Stage D2 Metastatic Prostate Cancer

How Is Prostate Cancer Diagnosed

Doctors describe the growth and spread of prostate cancer in stages. Doctors use these stages as guides when choosing treatment options or offering prognoses to their patients.

Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests such as a digital rectal exam or prostate-specific antigen test and imaging studies like bones scans, MRIs, CT scans, and trans-rectal ultrasounds.

Survival Of Prostate Cancer

Survival depends on many factors. No one can tell you exactly how long you will live.

Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.

Survival for prostate cancer is generally good, particularly if you are diagnosed early.

The Use Of Zoledronic Acid In Japanese Men With Stage D2 Prostate Cancer

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Abstract

Introduction

Prostate cancer is one of the most common types ofcancer in men worldwide . Although stage migration of prostatecancer has been reported, when metastatic disease occurs it usuallyinvolves the bones . In addition to bone metastases, bonedemineralization from previous castration contributes to an increased risk of skeletal complications . Complications from bone metastases area major cause of morbidity in patients with prostate cancer,causing intractable debilitating pain, spinal cord compression,pathologic fractures and abnormalities in serum calcium levels. Thus, patients with metastatichormone-refractory prostate cancer are particularly prone toincapacitating progressive bone disease .

Zoledronic acid is a new generationnitrogen-containing bisphosphonate with improved efficacybenefits over pamidronate in preclinical testing. In addition, ZOLis superior to pamidronate in the treatment of hypercalcemia ofmalignancy . It is also thefirst BP to demonstrate efficacy in patients with bone metastasesfrom solid tumors other than breast cancer, including prostatecancer, non-small cell lung cancer and a variety of other tumortypes . Although not an oral agent, ZOL canbe safely administered intravenously .

Patients and methods

Study population

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Survival Rates By Tnm Stage

The first approach is based on the TNM stage statistical survival times are matched to the stage of the disease.

By contrast, the one-year survival rate for stage 4 lung cancer was reported in one study to be between 15% and 19%, meaning this portion of patients with metastatic disease lived for at least a year.

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What Is Prostate Cancer

Prostate cancer is cancer that affects the prostate gland in men. Prostate cancer is the second-leading cause of cancer deaths for men in the US.

Growth in the prostate can be of two types

Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.

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What Will Happen In The Last Few Days

It can help to know what is normal in the last few days of life so that you know what to expect. You might not be aware of these changes when they happen because you may be drowsy or unconscious.

If you’re supporting someone who is dying, read about what you can do to help and how you can get support.

Pain

Many people worry about being in pain when they are dying. Some people do get pain if their prostate cancer presses on their nerves or makes their bones weak. But not everyone dying from prostate cancer has pain. And if you are in pain, there are things that can help to reduce and manage pain.

You should tell your doctor or nurse if youre in pain or if your pain gets worse. They can talk with you about how best to manage your pain and can help keep it under control.

You may find sitting or lying in some positions more comfortable than others, so ask if you need help getting into a different position.

Your doctor can give you medicines to help manage pain. The type of medicines they give you will depend on what is causing the pain and which medicines are suitable.

Your doctor will monitor how the pain medicines are working and may change the type of medicine or the dose. If youre still in pain or get pain in between taking medicines, its important to tell your doctor or nurse.

Sleeping and feeling drowsy

Not recognising people

Feeling restless or agitated

Changes in skin temperature or colour

Changes in breathing

Loss of appetite

Changes in urinating or bowel movements

Pharmacologic Agents In Prostate Cancer

Gonadotropin-releasing hormone analogues suppress ovarian and testicular steroidogenesis by decreasing luteinizing hormone and follicle stimulating hormone levels, whereas GnRH antagonists lower serum testosterone levels by suppressing LH and FSH.

Bisphosphonates are analogues of pyrophosphate that act by binding to hydroxyapatite in bone matrix, thereby inhibiting the dissolution of crystals. These agents prevent osteoclast attachment to the bone matrix and osteoclast recruitment and viability.

Antiandrogens are used as combination agents to treat prostate cancer. Antifungal agents produce a response similar to that of antiandrogens. These drugs inhibit various cytochrome P-450 enzymes, including 11-beta-hydroxylase and 17-alpha-hydroxylase, which in turn inhibit steroid synthesis. The antiandrogen abiraterone is a 17 alpha-hydroxylase/C17, 20-lyase inhibitor that was approved by the US Food and Drug Administration in 2011 for use in combination with prednisone for treatment of metastatic castration-resistant prostate cancer in patients who received prior chemotherapy containing docetaxel.

An ultramicronized abiraterone tablet was approved in May 2018 for CRPC in combination with methylprednisolone. The ultramicronized formulation may be administered with or without food, whereas, the original tablet formulation must be administered 1 hour before or 2 hours after meals.

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Epidemiology Of Advanced Prostate Cancer

Approximately 12.5% of men will develop prostate cancer in their lifetime, with the likelihood increasing with age prostate cancer is most often diagnosed in men age 65 to 74 years, and the median age at diagnosis is 67 years. Since the advent of prostate-specific antigen screening, prostate cancer is being detected and treated earlier.

Overall, incidence rates of prostate cancer began declining in 2000. Acceleration in the decline began in 2008, when organizations began recommending against routine PSA screening From 2011 to 2015, the rate decreased by about 7% per year.

A review of almost 800,000 cases of prostate cancer diagnosed from 20042013 found that although the incidence of low-risk prostate cancer decreased from 2007-2013 to 37% less than that of 2004, the annual incidence of metastatic prostate cancer during those years increased to 72% more than that of 2004. The increase in metastatic prostate cancer was greatest in men aged 5569 years.

At diagnosis, 77% of prostate cancer cases are localized in 13%, the cancer has spread to regional lymph nodes, and 6% have distant metastasis. The 5-year relative survival rate for localized and regional prostate cancer is 100%, compared with 30.5% for metastatic cases.

The mortality rate associated with prostate cancer continues to increase in Europe and in countries such as Australia, Japan, and Russia.

How Do Doctors Find Metastatic Prostate Cancer

When you are diagnosed with prostate cancer, your doctor will order tests such as:

These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.

If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spreading to your bones.

Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.

PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate, a prostate infection, trauma to the perineum, or sexual activity.

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The Tnm System For Prostate Cancer Stages

As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:

• Tumor. Whatâs the size of the main area of prostate cancer?
• Nodes. Has it spread to any lymph nodes? If so, how far and how many?
• Metastasis. How far has the prostate cancer spread?

Survival For All Stages Of Prostate Cancer

Generally for men with prostate cancer in England:

• more than 95 out of 100 will survive their cancer for 1 year or more
• more than 85 out of 100 will survive their cancer for 5 years or more
• almost 80 out of 100 will survive their cancer for 10 years or more

Survival for prostate cancer is also reported in Scotland and Northern Ireland. But it is difficult to compare survival between these countries because of differences in the way the information is collected.

Cancer survival by stage at diagnosis for England, 2019Office for National Statistics

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account the background mortality that they would have experienced if they had not had cancer.

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Life Expectancy Of Metastatic Prostate Cancer

In the past, the life expectancy of men with metastatic prostate cancer was 2-3 years. But with advancements in medicine and care, the life expectancy of men with metastatic prostate cancer has increased to about 5-6 years.

The 5-year survival rate of metastatic prostate cancer is 28%, which is much lower than local and regional prostate cancers. This refers to the percentage of people diagnosed with a particular cancer who can expect to live for at least 5 years after diagnosis.

Strategies To Improve Treatment

The progress that has been made in the treatment of prostate cancer has resulted from development of better treatments that were evaluated in clinical studies. Future progress in the treatment of prostate cancer will result from patients continued participation in appropriate clinical trials. Developing novel precision cancer medicines and immunotherapies is the main area of active current investigation.

Cabazitaxel : Cabazitaxel is administered intravenously and has been demonstrated to improve time to cancer progression and overall survival in men with HRPC previously treated with docetaxel. Cabazitaxels primary side effect is neutropenia, and it is recommended that patients receive a white blood cell growth factor if they are at high risk of this complication.

Sipuleucel-T: Sipuleucel-T is an immunotherapy that prompts the bodys immune system to respond against the cancer. A Phase III clinical trial that contributed to the FDA approval of sipuleucel-T was a study known as IMPACT which demonstrated an improvement in overall survival for men treated with sipuleucel-T. The main side effects reported were chills, fever, and headache.

References:

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How Long Can Someone Live With Stage 4 Cancer

Doctors usually describe a persons outlook using the 5-year survival rate. These are calculated based on data from thousands of other people with a similar cancer at a similar stage.

The original location of the cancer determines its type. Survival rates vary, depending on the type of cancer and how far it has spread within the body.

Below, we describe the survival rates for some of the most common forms of cancer in stage 4:

What Factors Determine Life Expectancy For Metastatic Prostate Cancer

The life expectancy of someone with cancer depends on the extent of metastasis and which organs are involved. Metastatic prostate cancer is designated as stage IV:

• Stage IVA: Cancer has progressed to surrounding lymph nodes but not to distant locations.
• Stage IVB: Cancer has progressed to distant tissues and organs, such as the bones or smooth muscles.

Generally, prostate cancers do not spread rapidly to other areas of the body. Most prostate tumors grow slowly and may not cause symptoms or complications for years, if at all.

Even when prostate cancer has spread to other regions of the body, it is usually treatable for an extended period. As a result, even men with advanced prostate cancer can enjoy good health for many years. However, if not properly treated, prostate cancer can cause serious symptoms and even turn fatal.

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What Are The Treatment Options For Prostate Cancer

Treatment for prostate cancer is determined based on the size of the tumor and extent of metastasis and may include the following:

Hormone therapy

Hormone treatment deprives the body of the male hormones needed for prostate cancer growth. Orchiectomy or luteinizing hormone-releasing hormone analogs are used alone or in conjunction with an anti-androgen.

Newer hormonal drugs that decrease androgen production and block androgen receptor signaling have been approved by the FDA for the treatment of metastatic prostate cancer following chemotherapy, and they are being studied for early usage in the disease.

Abiraterone

Abiraterone is an oral targeted medication that inhibits androgen synthesis not only in the testes but also in the adrenal glands and the tumor itself. When used with prednisone, abiraterone has been demonstrated to improve quality of life and decrease pain progression in patients with hormone-refractory prostate cancer .

Although this drug is normally well tolerated, adverse effects such as tiredness, elevated blood pressure, and electrolyte or liver problems are possible, and patients must be checked on a regular basis.

Enzalutamide

Enzalutamide interferes with molecular processes that enable prostate cancer growth by targeting various stages in the androgen-receptor-signaling cascade. Furthermore, the medicine does not cause the typical adverse effects of chemotherapy, such as nausea and hair loss.

Chemotherapy

Targeted therapy

Immunotherapy

Sipuleucel-T

What Is Metastatic Prostate Cancer

Sometimes cancer cells will escape the prostate and grow quickly, spreading to nearby tissue, or metastasizing. Nearby lymph nodes are often the first destination for a spreading cancer. If prostate cancer has spread to your lymph nodes when it is diagnosed, it means that there is higher chance that it has spread to other areas of the body as well.

If and when prostate cancer cells gain access to the bloodstream, they can be deposited in various sites throughout the body, most commonly in bones, and more rarely to other organs such as the liver, lung, or brain. Bone metastases are seen in 85% to 90% of metastatic cases.

No matter where a cancer turns up in the body, it is always identified by the tissue type in which it started. Prostate cancer can metastasize to other organs, but it is always prostate cancer, because it consists of mutated prostate cells.

Men diagnosed with metastatic prostate cancer , will often not undergo local treatments of the primary prostate tumor, such as surgery or radiation. Instead, their therapeutic journey might start with hormone therapy, and from there follow a similar path as men who were diagnosed at an earlier stage and had subsequent disease progression.

Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.

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Stages Of Prostate Cancer

Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.

While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.

What Are The Treatments For Metastatic Prostate Cancer

It mainly depends on the stage of your cancer. Metastatic prostate cancer is stage IV, and doctors divide it into two types: IVA and IVB.

If you have stage IVA prostate cancer, that means the disease has spread to nearby lymph nodes but not to distant parts of your body. If youââ¬â¢re healthy enough to get treatment, or if youââ¬â¢re having symptoms from the cancer, your doctor may recommend one of these treatment options:

External beam radiation treatment with androgen deprivation therapy . During EBRT, a machine outside your body sends beams of radiation to your prostate gland. Radiation destroys cancer cells.

ADT is a type of hormone therapy. It involves taking medications to lower the levels of male sex hormones that your testicles make, or getting surgery to remove the testicles. Androgens, like testosterone, often fuel the growth of prostate cancer cells.

Along with ADT, your doctor might also have you take a drug called abiraterone . It helps stop cells in other parts of your body, like your adrenal glands, from making androgens.

ADT with or without abiraterone. If your doctor recommends this option, you wonââ¬â¢t need to get external beam radiation treatment along with it.

If you have stage IVB prostate cancer, the disease has spread to distant organs, like your bones. Your doctor can give you treatments that help keep your cancer under control for as long as possible and improve your quality of life.

Some treatment options are:

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