the prostate, it can reach nearby tissues, the lymph system, or bloodstream. From there, it can metastasize to distant sites. Later-stage prostate cancer is difficult to treat and can be life-threatening.
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Types Of Radical Prostatectomy
There are three main types of radical prostatectomy:
- Retropubic. In this procedure, the surgeon uses an incision in the lower abdomen to remove the prostate and the lymph nodes for examination. This procedure allows for a nerve-sparing approach, which can lower but not totally eliminate the risk of impotence following surgery. In the nerve-sparing approach, the surgeon tries to preserve one or both of the small nerve bundles needed for unassisted erections. However, if the cancer has spread to the nerves, this approach may not be advised.
- Laparoscopic. In this recently developed procedure, the prostate is removed in a fashion similar to a retropubic prostatectomy, but the procedure is performed through five very small incisions using lighted, magnified scopes and cameras. The prostate specimen is then removed in a small bag through one of the incisions, which is expanded to 2 to 3 cm to allow specimen removal.Potential benefits of this procedure are less pain and earlier return to full activities. Nerve-sparing methods and lymph node dissections can be performed with this technique as well.
- Perineal. In this procedure, the prostate is removed through an incision in the skin between the scrotum and anus. The lymph nodes can’t be removed through this incision. If the lymph nodes need to be examined, removal can be done through a small abdominal incision or by a laparoscopic procedure. A nerve-sparing approach can be performed perineally.