Who Should Have Focal Therapy
Candidates for focal therapy must be carefully selected, most often based on well-performed, image-guided biopsy techniques . Patients with intermediate-grade tumors visible in a single location on imaging may be considered for focal therapy. Low-grade cancers can be treated this way but are usually more suitable for active surveillance. Some doctors feel that cancer close to the urethra can also be treated in this fashion, but there may be a higher risk of side effects or incomplete treatment. Some feel that additional candidates for focal therapy include patients with one dominant tumor as described above and a microfocus of low-grade disease elsewhere. These smaller cancer foci are followed through active surveillance.
Results of ablation therapies to date have been favorable, but the experience and time of follow-up are still limited. In addition, these patients must be evaluated carefully to avoid undertreating their cancer, and after treatment, they need to have periodic imaging, PSA assessment and at least one follow-up biopsy.
Does Prostate Cancer Have Any Symptoms
Most men with early prostate cancer dont have any signs or symptoms.
One reason for this is the way the cancer grows. Youll usually only get early symptoms if the cancer grows near the tube you urinate through and presses against it, changing the way you urinate . But because prostate cancer usually starts to grow in a different part of the prostate, early prostate cancer doesnt often press on the urethra and cause symptoms.
If you do notice changes in the way you urinate, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate, or another health problem. But its still a good idea to get it checked out. Possible changes include:
- difficulty starting to urinate or emptying your bladder
- a weak flow when you urinate
- a feeling that your bladder hasnt emptied properly
- dribbling urine after you finish urinating
- needing to urinate more often than usual, especially at night
- a sudden need to urinate you may sometimes leak urine before you get to the toilet.
If prostate cancer breaks out of the prostate or spreads to other parts of the body , it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- blood in the urine or semen
- unexplained weight loss.
These symptoms can all be caused by other health problems. But its still a good idea to tell your GP about any symptoms so they can find out whats causing them and make sure you get the right treatment, if you need it.
Further Treatments To Control The Cancer
Your first treatment may help keep your cancer under control. But over time, the cancer may change and start to grow again. If this happens you might be offered other treatments, including:
- more hormone therapy
- clinical trials
More hormone therapy
Your prostate cancer may respond well to other types of hormone therapy, such as abiraterone , enzalutamide , steroids or oestrogens, or to a combination of treatments.
More chemotherapy
If youve had hormone therapy on its own as a first treatment, you might be offered a chemotherapy drug called docetaxel . This may help some men to live longer, and can help to improve and delay symptoms. If youve already had docetaxel, you might be offered more docetaxel or another chemotherapy drug called cabazitaxel .
Radium-223
This is a type of internal radiotherapy that may be an option if your cancer has spread to your bones and is causing pain. A radioactive liquid is injected into your arm and collects in bones that have been damaged by the cancer. It kills cancer cells in the bones and helps some men to live longer. It can also help to reduce bone pain and delay some symptoms, such as bone fractures. Read more about radiotherapy for advanced prostate cancer.
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What Is My Outlook
Many men will want to know how successful their treatment is likely to be. This is sometimes called your outlook or prognosis. No one can tell you exactly what will happen, as it will depend on many things, such as the stage of your cancer and how quickly it might grow, your age, and any other health problems.
Many men with locally advanced prostate cancer have treatment that aims to get rid of their cancer. For some men, treatment may be successful and they may live for many years without their cancer coming back or causing them any problems. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.
Some men with locally advanced prostate cancer will have treatment that aims to help keep their cancer under control rather than get rid of it completely. For example, if you have hormone therapy on its own, it can help to keep the cancer under control. And there are other treatments available if your hormone therapy stops working so well.
For more information about the outlook for men with prostate cancer, visit Cancer Research UK. The figures they provide are a general guide and they cannot tell you exactly what will happen to you. Speak to your doctor or nurse about your own situation.
Symptoms Of Prostate Cancer Spread To The Bones
The most common place for prostate cancer to spread to is the bones. This can include the:
The most common symptom if cancer has spread to the bone is bone pain. It is usually there most of the time and can wake you up at night. The pain can be a dull ache or stabbing pain.
Your bones might also become weaker and more likely to break .
When prostate cancer spreads to the spine, it can put pressure on the spinal cord and cause spinal cord compression. This stops the nerves from being able to work properly. Back pain is usually the first symptom of spinal cord compression.
Spinal cord compression is an emergency. You should contact your treatment team immediately if you are worried you might have spinal cord compression.
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How Does Hormone Therapy Work
To grow, the prostate cancer cells need the male hormone testosterone. Hormone treatments work in different ways to prevent testosterone stimulating the prostate cancer cells. The LHRH agonists and GnRH antagonists will prevent testosterone from being produced by the testicles and are given as an injection. The anti-androgens block the action of testosterone on the prostate cancer cells and are given as tablets. They are both effective in treating this stage of prostate cancer but have different side effects.
It is important to know that many people will experience emotional as well as physical side effects while on hormone therapy. Many men on hormone therapy have less energy and feel less motivated, and you may also experience changes in your mood, such as feeling more sentimental, more irritable or more tearful than usual. This is nothing to be ashamed of.
What are the risks and side effects of anti-androgen drug therapy?
These drugs allow some men to maintain their sex drive and sexual activity and do not cause any reduction in bone strength, which can be a side effect of LHRH agonists and GnRH antagonists. In some men, the drugs cause loss of body hair, the breasts to grow and sore nipples.
What Happens After Undergoing Treatment
You will have routine check-ups throughout and after going through treatment to monitor its effectiveness. You may be required to go in for follow-up appointments. PSA blood tests are done regularly, and those attending to you can inform you of the frequency of these tests.
Reduced PSA levels are usually an indication of effective treatment. Make your physician aware of any side effects that you may be experiencing. There are many ways to deal with side effects. Ensure that you get the details of a person you can contact in case of any questions between check-ups.
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What You Can Do
Its important that you learn all you can about advanced prostate cancer so you can make informed decisions. Be open with your doctors and others on your healthcare team. Express your concerns and feel free to advocate for yourself and your quality of life. Get another medical opinion if you feel its necessary.
Some complementary therapies may prove helpful in coping with advanced cancer. For example:
- tai chi, yoga, or other movement therapy
- music therapy
- meditation, breathing exercises, or other relaxation techniques
A variety of services can help you with everything from lodging while youre getting treatment to getting some help around the house. Communicating with online or in-person groups are a good way to share information and lend mutual support.
Final Thoughts On Locally Advanced Prostate Cancer Staging
Understanding how far your cancer may have progressed is a crucial part of your medication course. As a result, having an open and interactive session with your doctor is a good starting point.
Links to Sources Used:
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Soreness In The Groin
When prostate cancer spreads, its common for cancer cells to go to your lymph nodes and then move to more areas of your body. The lymph nodes are a network of glands that help your body filter fluids and fight infections.
There are several lymph nodes in your groin. These are the ones closest to your prostate, so its common for the cancer to spread to them first. Cancer cells prevent your lymph nodes from draining fluid and working properly. When this happens, your lymph nodes swell. As a result, you might experience pain or soreness in the area.
Lhrh Agonist Injections Or Gnrh Antagonists
These drugs stop the release of a hormone that sends signals to the testicles to produce testosterone. It is a roundabout way of switching off testosterone and so helps to stop prostate cancer from growing.
The first injection is usually given at the hospital, but further injections can be given by your GP. The injections are repeated every month or every three months, depending on the type of hormone therapy and according to the recommendations of your doctor.
What are the risks and side effects of hormone-manipulation drug therapy?
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Expert Review And References
- American Cancer Society. Treating Prostate Cancer. 2019: .
- American Society of Clinical Oncology. Prostate Cancer. 2020: .
- Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
- Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
- Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatmentand follow-up. Annals of Oncology. 2020: 31: 1119-1134. .
What Tests Check For Prostate Cancer
Common tests to check for prostate cancer include:
- Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
- PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
- A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.
If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.
Note
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How Do You Know If You Have Prostate Cancer
Theres no way of knowing if you have prostate cancer without visiting your doctor, as most men with early prostate cancer dont have any symptoms. And if you do have symptoms they can be caused by other things.
And you cant check for prostate cancer yourself.
You may want to speak to your GP if you’re over 50 , even if you don’t have any symptoms. These are all things that can increase your risk of prostate cancer. Your GP can give more information or tests if necessary.
If youre not sure about what to say to your GP, print and fill out this form and show it to them. This will help you have the conversation.
I thought I could be at risk after learning that African Caribbean men are more likely to get prostate cancer than white men.
Other Professionals Who Can Help
Your doctor, nurse or GP can refer you to these professionals.
- Physiotherapists can help with mobility and provide exercises to help improve fitness or ease pain. This can help you stay independent for longer.
- Counsellors, psychologists or psychotherapists can help you and your family work through any difficult feelings and find ways of coping. Many hospitals have counsellors or psychologists who specialise in helping people with cancer. You can also get free counselling on the NHS without a referral from your GP. Visit nhs.uk/counselling to find out more.
- Dietitians can give you advice about healthy eating, which might help with fatigue and staying a healthy weight. They can also help if you are losing weight or having problems eating.
- Occupational therapists can provide advice and access to equipment and adaptations to help with daily life. For example, help with dressing, eating, bathing or using the stairs.
- Social services, including social workers, can provide practical and financial advice and access to emotional support. They can give you advice about practical issues such as arranging for someone to support you at home. Whats available varies from place to place. Your GP, hospital doctor or nurse might be able to refer you to some services. The telephone number for your local social service department will be in the phonebook under the name of your local authority, on their website and at the town hall.
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Joining A Clinical Trial
Clinical trials are medically supervised, carefully controlled patient studies that attempt to determine whether a proposed new treatment is both safe and effective. Clinical trials also look at whether a new treatment can lead to better outcomes than existing treatments. These studies may involve researchers from a variety of disciplines, such as general medicine, medical specialties, genetics, biology, chemistry, engineering and psychology. Clinical trials are conducted at medical centers around the country, and participants are often actively recruited.
New treatments are continually being developed for prostate cancer. Many prostate cancer trials are designated for patients with a rising PSA after local treatment or for those with advanced, metastatic cancers. However, there are also many trials for men with less aggressive cancer, such as the active surveillance trials at UCSF. We also conduct trials of neoadjuvant treatment, which are medications given before surgery for higher-risk prostate cancer. Several new treatments and approaches show promise some as simple as lifestyle changes in diet and exercise.
Funding sources for clinical trials include the National Cancer Institute, Department of Defense, universities and medical centers, private research foundations, pharmaceutical and biotechnology companies, and various combinations of these groups.
Clinical trials usually occur in phases:
What Is A Prostate Cancer
Prostate cancer has become one of the most commonly occurring cancers in men in recent times. When a group of cells grows faster than normal in the prostate gland, it is known as prostate cancer. This type of cancer can spread to other regions as well and as it spreads, it begins to kill the healthy tissue in the prostate area. The prostate gland is located just underneath the bladder and is responsible for making a part of the fluid for semen. With time, as a man grows older, the prostate also tends to become larger in size.
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Difficulty Controlling Bowel Movements: Sign Of Advanced Prostate Cancer
It is possible for advanced prostate cancer to spread to the bowel area. The rectum is the first organ that is affected as it is the part of the bowel located closest to the prostate gland. If prostate cancer spreads to your bowels, it becomes difficult to control bowel movements and many men tend to lose control of their bowels as well. Signs and symptoms of prostate cancer spreading to the bowels include: constipation, blood in stool and stomach pain.
Bowel problems that ensue from prostate cancer include:
- Constipation.
- Flatulence.
Apart from the actual spreading of prostate cancer to the bowel area, men suffering from advanced prostate cancer can also get bowel problems due to other reasons. One of the most common reason is radiotherapy to the prostate and surrounding areas. You can either get bowel problems immediately during the treatment, or you can develop them months or even years later.
Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What is my Gleason score?
- How far has my cancer spread?
- What treatments are suitable for me?
- What do they involve?
- What are the advantages and disadvantages of each treatment, including their possible side effects?
- How effective is my treatment likely to be?
- Can I see the results of treatments youve carried out?
- Can I get copies of all my test results and letters about my treatment?
- Is the aim to keep my prostate cancer under control, or to get rid of it completely?
- Are all of the treatments available at my local hospital? If not, how could I have them?
- Can I join any clinical trials?
- How quickly do I need to make a decision?
- After treatment, how often will I have check-ups and what will this involve?
- If I have any questions or get any new symptoms, who should I contact?
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