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Stage One Prostate Cancer Treatment Options

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Prostate Cancer Stage I Treatment Options

What are the Treatment Options for Stage 1 Prostate Cancer

Stage I prostate cancer is often called localized, meaning it has not spread and remains contained within the prostate, usually taking up less than one half of one side of the gland. It is probably slow growing and cannot be felt by the doctor with a digital rectal exam . The cancer cells resemble healthy cells and PSA levels remain normal.

Treatment options for stage I prostate cancer includes:

  • Prostatectomy, which is surgery to remove the prostate gland.
  • Radiation therapy, which uses targeted high-energy beams to kill prostate cancer cells. Often combined with a hormone treatment called androgen deprivation therapy .
  • Brachytherapy, in which radioactive pellets are implanted in the prostate gland to kill cancer cells.
  • Active surveillance, an alternative chosen by a growing number of men, who elect to forego immediate treatment. Instead, a man who chooses active surveillance is closely monitored by a doctor, who uses frequent PSA tests and other exams to monitor his health and determine if a tumor has begun to grow or spread. If so, the man can opt to receive prompt treatment.

When Is Brachytherapy Alone The Right Choice

For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.

This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.

Side Effects Of Hormone Therapy

Hormone therapy may cause side effects associated with low testosterone, such as hot flashes, sweating, weight gain, reduced sexual desire and depression. Some men also may experience swollen breasts, depression, memory loss and heart problems. Eventually, the cancer may become resistant to hormone therapy. If hormone therapy stops working, doctors may switch treatments.

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What Active Surveillance Means

For many men, prostate cancer never affects their lives, said Christopher L. Runz, DO, attending urologist at University of Maryland Shore Regional Health. Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.

Active surveillance requires regular prostate specific antigen screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 .

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Considering Complementary And Alternative Methods

Prostate Surgery Facts

You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.

Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.

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What Is Advanced Prostate Cancer

When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.

Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.

  • Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
  • Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
  • Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.

When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.

There are several types of advanced prostate cancer, including:

Biochemical Recurrence

With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.

Castration-Resistant Prostate Cancer

Non-Metastatic Castration-Resistant Prostate Cancer

Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.

Metastatic Prostate Cancer

  • Lymph nodes outside the pelvis
  • Other organs, such as liver or lungs

Metastatic Hormone-Sensitive Prostate Cancer

Stage 1 Prostate Cancer Treatment

Where stage 1 prostate cancer patients are of an advanced age, a watch and wait approach* is usually chosen over conventional medical treatment. This is because tumors can be slow growing at this early first stage and the survival rate is very high. For example, a person over 80 years old who is diagnosed with stage 1 prostate cancer could be more likely to die from other causes. Treatment could mean the benefits are outweighed by negative side effects. *also referred to as ‘watchful waiting’

However, in cases where a younger person has been diagnosed with first stage prostate cancer, there may be more immediacy in treating the disease rather than monitoring it. A younger person will have more years ahead of them in which the cancer can develop, and they may also make a better recovery following medical treatment.

When treatment is given, the treatment options are similar to those for stage 2 prostate cancer. The prostate gland may be removed through a procedure known as a radical prostatectomy. Radiation therapy and hormonal therapy may also be administered to shrink any tumors.

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Diagnostic Tests Are Limited

We always knew that prostate cancer is common and that, until recently, it often went undiagnosed: Autopsies of men who died of other causes have shown that about one-third of men over age 50 have some cancerous cells in their prostate, while 90% of men over age 90 have such cells.

As PSA screening has grown more widespread, we are finding more tumors that otherwise would have escaped detection. Yet current diagnostic technology does not always enable urologists to determine which tumors will lie dormant and which will become active, spreading elsewhere in the body.

Studies estimate that anywhere from 16%56% of men diagnosed with prostate cancer, generally because of an abnormal PSA test, have tumors that might never have caused problems had they not been found. And the landmark Prostate Cancer Prevention Trial unexpectedly yielded data that early-stage prostate tumors are incredibly common, even at PSA levels considered normal.

The PCPT was a randomized controlled study the type considered to be the gold standard in research . The study, which involved almost 19,000 healthy men, was designed to evaluate whether the drug finasteride could prevent prostate cancer from developing. Finasteride is a hormonal medication originally approved to treat benign prostatic hyperplasia , but which has also been investigated as a potential treatment for prostate cancer.

How Prostate Cancer Is Diagnosed And Staged

The Five Stages of Prostate Cancer | Prostate Cancer Staging Guide

Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.

The most widely used staging system for cancer is the TNM system that classifies cancer from stage 1 to stage 4.

TNM stands for:

  • Tumor: the size and extent of the tumor
  • Nodes: the number or extent of nearby lymph node involvement
  • Metastasis: whether cancer has spread to distant sites in the body

The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:

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Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy

When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.

Intermediate Risk Group Treatment Options

Intermediate-risk prostate cancer refers to tumors that havent spread outside the prostate, but have a Gleason score of 7 and medium PSA levels . Treatment aims to reduce the risk of metastasis to other parts of the body. In this risk group, treatment options include:

  • Radiation therapy or brachytherapy, often with ADT
  • Radical prostatectomy with pelvic lymph node dissection
  • Active surveillance, though the risk for cancer spreading is higher than in very low and low risk groups, so many doctors discourage this option

Patients will be monitored closely with PSA testing if levels rise, radiation therapy may be recommended.

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Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

Stages Of Prostate Cancer

When is prostate cancer considered terminal?

Any T, any N, M1

Any Grade Group

Any PSA

The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.

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.

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Focal Therapy For Prostate Cancer

With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer. Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function

Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer. Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.

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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.

An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.

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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someoneâs risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.

Gleason Score Vs Grade Groups

Treatment Options for Advancedâ Prostate Cancer (High Royal Stage) | Prostate Cancer Staging Guide

The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.

One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:

  • 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
  • 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.

So, although both situations give a Gleason score of 7, they actually have very different prognoses.

Heres an overview of how the two grading systems compare:

Cancer grade
grade group 5 910

Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.

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The Ajcc Tnm Staging System

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCCTNM system, which was most recently updated in 2018.

The TNM system for prostate cancer is based on 5 key pieces of information:

  • The extent of the main tumor *
  • Whether the cancer has spread to nearby lymph nodes
  • Whether the cancer has spread to other parts of the body
  • The PSA level at the time of diagnosis
  • The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .

*There are 2 types of T categories for prostate cancer:

  • The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
  • If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.

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