Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
Watchful Waiting And Active Surveillance
Prostate cancer often grows very slowly. You might not need to treat it right away — or at all — especially if you’re older or have other health issues.
For some men, the treatments themselves have risks that are greater than the benefit of getting rid of the cancer. Watchful waiting may be an option in this case. It means you and your doctor will look out for symptoms and treat them if they start. The doctor may do tests from time to time to see if the cancer is growing.
Active surveillance might be a choice if the cancer is likely to grow very slowly, if at all, but you would still want to cure it if it does get worse. Your doctor will do tests, including PSA blood tests and rectal exams, usually about every 3-6 months to check on the cancer. You might also have a biopsy, where your doctor takes a small piece of tissue from your prostate and checks it under a microscope.
These options donât mean that you ignore your cancer. Your doctor will keep a close eye on your health to be sure the disease doesnât cause any problems for you. If it does, your doctor will talk to you about starting treatment.
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
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Questions You May Want To Consider Asking Your Doctor Include:
- What type of prostate problem do I have?
- Is more testing needed and what will it tell me?
- If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
- What type of treatment do you recommend for my prostate problem?
- For men like me, has this treatment worked?
- How soon would I need to start treatment and how long would it last?
- Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
- What are the side effects of the medicine?
- Are there other medicines that could interfere with this medication?
- If I need surgery, what are the benefits and risks?
- Would I have any side effects from surgery that could affect my quality of life?
- Are these side effects temporary or permanent?
- How long is recovery time after surgery?
- Will I be able to fully return to normal?
- How will this affect my sex life?
- How often should I visit the doctor to monitor my condition?
Related Resources
Choosing The Best Treatment
It can be difficult to choose the best treatment for you. Your doctor and specialist nurse will explain the different treatment options and help you make a decision. The Predict Prostate tool can also help you decide between monitoring and radical treatment. We have more information about this tool further down this page.
A UK trial showed that there can be very little difference in survival between the treatments especially if you are diagnosed with early prostate cancer.
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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 .
About The Prostate And Prostate Cancer
The prostate gland, which grows during puberty, is considered an organ and is made up of several dozen lobules or saclike glands, held together with connective prostate tissue and muscle between them. The glands are called exocrine glands, because they secrete liquid to outside the body.
An enlarged prostate, called benign prostatic hyperplasia , is common in men over the age of 40 and may obstruct the urinary tract. The abnormal prostate cell growth in BPH is not cancerous and doesnt increase your risk of getting prostate cancer. However, symptoms for BPH and prostate cancer can be similar.
A condition called prostatic intraepithelial neoplasia , where prostate gland cells look abnormal when examined under a microscope, may be connected to an increased risk of prostate cancer. Prostate cancer is often caught by a doctor performing a digital rectal exam , through a prostate-specific antigen blood test, through a prostate biopsy or with a CT scan.
Another condition, prostatitis, is the inflammation of the prostate. While not cancerous, it may cause higher PSA levels in the blood.
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Cases Of Aggressive Prostate Cancer On The Rise Research Finds
Cases of aggressive prostate cancer appear to be on the rise, researchers reported Tuesday.
The good news is its still rare for prostate cancer to spread. Just 3 percent of cases have already started spreading when men are diagnosed and prostate cancer overall has not become more common, the team found.
And the American Cancer Society strongly questioned the findings and the methods used to get them.
The researchers who were looking for evidence to support a return to widespread prostate cancer screening found that cases of metastatic prostate cancer the type that has started to spread in the body nearly doubled in men aged 55 to 69 since 2004. The reason is not yet clear.
One hypothesis is the disease has become more aggressive, regardless of the change in screening, said Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine and Northwestern Medicine, who led the study.
The other idea is since screening guidelines have become more lax, when men do get diagnosed, its at a more advanced stage of disease. Probably both are true. We dont know for sure, but this is the focus of our current work, Schaeffer continued.
One hypothesis is the disease has become more aggressive, regardless of the change in screening.
In 2012, the U.S. Preventive Services Task Force recommended against using a blood test called a prostate-specific antigen test to check most healthy men for prostate cancer.
Are There Side Effects
The treatments for prostate cancer also can affect your body in other ways. Side effects can include:
- Loss of your ability to get a woman pregnant
- Leaky bladder or loss of bladder control. You might also need to pee a lot more often.
Side effects are another thing to think about when youâre choosing a treatment. If theyâre too tough to handle, you might want to change your approach. Talk to your doctor about what you can expect. They can also help you find ways to manage your side effects.
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For Many Men Diagnosed With Prostate Cancer The Treatment May Be Worse Than The Disease
To screen or not to screen? For prostate cancerthe second leading cause of cancer deaths in men, after lung cancerthat is the bedeviling question.
The dilemma springs the wide variation in the potential of prostate cancers to spread to the rest of the body. The vast majority of these malignancies, especially those discovered with the extensively used prostate-specific antigen, or PSA, test, are slow-growing tumors that are unlikely to cause a man any harm during his lifetime. Yet in 10 to 15 percent of cases, the cancer is aggressive and advances beyond the prostate, sometimes turning lethal.
Watchful Waiting Or Active Surveillance/active Monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrantconsideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Watchful waiting and active surveillance/active monitoring are the most commonly used terms, and the literature does not always clearly distinguish them, making the interpretation of results difficult. The general concept of watchful waiting is patient follow-up with the application of palliative care as needed to alleviate symptoms of tumor progression. There is no planned attempt at curative therapy at any point in follow-up. For example, transurethral resection of the prostate or hormonal therapy may be used to alleviate tumor-related urethral obstruction should there be local tumor growth hormonal therapy or bone radiation might be used to alleviate pain from metastases. Radical prostatectomy has been compared with watchful waiting or active surveillance/active monitoring in men with early-stage disease .
- Regular patient visits.
- Transrectal ultrasound .
- Transrectal needle biopsies .
Patient selection, testing intervals, and specific tests, as well as criteria for intervention, are arbitrary and not established in controlled trials.
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Side Effects Of Radical Prostatectomy
The most common side effects of the procedure are incontinence and erectile dysfunction . The incontinence, though common early after surgery, usually goes away. Whether erectile function returns depends on whether the nerves surrounding the prostate can be spared at surgery, patient age and baseline function. Men who are older or already have erection problems are most likely to have erectile dysfunction afterward.
For more information on erectile dysfunction and treatment, see Managing Erectile Dysfunction A Patient Guide.
Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
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What Are Grade Groups
Grade Groups are a new way to grade prostate cancer to address some of the issues with the Gleason grading system.
As noted above, currently in practice the lowest Gleason score that is given is a 6, despite the Gleason grades ranging in theory from 2 to 10. This understandably leads some patients to think that their cancer on biopsy is in the middle of the grade scale. This can compound their worry about their diagnosis and make them more likely to feel that they need to be treated right away.
Another problem with the Gleason grading system is that the Gleason scores are often divided into only 3 groups . This is not accurate, since Gleason score 7 is made up of two grades , with the latter having a much worse prognosis. Similarly, Gleason scores of 9 or 10 have a worse prognosis than Gleason score 8.
To account for these differences, the Grade Groups range from 1 to 5 :
- Grade Group 1 = Gleason 6
- Grade Group 2 = Gleason 3+4=7
- Grade Group 3 = Gleason 4+3=7
- Grade Group 4 = Gleason 8
- Grade Group 5 = Gleason 9-10
Although eventually the Grade Group system may replace the Gleason system, the two systems are currently reported side-by-side.
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Watchful Waiting Or Active Surveillance
Your doctor might suggest waiting to see if your tumor will grow or spread before you treat it. Most prostate cancer grows slowly. Some doctors think itâs better not to treat it unless it changes or causes symptoms. In watchful waiting, your doctor will closely track how the disease makes you feel. With active surveillance, youâll also get regular tests to check on the cancer.
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Getting Help With Treatment Decisions
Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.
Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.
You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.
Cancer Lethality Set Early
The study looked for changes in cancer aggressiveness in men diagnosed with prostate cancer from 1982 to 2004. All of the men had their prostates removed after diagnosis, and biopsy samples were taken from the glands. The Harvard team reexamined the samples and graded them using a tool called the Gleason score, which assigns a number from 2 to 10 based on how abnormal the cells look under a microscope. High-scoring or high-grade cancers tend to be the most lethal.
Over the study period, fewer and fewer men were diagnosed with advanced, late-stage prostate cancers that had spread beyond the prostate gland. This reflected the growing use of prostate-specific antigen testing to diagnose prostate cancers earlier and earlier. In contrast, the proportion of high-grade cancers, as measured by the Gleason score, remained relatively stable rather than gradually becoming more aggressive. Previous studies have seen a similar pattern.
Its a very interesting study that confirms what previous studies have found, says Dr. Marc B. Garnick, a prostate cancer specialist at Harvard-affiliated Beth Israel Deaconess Medical Center who was not involved in the study. There may be rare exceptions, but in the vast majority the cancer is born with a particular Gleason score.
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Is Active Surveillance The Best Treatment For My Prostate Cancer
Prostate cancer is the second leading cause of cancer death in men. There are 240,000 new prostate cancer cases diagnosed annually, and it accounts for 30,000 deaths per year. However, unlike many other cancers, prostate cancer is often not a fatal disease and may never need to be treated.
Patients with slow-growing, early stage prostate cancer as well as older men with other health issues may be put on active surveillance, also known as watchful waiting, as opposed to traditional treatment with surgery or radiation.
The problem is that not all prostate cancer cases are slow-growing and early stage. The challenge is predicting the future behavior of the cancer so it can be treated appropriately offering cure to those with aggressive cancer, but sparing the side effects of treatment in those who have non-aggressive cancer.
What is active surveillance?
About 1 in 6 men will be diagnosed with prostate cancer during his lifetime, yet only 1 in 40 men will die from it. These statistics point out that many men with prostate cancer have a slow growing cancer. Because of this fact, an alternative strategy to aggressive management of prostate cancer is active surveillance, which includes careful follow-up with strict monitoring and immediate intervention should signs of progression develop.
Which patients are good candidates for active surveillance?
How is prostate cancer grade determined?