Prostate Cancer: A Guide For Aging Men
Prostate cancer is one of the most frequently diagnosed cancers in the world, despite it only being diagnosed in males . In fact, more than 70 percent of men over the age of 80 have some quantity of cancer cells in their prostate.
Its so common that it sometimes doesnt go diagnosed until autopsies are performed, though that doesnt mean the cancer is the cause of death. On the contrary, the overall prognosis for men diagnosed with prostate cancer is as positive as you can get when talking about the dreaded c word. The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.
The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.
Nevertheless, prostate cancer is serious business, and the best way to handle a diagnosis is to be informed. Lets take a look at the frequency at which its diagnosed, how youre tested for it, how it can affect your daily life, and what we can do to try and prevent the disease.
Average Age of Prostate Cancer Diagnosis
Hormone Therapy For Prostate Cancer Tied To Alzheimers Disease Risk
Many men who are treated for prostate cancer receive androgen deprivation therapy, or ADT, as part of their treatment. ADT can decrease the risk of cancer progression and death. But the therapy, which is designed to block testosterone and other hormones that may fuel the growth of cancer cells, may increase the risk of Alzheimers disease down the road, a new study found.
For the study, published in JAMA Network Open, researchers looked at Medicare claims of nearly 155,000 older men who had been diagnosed with prostate cancer between 1996 and 2003. Their average age was 74.
About 40 percent of the men received androgen deprivation therapy as part of their cancer treatment within two years of their diagnosis. The men had cancer of varying degrees of severity. The ADT had been given alone or in combination with chemotherapy, radiation or other cancer treatments.
The researchers followed the men over the next eight to 10 years. They found that those men who had received one to four doses of ADT were 19 percent more likely than those who hadnt been given the hormone to be diagnosed with Alzheimers disease or other forms of dementia.
The risk increased in parallel with the number of doses of hormone therapy the men got. Among those who had gotten five to eight doses of ADT, the risk of Alzheimers increased by 28 percent, and the increased risk of all forms of dementia increased by 24 percent.
By ALZinfo.org, The Alzheimers Information Site.
When Is Hormone Therapy Used
Hormone therapy may be used:
- If the cancer has spread too far to be cured by surgery or radiation, or if you cant have these treatments for some other reason
- If the cancer remains or comes back after treatment with surgery or radiation therapy
- Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment
- Before radiation to try to shrink the cancer to make treatment more effective
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Link Between Adt & Dementia
Researchers from the University of Pennsylvanias Perelman School of Medicine and the Stanford School of Medicine looked at the medical records of 10,000 men diagnosed with prostate cancer. Of those who were treated with ADT, 7.9 percent were diagnosed with dementia within five years. The likelihood of being diagnosed with dementia dropped to 3.5 percent in the men who didnt receive ADT. A British study published in The New England Journal of Medicine suggested active monitoring of the tumor might be as effective as radical treatment of prostate cancer.
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Prostate Drug Helps Women With Alzheimers
Prostate Drug Helps Women with Alzheimers
A new study evaluated the effectiveness of Lupron, a drug commonly used to treat prostate cancer in men, on treating Alzheimers disease in women. Previous studies have linked Lupron to a decreased risk of Alzheimers in men who were using the drug to treat prostate cancer.
The study found that women who received a high dose of the drug, also performed better on memory tests than those who received a low dose or a placebo.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Treatment To Lower Androgen Levels From The Adrenal Glands
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.
Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.
Abiraterone can be used in men with advanced prostate cancer that is either:
- High risk
This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.
Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.
Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .
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Weighing The Benefits Of Adt Against The Risks
While the number of individuals who develop dementia from ADT therapy is relatively small, researchers say its a very real risk. When deciding on a plan for prostate cancer treatment, the benefits of receiving ADT must be weighed against potential risks as well as the feasibility of other treatment options. Depending on individual risk factors and possible vulnerability to dementia, doctors may want to consider alternative treatments in some men.
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New Decisions To Make
This new information presents a man diagnosed with prostate cancer with a new paradigm. The question likely comes down to age at the time of diagnosis, and the relative progression of the disease.
These are not easy questions to answer for everyone. They are best discussed with ones doctor, and perhaps with a second opinion from a specialist.
We can contribute by providing additional research relating to natural prostate strategies:
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Early Versus Delayed Treatment
For men who need hormone therapy, such as men whose PSA levels are rising after surgery or radiation or men with advanced prostate cancer who dont yet have symptoms, its not always clear when it is best to start hormone treatment. Some doctors think that hormone therapy works better if its started as soon as possible, even if a man feels well and is not having any symptoms. Some studies have shown that hormone treatment may slow the disease down and perhaps even help men live longer.
But not all doctors agree with this approach. Some are waiting for more evidence of benefit. They feel that because of the side effects of hormone therapy and the chance that the cancer could become resistant to therapy sooner, treatment shouldnt be started until a man has symptoms from the cancer. This issue is being studied.
Electronic Medical Record Processing
We used a previously validated18 and implemented19–21 text-processing pipeline22 to analyze clinical data. We extracted International Classification of Diseases-9th revision diagnosis and Current Procedural Terminology codes, medication lists, and positive-present mentions of drug and disease concepts from all clinical notes. We removed uninformative phrases based on term frequency analysis of more than 50 million clinical documents23 and suppressed terms having fewer than four characters because the majority of these are ambiguous abbreviations. We used NegEx regular expressions to flag negative mentions and to determine if a term was mentioned in the history or family history section of the note.24 The result is a list of present, positive mentions of biomedical concepts, which are converted into a patient-feature matrix for analysis .
These methods have been compared against advanced natural languageprocessing methods in a functional evaluation, which showed little impact on the accuracy of association detection in large data sets.22 As further validation, in drug safety studies, the sensitivity and specificity in detecting 25 different conditions via methods used in this study were 0.74 and 0.96, respectively.18
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Active Surveillance And Watchful Waiting
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.
Prostate Cancer Therapy Linked To Dementia
by Case Adams, PhD·
Normal prostate on the left.
Men diagnosed with prostate cancer now need to know two things about prostate cancer treatment. The first is that prostate cancer treatment doesnt significantly reduce the risk of dying from the disease. At least within the next 10 years.
The second is about one of the primary prostate cancer treatments, called androgen deprivation therapy. This prostate cancer therapy has been shown to double the risk of dementia. This is in addition to other adverse side effects of ADT drugs.
In this article
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Testosterone Deprivation And Alzheimers Disease Pathogenesis In Small Animals
AD is characterized from a pathological point of view by two pathognomonic lesions: 1/extracellular plaques of insoluble -amyloid peptides and 2/neurofibrillary tangles composed of hyperphosphorylated tau protein in neural cytoplasm. Using preclinical experiments in rodents, testosterone has been shown to modulate A and potentially hyperphosphorylation of tau in the serum and the central nervous system.
The Role of Testosterone Depletion on A Accumulation
Ramsden et al., comparing gonadectomized and sham GDX male rats, were the first to show that depletion of endogenous sex steroid hormones via GDX caused a 25% increase in soluble brain levels of A40 and A42. They also revealed that injections of 5-dihydrotestosterone to GDX rats not only reversed the GDX-induced increase in A but significantly lowered brain levels of both A species compared to sham GDX animals. In contrast to the increase in soluble brain levels of A, no effect of GDX on plasma A was observed .
The effect of testosterone on the level of A peptides was also investigated by Wahjoepramono et al. in guinea pigs . In accordance with the previous studies, castrated guinea pigs exhibited lower cerebrospinal fluid A40 level that non castrated animals. But, unlike Ramsden et al., these authors showed also a decrease in plasma A40 level for GPX.
If the link between testosterone depletion in plasma and brain A accumulation has been pointed out, the underlying molecular mechanisms are still unclear.
Prostate Cancer Treatment Linked With Alzheimers Disease Risk
A common prostate cancer treatment has been linked to an increased risk of Alzheimers disease. The research was led by Stanford University School of Medicine and the University of Pennsylvania Perelman School of Medicine. The research reviewed electronic medical records of prostate cancer patients, and researchers found the risk of Alzheimers disease was nearly doubled in those who were treated with androgen deprivation therapy .
Testosterone has been shown to promote the growth of prostate tumors and so ADT has been used to reduce testosterone and other androgens in prostate cancer patients. In the U.S. nearly half a million men currently receive ADT for prostate cancer.
The researchers identified nearly 18,000 prostate patients from two institutions 16,888 had non-metastatic prostate cancer and 2,397 had been treated with ADT.
Those who received ADT had 1.88 times increased risk of being diagnosed with Alzheimers disease during the follow-up period in comparison to those patients who did not undergo ADT. Men who were treated with ADT longer than 12 months had a 2.12 increased risk of Alzheimers disease more than double the risk compared to those who did not receive ADT.
Senior author Nigam Shah, Ph.D., said, The association found in this study should be evaluated in the context of the overall treatment choices available to any specific patient. This study demonstrates the value of using existing EMR data to quantify the trade-offs that various treatments offer.
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How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
Weighing Pros And Cons Of Adt
ADT reduces levels of male hormones in the body, called androgens, to stop them from helping prostate cancer cells grow. It can help some men with high-risk localized or advanced prostate cancer live longer.
But ADT can often cause negative side effects that include reduced sexual desire, impotence, hot flashes, osteoporosis, loss of muscle mass, and depression. The study authors say the risk of dementia is one more possible negative side effect that should be considered when weighing the benefits and risks of ADT, especially for men who have a longer life expectancy because it takes time to develop dementia.
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