Tuesday, March 21, 2023

Prostate Cancer Treatment In Elderly

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How To Find Out If You Have Prostate Cancer

Managing Prostate Cancer in Elderly/Unfit Patients

Ah, the dreaded, stigmatized prostate exam: a necessity for every man over 50. As weve learned, an symptom of prostate cancer is an enlarged prostate, so the main way doctors test for it is by feeling the prostate. Formally called a digital rectal exam, doctors place a lubricated finger, covered with a glove, up your rectum and feel for the prostate, which is right next to the rectum. The doctor feels for any abnormalities, like if its larger than it should be, feels different than it should, or the shape of it is different. But a DRE is not the be-all, end-all of prostate tests. There are plenty of tests doctors run to confirm a diagnosis. These tests include:

Deaths From Prostate Cancer

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA . SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Last Revised: January 12, 2021

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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:

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Comparison Among Different Treatment Strategies For Localized Pca

There is no unbiased direct comparison of each treatment modality to assess their impact on clinical outcomes in older patients with localized PCa. A study analysed data from the Surveillance, Epidemiology, and End Results-Medicare linked database pertaining to 67087 men with localized PCa aged 65 years in the USA. Radical prostatectomy was associated with improved survival compared with RT and observation regardless of the disease stage in men with life expectancy 10 years . Bandini et al. assessed the efficacy of local treatment including RP and RT in patients with PCa aged 75 years using the SEER database . The results showed higher cancer-specific mortality rate in the non-local treatment group with Gleason grade 2 compared with that in the local treatment group . A Korean study to compare the efficacy of RALP over RT using the National Health Insurance Sharing Service data found comparable adjusted mortality rate in men aged 75 years between RALP and RT . Although these findings support local treatment as a reasonable option for older men with long-life expectancy and advanced characteristics of PCa, unbiased prospective studies are warranted to determine which definitive therapy is more appropriate in older patients with localized PCa.

What Are The Symptoms Of Prostate Cancer

Pin on Prostate Cancer

Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:

  • Frequent, sometimes urgent, need to urinate, especially at night.
  • Weak urine flow or flow that starts and stops.
  • Painful urination .
  • Lower back pain, hip pain and chest pain.
  • Leg or feet numbness.

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Treating Advanced Prostate Cancer

If the cancer has reached an advanced stage, its no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

  • hormone treatment

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

Addition Of Other Therapies In The Hormone

Docetaxel

As in many other malignancies, we have learned that combination therapy at the outset of treatment improves long-term disease control and survival outcomes. Both docetaxel and abiraterone acetate in the hormone-sensitive setting have demonstrated a survival benefit when added to standard ADT . Based on these data, most providers should offer, or at least consider, additional therapies to treat patients at this stage. Certainly in a frail patient population, one must continue to assess the overall fitness of a patient. Any patient already thought of as fit should be offered unaltered therapy. Those found to be vulnerable or frail could be considered based on the ability to reverse at-risk conditions.

Abiraterone acetate and prednisone

The patients enrolled in the LATITUDE and STAMPEDE-abiraterone trials were generally older , with ECOG scores of 02 compared with the CHAARTED and STAMPEDE-chemotherapy cohorts. Of note, patients being treated with abiraterone must take a low-dose corticosteroid to avoid mineralocorticoid excess, which results from alteration of adrenal function. In addition, patients may not have the means to pay for this costly agent, since older patients usually have a fixed income. Overall, there is little need for dose interruptions or reductions of abiraterone, and it should be considered for a broad group of older patients with newly diagnosed metastatic hormone-sensitive prostate cancer.

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Common Urinary Problems In Elderly Men

These problems are not cancer. Acute prostatitis is an infection of the prostate caused by bacteria. It usually starts all of a sudden. It can cause fever, chills, or pain in the lower back and between the legs. It can cause pain when your aging dad urinates. If your father has these symptoms, see your doctor right away. Antibiotic drugs can kill the bacteria and help him feel better.

Chronic prostatitis is an infection of the prostate that keeps coming back time after time. This problem can be hard to treat. Sometimes, taking antibiotics for a long time may work. Talk with your doctor about other things you can do to help your elderly father feel better.

Benign prostatic hyperplasia, or BPH, is very common in older men. The prostate is enlarged, but it is not cancerous. Over time, an enlarged prostate may press against the urethra, making it hard to urinate. It may cause dribbling after an elder urinates or a need to urinate often, especially at night. Your doctor will do a rectal exam to check for BPH. And your elderly father may need to have special x-rays or scans to check his urethra, prostate, and bladder.

Treatments for BPH include:

Usually, men have surgery only if medicine hasnt worked. Surgery does not protect against prostate cancer. Regular check-ups are important after BPH surgery. Talk with your doctor about this treatment choice. There are three kinds of surgery. All are done with anesthesia:

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What Questions Should I Ask My Healthcare Provider

Advances in radiotherapy for elderly patients with prostate cancer

If you have prostate cancer, you may want to ask your healthcare provider:

  • Why did I get prostate cancer?
  • What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
  • Has the cancer spread outside of the prostate gland?
  • What is the best treatment for the stage of prostate cancer I have?
  • If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
  • What are the treatment risks and side effects?
  • Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
  • Am I at risk for other types of cancer?
  • What type of follow-up care do I need after treatment?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.

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Symptoms Of Prostate Cancer

Now that we know what prostate cancer is, how can we tell if we have it aside from being tested regularly? A lot of the symptoms of the disease have to do with discomfort while urinating while ejaculating. According to the Prostate Cancer Foundation, these can include:

  • Blood in your urine
  • Frequently having to urinate especially at night and not being able to hold it back
  • Pain while urinating
  • Trouble getting and maintaining an erection
  • Loss of control of your bladder and bowels
  • Pain in your hips, back, spine, and other parts of your body close to your prostate, indicating the cancer may have spread
  • Pressure in your rectum

In its earliest stages, none of these symptoms may be present, which is why its important to get ahead of the disease with testing.

Comorbidities And Life Expectancy

In general, older people have more comorbidities. A precise estimation of life expectancy is important in the decision whom to screen, whom to treat, and when choosing between different options. Patients with a long life expectancy may be offered aggressive treatment, whereas those with short life expectancy because of underlying disease may be advised to follow a conservative approach. Health status can be assessed by many different indices, for example the WHO status, the Charlson comorbidity index, and the Total Illness Burden Index for prostate cancer. To assess competing risks, Daskivich et al. used Charlson scores in a retrospective study of 1482 men diagnosed with nonmetastatic prostate cancer from 1997 to 2004. The study had a mean follow-up of 6 years. Older men and those managed by primary androgen deprivation therapy had higher Charlson scores, which in turn were associated with greater non-PCa mortality. Ten years after treatment, men with Charlson scores of 0 had a non-PCa mortality rate of 17 %, while men with Charlson scores of 3+ had a non-PCa mortality rate of 74 %. During the observation period, 32 % of men died, of which 3 % died from PCa and 25 % died from other causes. Prostate cancer mortality was extremely rare in the low-risk and intermediate-risk groups, independent of the treatment received. Tewari et al. also calculated a probability of 10-year overall survival in men with and without prostate cancer using Charlson scores.

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Certain Factors Affect Prognosis And Treatment Options

The prognosis and treatment options depend on the following:

  • The stage of the cancer .
  • The patients age.
  • Whether the cancer has just been diagnosed or has recurred .

Treatment options also may depend on the following:

  • Whether the patient has other health problems.
  • The expected side effects of treatment.
  • Past treatment for prostate cancer.
  • The wishes of the patient.

Most men diagnosed with prostate cancer do not die of it.

Good Prostate Cancer Care

The Problem with PSA Screenings, Prostate Cancer and Risk

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

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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:

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

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Metabolic And Body Composition

Patients may experience changes in metabolic parameters and body composition, such as bone mineral density loss and sarcopenic obesity. These changes occur naturally through the aging process and are accelerated with the use of ADT. The risk of osteoporosis development is important to keep in mind because geriatric syndromes can predispose patients to osteoporotic fractures. Men who suffer an osteoporotic fracture have a higher mortality risk compared with women. As such, preventing bone mineral density loss may in turn prevent a fracture and the associated morbidity and mortality risk of such an event. In order to modify this risk, all patients on ADT should take a daily vitamin D and calcium supplement and engage in weight-bearing exercise.

Everything You Need For Healthy Aging

Making Decisions After Being Diagnosed with Early Stage Prostate Cancer | UCLAMDChat

Seniors havent reached the end: theyve reached a new beginning. And Aging.com was set up to help youstartthis new phase of your life on the right foot. Our mission is to help you and thousands of other olderadults who want to live independently, plan your finances, and take charge of your health care.

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Early Stage Prostate Cancer

Most prostate cancer is caught in the early stage. Prostate cancer is in the early stage when the prostate hasnt grown or swelled because of the cancers presence, and its still localized in the gland. While there are four stages of prostate cancer, each with their own levels of severity, nearly all of these stages are considered in the early stage as long as the cancer hasnt spread outside of the prostate. After various tests, your doctor will assign a stage or a Gleason score based on what your

prostate looks like and how aggressive the cancer is. The higher Gleason score you have , the more aggressive the cancer is. While the cancer is still is in the prostate, its still in the early stages. According to the ACS, the five-year survival rate for those diagnosed with prostate cancer is almost 100 percent.

Treatment

There are several treatment options available in the early stages of prostate cancer. These options include:

Surgically Removing The Prostate Gland

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.

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 .

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