A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms male, female, or both to refer to sex assigned at birth. .
will depend on the cancer stage, among other factors, such as the Gleason score and PSA levels. It is also worth noting that many treatment options may be applicable, regardless of the stage of cancer.
In the sections below, we list some for prostate cancer and explore what treatment may mean for fertility.
What Types Of Hormone Therapy Are Used For Prostate Cancer
Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Androgen production in men. Drawing shows that testosterone production is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which stimulates the release of LH from the pituitary gland. LH acts on specific cells in the testes to produce the majority of testosterone in the body. Most of the remaining androgens are produced by the adrenal glands. Androgens are taken up by prostate cells, where they either bind to the androgen receptor directly or are converted to dihydrotestosterone , which has a greater binding affinity for the androgen receptor than testosterone.
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
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.
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Stage Iv Prostate Cancer Prognosis
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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Body Image Concerns Of Gay And Bisexual Men Treated For Prostate Cancer
The burden of PCa treatments on gay and bisexual men has received substantial research in recent years , however body image has not yet been rigorously studied in the GBM PCa population. GBM without PCa are likely to have poorer body image and more body dissatisfaction than straight men. As such, PCa side effects may differentially affect GBM. GBM with PCa are also less likely than straight patients to be in a committed relationship and more likely to have casual sexual relationships . Thus, the impact of changes in body image induced by PCa treatment may be particularly burdensome for GBM when it comes to dating and seeking new sexual relationships. Sexual dysfunction has been identified as a major deterrent for attempting to establish new intimate relationships for single PCa patients in general . It remains to be determined if this problem is more severe for non-heterosexual men.
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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.
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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How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented byCT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
Risk Factors And Causes Of Prostate Cancer
Researchers are unsure of the exact causes of prostate cancer. They have found possible risk factors and how they could lead to the development of cancerous cells. When cancer forms in the prostate, its because of changes to the cells DNA. DNA makes up a persons genes and controls cells, deciding when they divide, grow, and die.
There have been studies of other possible risk factors with inconsistent results, such as:
There is ongoing research to determine the exact risk factors and causes of prostate cancer. If one or more of the factors above apply to you, theres a chance you might not develop the disease. Nothing has been proven yet. If youre worried about your risk of getting prostate cancer, you could consult with your doctor about making changes to your lifestyle.
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When Further Treatment Is Needed
While prostate cancer diagnosis and treatment have improved significantly in recent years, the cancer can still recur. That’s why it is essential that you and your doctor continue to monitor your PSA on a quarterly basis for some period of time, no matter how successful your treatment seems to be. Patients usually can consider a number of treatment options to treat or control recurrent cancer. Choosing among them requires a new decision-making process.
Lymphangiogenesis & Lymph Node Metastasis
During embryogenesis lymphatic vessels develop from blood vessels . Therefore, lymphangiogenesis and angiogenesis are stimulated by the same family of growth factor proteins. VEGF-A/VPF is the most potent growth factor for angiogenesis . Other VEGF family members, such as VEGF-C and VEGF-D, are potent lymphangiogenic factors . Flt-4, also known as VEGF receptor-3 , is the tyrosine kinase receptor for VEGF-C or -D in lymphatic endothelial cells. Upon activation, this receptor triggers signaling events to initiate the proliferation and migration of lymphatic endothelial cells . Neuropilin-2, a nontyrosine kinase receptor, is also expressed in lymphatic endothelial cells and acts as a coreceptor for VEGF-C during lymphangiogenesis . Both VEGF-C and -D are expressed by tumor cells and, therefore, promote lymphangiogenesis from the tumor-associated surrounding lymphatics . Importantly, cancer cells have also been shown to express neuropilin-2 and/or VEGFR-3, thus suggesting autocrine regulation of lymphangogenic growth factors . Our laboratory has reported one such autocrine regulation of VEGF-C and its receptor neuropilin-2 in prostate cancer this autocrine function promotes the survival of prostate cancer cells during oxidative stress and, thereby, is important for metastatic progression .
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Prostate Cancer Risk Groups
In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.
Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.
ON THIS PAGE: You will learn about the different types of treatments doctors use for people with prostate cancer. Use the menu to see other pages.
Recurrent Prostate Cancer Symptoms
Prostate cancer that returns after treatment is considered recurrent. When it returns to the area around the prostate, the disease is classified as a local recurrence. If the cancer is found in another part of the body, the recurrent cancer is considered metastatic. If the cancer metastasizes outside the prostate, it most likely develops in bones first. Metastatic prostate cancer most often spreads to the liver, bones and lungs.
After initial treatment for prostate cancer, PSA levels are expected to drop dramatically. The first sign of recurrent prostate cancer may be a rise in the PSA level. Other symptoms of recurrent cancer may depend on whether and where the cancer has spread. Symptoms include:
- Blood in the urine
- Difficulty breathing
Patients should discuss any symptoms with their doctor and ask about scheduling regular PSA tests after treatment.
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There Are Different Types Of Treatment For Patients With Prostate Cancer
Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
My Prostate Cancer Diagnosis
I was diagnosed two years ago, at the relatively young age of 51, after a routine PSA test. I had no symptoms, no urinary issues and no troubles in the bedroom, as the health magazines carefully refer to it. But I found doctors curiously unwilling to advise me on what to do.
They load you up with documents about the possible side effects of each treatment option. They direct you to online decision-making tools that ask you questions about how afraid of death you are and how important your sex life is. They make a lot of hand gestures that signal that youre weighing equally heavy things.
They tell you: yes, I can make pretty sure your cancer doesnt spread. But your quality of life will be diminished forever. Then they ask: you sure you want me to go ahead?
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Impact On Everyday Activities
If you have no symptoms, prostate cancer should have little or no effect on your everyday activities. You should be able to work, care for your family, carry on your usual social and leisure activities, and look after yourself.
However, you may be understandably worried about your future. This may make you feel anxious or depressed and affect your sleep.
If your prostate cancer progresses, you may not feel well enough to do all the things you used to. After an operation or other treatment, such as radiotherapy or chemotherapy, you’ll probably feel tired and need time to recover.
If you have advanced prostate cancer that has spread to other parts of your body, you may have symptoms that slow you down and make it difficult to do things. You may have to reduce your working hours or stop working altogether.
Whatever stage your prostate cancer has reached, try to give yourself time to do the things you enjoy and spend time with those who care about you.
Coping With Physical Side Effects
Common physical side effects from each treatment option for prostate cancer are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancers stage, the length and dose of treatment, and your general health. Any discussion of side effects should also cover fertility, sexual health and function, and problems with urination.
Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.
You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.
Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.
Coping with sexual side effects
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Prostate Cancer And Incontinence
Incontinence — the inability to control urine flow — is a common side effect of all therapies directed at the prostate gland. Most patients do eventually regain complete urinary control. Exercises to strengthen the sphincter and surrounding pelvic muscles can help you regain urinary control. These are called Kegel exercises. A training program called biofeedback helps reinforce the proper performance of Kegel exercises. Medications may also help relieve incontinence. A male sling is a surgical option, as is an artificial urinary sphincter which can be surgically inserted in cases of severe incontinence. Also, penile clamps are another option as a non surgical treatment for urinary incontinence. Ask your doctor about these options .
Accessing Clinical Trials At Ucsf
UCSF is currently conducting research in four main areas:
- Identification of genetic and lifestyle factors that predispose men to clinically significant prostate cancer
- Discovering alterations in genes and proteins to improve current prostate cancer treatment
- Developing new therapies for men with recurrent widespread prostate cancer
- Preventing progression of early-stage untreated disease
To learn more, search for a trial or contact us, visit Cancer Clinical Trials at UCSF.
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A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.