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Late Stage Prostate Cancer Treatment

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Surgically Removing The Prostate Gland

Understanding Late Stage Prostate Cancer

A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.

In extremely rare cases, problems arising after surgery can be fatal.

It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .

Initial Treatment Of Prostate Cancer By Stage And Risk Group

The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.

For prostate cancers that haven’t spread , doctors also use risk groups to help determine if more tests should be done and to help guide treatment options. Risk groups range from very-low-risk to very-high-risk, with cancers in the lower risk groups having a smaller chance of growing and spreading compared to those in higher risk groups.

Other factors, such as your age, overall health, life expectancy, and personal preferences are also taken into account when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.

You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here.Taking part in a clinical trial of newer treatments is also an option for many men with prostate cancer.

Advanced Immunotherapy For Prostate Cancer

Studies indicate how immunotherapy can be optimized in prostate cancer treatment with combinationtherapies which can change the cold prostate cancer tumor microenvironment to immunologically hot bydriving T cells to thetumor, which is exactly what we are already doing here at Envita.
In our clinical opinion, including immunotherapy in early-stage cancer treatment limits chances of metastasis,becauseimmunotherapy aims to equip your body to better tackle the cancer.
To establish actionable chemo and immuno targets, we use Envitas Ultra Analytes Liquid Biopsy, which analyses theCirculating Tumor Cells free flowing in your bloodstream. CTCs are small particles of a growing tumor,whichbreak away and enter your blood stream, spreading the cancer to other parts of your body.
Detailed investigation of these CTCs helps us examine the most recent mutations, allowing us to proactively treatthecancer in its trajectory, as opposed to treating where it has been.

Our liquid biopsy overcomes the challenges of a traditional tissue biopsy, which is invasive,difficult, andmaycontainoutdated data, leading to poor treatment selection. Certain aggressive prostate cancers mutate fast, which iswhybasingyour treatment on an old tissue biopsy, usually performed during initial cancer diagnosis, may be limiting initsscope.

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Early Versus Delayed Treatment

In the years following the introduction by Huggins and Hodges of hormone therapy for prostate cancer, early institution of such treatment was recommended, based on comparison with historical controls. Later, the Veterans Administration Cooperative Urology Research Group studies resulted in the recommendation to defer hormone therapy until symptomatic progression occurred this was thought to avoid the promotion of early androgen resistance in prostate tumors.

Subsequently, the controversy of the appropriate timing of ADT was renewed because of the advent of an LHRH antagonist and LHRH agonists. Laboratory studies demonstrated that early hormone therapy does not confer early resistance. Moreover, clinical trials found that it provided significantly longer survival with fewer complications than did deferred treatment.

Genomic Identification Dives Deep Into Your Specific Cancer

Prostate cancer stages

A key factor in prostate cancer treatment includes diving deep into your specific cancer to treat the causes drivingthedisease, an often-ignored facet in standard NCCN guideline treatments. The majority of the patients following theseone-size-fits-all protocols do not get access to genomic testing, which is a part of precision oncology.

At Envita, Every Patients Entire Treatment Plan Is Based on Our Detailed Precision Algorithms!

Lessthan 20% of cancer patients get access to precision oncology, and the limited few who do get precision care,receive a watered-down version of Envitas detailed precisionalgorithm. At Envita, we not only run in-depth genomic testing for all our patients, but our detailed precisionalgorithm analyses many more parameters than standard oncology precision testing to identify and treat each patientsunique cancer drivers.

Envitas Detailed Precision Algorithm Decodes Patient-Specific Cancer Drivers to Help in theJourney Towards Remission.

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Radiation Therapy Plus Androgen Ablation Therapy

Androgen ablation has been shown to improve survival in men with localized disease who are treated with external radiation. DAmico et al reported higher overall survival with the combination of radiation therapy and 6 months of ADT in men with intermediate-risk prostate cancer. Median follow-up was 7.6 years.

A study by Jones et al found that for patients with stage T1b, T1c, T2a, or T2b prostate cancer and a PSA level of 20 ng/mL or less, short-term ADT increased overall survival in intermediate-riskbut not low-riskmen. The 10-year rate of overall survival was 62% with combination therapy, versus 57% with radiation therapy alone 10-year disease-specific mortality was 4% and 8%, respectively. In this study, ADT was given for 4 months, starting 2 months before radiation therapy.

In a study by Pisansky et al of 1489 intermediate-risk prostate cancer patients, disease-specific survival was not significantly different whether total androgen suppression was given for 8 weeks or for 28 weeks prior to radiation therapy. Patients in the study were randomized to 8 or 28 weeks of TAS with LHRH agonist, along with a daily nonsteroidal antiandrogen, prior to radiation treatment. This was followed in both groups by an additional 8 weeks of androgen suppression, administered concurrently with radiotherapy.

Taken together, radiation therapy is generally given for 4-36 months, depending on the risk group of the patient.

Surgery In Metastatic Disease

Physicians have suggested that the benefits seen from radiation to the prostate point to the benefits of local therapy, raising the question of whether radical prostatectomy might have the same results. Trials are ongoing, and at present the use of surgery should be considered investigational and conducted only within the context of a trial. However, transurethral resection is sometimes needed in men who develop obstruction secondary to local tumor growth. Bilateral orchiectomy can be used to produce androgen deprivation in patients with widely advanced and metastatic prostate cancer.

Since the introduction of LHRH agonist and antagonist therapies, surgical intervention has been practiced less often. An indication for immediate bilateral orchiectomy is spinal cord compression, because it avoids the potential flare response that can occur during the first 3 weeks of treatment with an LHRH agonist.

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Prostate Cancer: Treatment Options For Late

The treatment choices for prostate cancer depend on several things. These include your age, personal preferences and overall health, as well as the size and location of the cancer. Treatment also depends on lab test results and the stage of the cancer. When prostate cancer has spread to places in your body not near your prostate, it’s called advanced or late-stage prostate cancer. This includes some stage III and all stage IV prostate cancers, as well as cancer that comes back after treatment. It’s also called metastatic prostate cancer.

Active Surveillance And Watchful Waiting

The Five Stages of Prostate Cancer | Prostate Cancer Staging Guide

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

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Radical Prostatectomy In Metastatic Disease

For men with high-risk localized disease, radical prostatectomy with pelvic lymph node dissection reduces the risk of cancer-related death . For men with metastatic prostate cancer, radical prostatectomy has been shown to be feasible and safe , although the survival benefit is less certain because it has not been formally confirmed in a prospective, randomized setting . Nevertheless, large retrospective series analyses and population-based data suggest a survival benefit. In an analysis of the SEER database of more than 8,000 men with metastatic prostate cancer, the five-year OS and disease-specific survival rates were higher for patients who underwent radical prostatectomy than for those who underwent brachytherapy or those without local therapy , and the benefit persisted even after accounting for heterogeneity with propensity analysis .

Questions To Ask Your Doctor Or Nurse

  • What type of hormone therapy are you offering me and why?
  • Are there other treatments I can have?
  • What are the advantages and disadvantages of my treatment?
  • What treatments and support are available to help manage side effects?
  • Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
  • How often will I have check-ups and what will this involve?
  • How will we know if my cancer starts to grow again?
  • What other treatments are available if that happens?
  • Can I join any clinical trials?
  • If I have any questions or get any new symptoms, who should I contact?

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How Is Prostate Cancer Staged

Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.

The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.

The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.

  • Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
  • The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
  • Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.

Treatment Options For Localized Prostate Cancer

Stages of Prostate Cancer

If you are diagnosed with low-risk prostate cancer, you may be presented with a number of different treatment options. The most common include:

  • Active Surveillance: Your healthcare provider may want to monitor your disease to see if treatment is necessary. With active surveillance, you will have regular check-ups with your healthcare providers, and he or she may perform biopsies regularly. If your test results change, your healthcare provider will discuss your options for starting treatment.
  • Watchful Waiting: While some healthcare providers use the terms active surveillance and watchful waiting interchangeably, watchful waiting usually means that fewer tests are done. You will still visit your healthcare provider regularly, but your healthcare provider will discuss changes in your health as they relate to managing your symptoms, not curing your disease.
  • Prostatectomy: Removal of the prostate, called prostatectomy, is an option that has a strong likelihood of removing your cancer since you are removing the gland where it is located. However, this is an invasive procedure that can lead to other issues, which will be covered later.
  • Radiation: Your healthcare provider may suggest radiation as a means of therapy that targets tumors with radiation, usually through daily treatments in a hospital or clinic over multiple weeks.

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Personalized Precision Oncology Helps Overcome Standard Treatment Challenges

Treatment of prostate cancer can be challenging because the standard NCCN guideline protocols may involve a risk of undertreatment or overtreatment, which can have devastating effects. Almostall major cancer institutions follow the NCCN guidelines to treat prostate cancer, based on its staging, which dependsupon certain factors such as the PSA levels, Gleason score, and extent of spread. Thesefactors help in categorizing patients into low, intermediate, or high-risk groups which determine whether they needactive surveillance or aggressive treatment.

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However, in our clinical opinion, analyzing these factors alone may not be an accurate guide to precision-targetedtreatments. The absence of precision-targeted treatments in standard treatment protocols can lead to metastaticdisease,despite early diagnosis and prostate gland removal via surgeries like radical prostatectomy. Though the prostate isremoved, the micro metastatic cancer cells may be sitting dormant in your blood stream for years before manifestingwithsymptoms, such as bone pain, back pain, blood in urine, and elevated PSA levels.

According to the American Cancer Society, which relies on data compiled and maintained by theNationalCancerInstitute, prostate cancer is thesecond leading cause of cancer death in American men, due to these challenges instandard cancer care regimens.

Prostate cancer survival rates drop dramatically if the cancer metastasizes, pointing to the need forprecision-targetedtreatments to decrease the chances of cancer spread. Medical studies show how variouschemotherapeutic drugs andradiation therapies may allow aggressive prostate cancer cells to gainadvantageous mutations rendering them resistant to treatment.

To address these challenges of overtreatment and sometimes undertreatment instandard cancer care facilities, we useprecision oncology which helps in identifying the key cancer drivers of each patient and the most appropriateanti-cancer medicines to treat them.

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Eight Types Of Standard Treatment Are Used:

Watchful waiting or active surveillance

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.

Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.

Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.

Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.

Surgery

Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:

There Are Different Types Of Treatment For Patients With Prostate Cancer

Treatment Options for Late Stage 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.

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Side Effects Of Targeted Therapy

Some men may experience side effects such as diarrhea, nausea and low red blood cell counts. Other possible side effects include:

  • Fatigue
  • Skin rash

Liver blood tests may also be abnormal.

One of the targeted therapies for prostate cancer, Lynparza® , may increase the risk for blood clots in the lungs and legs. These drugs may also cause a blood cancer such as myelodysplastic syndrome or acute myeloid leukemia, but this is rare.

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.

These drugs

Two possible targeted therapy treatments are:

Treating prostate cancer that has spread to the bones

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