Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
Stage Iv Prostate Cancer
When prostate cancer spreads, its often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, its treated as prostate cancer, not bone cancer. Doctors call the new tumor distant or metastatic disease.
The cancer has spread beyond the prostate.
- Stage IVA: The cancer has spread to the regional lymph nodes.
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Stage IVB: The cancer has spread to distant lymph nodes, other parts of the body, or to the bones.
Overview Of The Staging System
After a thorough assessment by your oncologist, your cancer will be assigned a stage between I and IV. Prostate cancer stages are based on the American Joint Committee on Cancer TNM system. Using the TNM system, your oncologist:
- Examines the tumor
- Determines if the cancer has spread to any lymph nodes
- Assesses whether the cancer has metastasized
- Considers the prostate-specific antigen level from blood testing
- Assigns a grade group based on how abnormal the cancer appears under a microscope
With this information in mind, you can better understand how stages are assigned and what they mean for patients in general.
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Prevalence Of Prostate Cancer
Prostate cancer is the second most common cancer in U.S. men and is the second leading cause of cancer death in men. One in nine men born in the U.S. today will be diagnosed with prostate cancer during his lifetime. The risk of dying from prostate cancer, however, is much lower, at one in 41. Your individual risk depends on your risk factors. Continue reading this document to better understand your particular risk.
The American Cancer Society has estimated that more than 248,000 new cases of prostate cancer will be diagnosed each year in the United States and more than 33,000 men will die from the disease. The death rate for prostate cancer is twice as high for African American men as for the general population.
Most cases are diagnosed when men are in their 60s and 70s , although prostate cancer is sometimes detected in men in their 50s or younger. The good news is that the five-year survival rate for all stages of prostate cancer has increased from 69% to almost 99% over the past 20 years. These rates vary depending on the extent of disease. Reasons for this improvement include increased public awareness, earlier detection though screening with prostate specific antigen blood tests, and advances in the treatments for this cancer.
Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
Does It Matter Where Treatment Is Performed
A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We don’t have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.
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How Prostate Cancer Is Diagnosed And Staged
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:
- grade groups
What Do Cancer Stages And Grades Mean
The stage of a cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells.
If you’re diagnosed with cancer, you may have more tests to help determine how far it has progressed. Staging and grading the cancer will allow the doctors to determine its size, whether it has spread and the best treatment options.
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Transitional Cell Carcinoma Of The Prostate
Transitional cell carcinoma of the prostate starts in the cells that line the tube carrying urine to the outside of the body . This type of cancer usually starts in the bladder and spreads into the prostate. But rarely it can start in the prostate and may spread into the bladder entrance and nearby tissues.
This is sometimes called urothelial carcinoma of the prostate. Between 2 and 4 out of 100 prostate cancers are this type.
Metastases: Whether The Cancer Has Spread
The spread of cancer is measured in two ways: by lymph node involvement, and by its appearance in other organs or parts of the body, or metastasis.
Lymph node staging, or N-staging, determines whether the cancer is present in nearby lymph nodes. Lymph nodes are tiny organs that are part of the immune system.NX: The regional lymph nodes cannot be evaluated.N0: The cancer has not spread to lymph nodes in the immediate area.N1: The cancer has spread to lymph nodes in the pelvic region.
The M in the TNM system indicates whether the prostate cancer has spread to other parts of the body, such as the lungs or the bones. This is called distant metastasis.
MX: Metastasis cannot be evaluated.M0: The cancer has not metastasized beyond the immediate prostate region.M1: The cancer has metastasized deeper into the body.
- M1a: The cancer has spread to lymph nodes away from the groin area.
- M1b: The cancer has spread to the bones.
- M1c: The cancer has spread to another part of the body, with or without spread to the bones.
The combination of your full staging results, including your grade and your T, N, and M stages, paints a more complete picture of how the cancer is progressing. This enables your doctors to determine which treatments have the best chance or controlling or eradicating your cancer.
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Learn More About Prostate Cancer Care At Rcca
If youve been diagnosed with prostate cancer or are concerned about potential symptoms, contact RCCA today. Our team of cancer care specialists will assess the stage of your cancer using the latest diagnostic methods and work with you to design a fully individualized care plan that includes advanced treatment options, the potential for clinical trials, and support that addresses physical and emotional well-being. To speak with a representative right away, please call .
Sample Collection And Preparation
Once accepted and enrolled into our study, body mass index of subjects were recorded and blood samples were collected. All the participants were overnight-fasted and the fasting blood samples were collected on the next morning following a standard operating procedure. Then, the blood samples were thawed for 15 min under ambient temperature, and centrifuged for 10 min at 1024 g and 4 °C to obtain serum samples. Serum supernatants were collected and stored at 80 °C for further analysis. Before undertaking the metabolomic analysis, serum samples were thawed at 4 °C and vortexed for ten seconds, followed by the dilution of the serum sample with phosphate buffer as well as deuterium oxide . Thereafter, the mixed serum sample was vortexed for ten seconds and centrifuged at 10,000 g for 15 min at 4 °C followed by the supernatant transfer into a 5-mm NMR tube for further metabolomics analysis.
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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 AJCC TNM 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.
General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
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What Does Staging And Grading Mean For Treatment
The prostate cancer stage and grade are important for determining your course of treatment. Some treatments are only effective for Stage I and II prostate cancer and other treatments are only necessary for Stage III and IV prostate cancer.
Grading is especially useful in early-stage disease. If the tumor shows signs of being aggressive, it may make sense to go forward with more aggressive prostate cancer treatment options. If the tumor does not seem aggressive, it may make sense to go forward with active surveillance or watchful waiting and avoid common side effects.
In any case, the stage and grade must be discussed with your doctor and healthcare team.
Adenocarcinoma Of The Prostate
Adenocarcinomas may occur almost anywhere in the body. They form in the glandular epithelial cells that line the insides of the organs and secrete mucus, digestive juices or other fluids. In the prostate, adenocarcinoma is also called glandular prostate cancer.
Symptoms of adenocarcinoma of the prostate may include a frequent urge to urinate, painful urination and ejaculation, and blood in the semen. Treatment options may start with active surveillance of the cancer, which generally grows very slowly. Treatments may include surgery, chemotherapy, radiation therapy, immunotherapy or hormone therapy. A radical prostatectomy, which is a surgical procedure to remove the prostate, may be an option when the cancer is limited to the prostate.
Some side effects of treatment may include urinary problems or erectile dysfunction.
Main subtypes of adenocarcinoma of the prostate
Acinar adenocarcinoma : This cancer accounts for virtually all prostatic adenocarcinomas. Acini cells line the prostates fluid-secreting glands. The cancer starts growing in the back of the prostate near the rectum and may be felt during a doctors digital rectal exam. The disease increases PSA levels.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
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What Is The Difference Between Prostate Cancer And Advanced Prostate Cancer
Prostate cancer occurs when cells in the prostate gland begin to grow out of control. In the early stages of prostate cancer, the cancer cells are only present in the prostate and have not spread to nearby tissues.
Advanced prostate cancer, also known as stage 4 prostate cancer, occurs when cancer cells have spread to other areas of the body.
Accessing Clinical Trials At Ucsf
UCSF is currently conducting research in four main areas:
- Identification of genetic and lifestyle factors that predispose men to clinically significant prostate cancer
- Discovering alterations in genes and proteins to improve current prostate cancer treatment
- Developing new therapies for men with recurrent widespread prostate cancer
- Preventing progression of early-stage untreated disease
To learn more, search for a trial or contact us, visit Cancer Clinical Trials at UCSF.
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Types Of Prostate Cancer
The type of prostate cancer tells you which type of cell the cancer started in. There are different types of prostate cancer. The most common type is adenocarcinoma of the prostate.
Doctors use the information about your prostate cancer type along with:
- how abnormal the cancer cells look under the microscope. This is the grade of the cancer
- the size of the cancer and whether it has spread. This is the stage
This helps your doctor decide which treatment you need. Another way doctors may describe your cancer is as localised, locally advanced or advanced.
Gleason Score For Grading Prostate Cancer
Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.
The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.
Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
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