Advanced And Metastatic Prostate Cancer What Is It
02 October 2020
Prostate cancer is the most commonly diagnosed cancer in Australian men, with about 17,000 men newly diagnosed each year. For most men the long-term outlook is very good – relative to the general population and considering other causes of death, 95% of men with prostate cancer will survive at least five years after diagnosis and 91% of men with prostate cancer will survive 10 years or more. Today there are around 220,000 Australian men alive after a diagnosis of prostate cancer.
Of concern to our mission, for men who develop advanced prostate cancer, the outlook is not as good. Prostate cancer kills more than 3,000 men in Australia every year, representing about 12% of all male deaths from cancer. So, what is advanced prostate cancer, how is it detected and how is it treated?
What is the prostate?
The prostate is a small gland located below the bladder and in front of the rectum in men. It surrounds the urethra, the passage that leads from the bladder, out through the penis through which urine and semen pass out of the body. The prostate gland is part of the male reproductive system .
The prostate produces some of the fluid that makes up semen, which enriches and protects sperm. The prostate needs the male hormone testosterone to grow and develop. Testosterone is made by the testicles.
What is prostate cancer?
Diagnosing advanced and metastatic prostate cancer
Further tests to determine where the cancer has spread to and the size of the cancers include:
Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
- a chemotherapy nurse
- a urologist
- an oncologist
- a diagnostic radiographer
- a therapeutic radiographer
- a radiologist
- other health professionals, such as a dietitian or physiotherapist.
Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.
Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.
How Prostate Cancer Spreads
Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries — tiny blood vessels — at some distant location.
The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.
Most break-away cancer cells form new tumors. Many others don’t survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.
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What Are Lymph Nodes
The lymph nodes act as filters for infections, cancer cells, and disease. This happens through the lymph vessels, which transport fluids throughout the body as needed. Lymph fluids have immune cells that fight off and kill germs as they are carried into the body. Various lymph nodes are located throughout the body in locations such as the neck, armpit, abdomen, and groin.
Everyone has hundreds of lymph nodes. These hundreds of lymph nodes are all connected. The lymph fluid within each of your lymph nodes is similarly interconnected. The lymph fluid in the armpit, for instance, will flow toward your chest, as will the fluid from all of the lymph nodes in your body. Your lymph nodes can be located deep in your body or closer to the surface.
What Is Cancer Of The Lymph Nodes
When cancer originates in the lymph nodes or other areas of the lymphatic system, its referred to as lymphoma.2 The most common types are hodgkins lymphoma and non-hodgkins lymphoma. In rare instances, theres also a chance for the development of lymphoma of the skin. If youre wondering, Is lymphoma hereditary, we cover this question in our latest blog article.
People with hodgkins lymphoma usually experience enlarged lymph nodes with a small number of Reed-Sternberg cells present surrounded by normal immune cells. With classic hodgkins lymphoma, which accounts for 9 out of 10 cases of this type of cancer, there are four subtypes that may develop.3 These are:
- Nodular sclerosis hodgkins lymphoma is the most common and tends to start in the lymph nodes in the neck or chest. Though it is more prevalent in teens and young adults, it can develop at any age.
- Mixed cellularity hodgkins lymphoma is the second most common subtype and occurs mainly in the lymph nodes found in the upper half of the body. Its mostly detected in people with HIV infection and affects mostly children and the elderly.
- Lymphocyte-rich hodgkins lymphoma is a rarer subtype and usually occurs in the upper half of the body in a few lymph nodes.
- Lymphocyte-depleted hodgkins lymphoma is the rarest subtype of this type of cancer and occurs mainly in older people with HIV infection. Its mostly found in lymph nodes in the stomach, spleen, liver, and/or bone marrow.
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What To Think About
Antiandrogen hormone therapy also may cause diarrhea, breast tenderness, and nausea. Cases of liver problems, some serious, have been reported.
Hormone therapy can also affect the bones, making them thin and brittle and more likely to break. Medicines such as bisphosphonates and denosumab may help prevent bone loss during long-term hormone therapy.
What Causes Prostate Cancer And Am I At Risk
Every man is at risk for prostate cancer as he ages. Although prostate cancer can affect younger men, about 6 out of 10 cases are diagnosed in men over the age of 65. The average age of diagnosis is 66. After non-melanoma skin cancer, prostate is the most common cancer diagnosed in men in the United States. The American Cancer Society estimates there will be 248,530 new cases of prostate cancer each year.
Although there are several known risk factors for getting prostate cancer, no one knows exactly why one man gets it and another doesn’t. Some important risk factors for prostate cancer are:
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What Is The Lymph System
The lymph system is a part of your bodys immune system. It includes a network of lymph vessels and lymph nodes. Lymph vessels are a lot like the veins that collect and carry blood through the body. But instead of carrying blood, these vessels carry the clear watery fluid called lymph. Lymph fluid also contains white blood cells, which help fight infections.
Lymph fluid would build up and cause swelling if it were not drained in some way. Lymph vessels draw up the lymph fluid from around the cells to send it towards the chest. There, lymph fluid collects into a large vessel that drains into a blood vessel near the heart.
Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment
If your prostate-specific antigen blood level shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment you’ve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.
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Can I Survive Advanced Prostate Cancer Whats The Prognosis
Prostate cancer is the second leading cause of death from cancer in men, according to the National Cancer Institute. While theres no cure, men can live with it for years if they get the right treatment. Each man with advanced prostate cancer is different, of course. You and your cancer have unique qualities that your doctor takes into consideration when planning the best treatment strategy for you.
According to Harvard Medical School, the prognosis for men with advanced prostate cancer is improving because of newer medications that help them get past a resistance to androgen-deprivation therapy that typically develops after a few years of treatment. With these medications, many men are living longer, and a number of men diagnosed with advanced prostate cancer are dying with the cancer, not from it.
Promptly treating prostate cancer bone metastases with the newest medication can help change a mans prognosis dramatically, Tagawa says. There are men who do well for decades, he says. Some men can even stop treatment, go on to live many years, and actually die of something unrelated.
Tagawa says that cancer specialists who use sophisticated imaging technologies, like positron-emission tomography scans, have gotten very good at finding even tiny bone metastases, which is valuable in diagnosing and removing early stage metastases.
What Screening Tests Are Used For Prostate Cancer
There are two tests used for prostate cancer screening:
The American Cancer Society recommends that men make an informed decision on whether or not they should be screened after talking about the risks and benefits of screening with their healthcare provider. Screening is not recommended in men without symptoms of prostate cancer if they have a life expectancy of less than ten years. Men at average risk of developing prostate cancer should begin this conversation at age 50. African American men and men with one relative with prostate cancer should talk with their healthcare provider about screening beginning at age 45. Men at the highest risk, those with more than one first degree relative with prostate cancer at an early age should begin talking about screening at age 40. Repeat screening is based on baseline PSA results, but typically occurs every 1-2 years.
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Diagnosing Cancer Of The Lymph Nodes
In addition to a biopsy, the TNM system is commonly used to issue a diagnosis and determine which type of treatment is best. The T refers to the size of the tumor or cancerous growth. The N refers to the number of lymph nodes that contain cancerous cells. And, the M is for metastasis, which refers to cancer thats spread to areas far from the originating tumor.5
This categorization is used in addition to other diagnostic tests and tools to determine the cancer stage such as:
- Imaging tests X-rays, CT scans, MRIs, and other types of imaging tests can provide a clearer picture and more information about where the cancer is located and how much is present.
- Endoscopy exams An endoscope is a thin, lighted tube with a video camera attached that looks around on the inside of the body for cancerous areas.
In general, cancers assigned as Stage I are less advanced and have a better prognosis and response to treatment. Whereas, a higher stage indicates that the cancer has spread further and requires a more intense or multiple types of treatment. Other factors that affect treatment are:
Types Of Imaging Studies
If your doctor suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a bone scan and a CT scan of the abdomen and pelvis. An MRI might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.
Prostate Cancer Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
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The Case For Pn1 Patients
No randomized controlled study has ever tested the role of adjuvant RT in node-positive patients after RP and ePLND. In a large retrospective study, the role of adjuvant pelvic RT in the case of LN involvement after PR and ePLND was investigated. One hundred and twenty-one patients treated with adjuvant standard hormone therapy were compared with 129 patients treated with WPRT combined with HT. With a median follow-up of 95.9 months, the rates of biochemical recurrence-free and cancer-specific survival at 10 years were 53% and 80%, respectively. In multivariate analysis, no adjuvant RT and the number of positive LN were strong predictors of failure.
Where Can I Find Support
It can be very difficult to deal with a diagnosis of advanced prostate cancer. Its natural to wonder if youre doing all you can to fight the cancer and how to handle guilt, intimacy with a partner, and concerns about masculinity. And finding and paying for the best care can, of course, be a challenge.
But emotional and practical support can help you move forward. An important thing to remember is that youre not alone. There are many kinds of help available, and the right cancer resources can make a world of difference.
Ask your doctor for resources you can contact, including social workers and support systems in your community. The Patient Navigator Program of the ACS can be reached at 1-800-227-2345 youll be connected to a patient navigator at a cancer treatment center who can help you with practical and emotional issues.
The Prostate Cancer Foundation has links to in-person and online support groups around the country, and the ACS lists nationwide support programs as well. The PCF also offers resources ranging from help with housing during cancer treatment to finding ways you can look good and feel better while living with cancer.
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Clinical Staging Options For Lymph Node Involvement
Several user-friendly but sometimes sophisticated tools based on initial clinical and pathological characteristics have been developed to predict the risk of nodal involvement in patients. These tools are useful for predicting the probability of finding positive nodes in populations of patients, but they cannot determine if and where nodes are involved in an individual. As a result, the use of these tools has generated a lot of controversy not only because of significant differences in the observed vs. expected rates of pathological stage in the modern era of lymph-node dissection, but also because of concerns about their clinical relevance.
What Does It Mean If Theres Cancer In My Lymph Node
If cancer is found in one or more lymph nodes, it could mean that more tests are needed to know how far the cancer has spread. This information is used to determine the stage of your cancer and the best treatment options.
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The Case For Rn1 Patients
Lymph node recurrent PCa after the primary treatment is considered an unfavorable situation, and systemic hormone therapy is the gold standard in this patient population. However, there are very few data on irradiation of recurrent LN disease. Elective LN irradiation combined with SRT boosts to the recurrent LN could reduce the risk of regional LN progression. This hypothesis has recently been strengthened by the results from a surgical study. In this study, only LNM detected by choline PET/CT were removed by the surgeon and no adjuvant therapy was delivered. All of the patients had a PSA response and 3 out of the 6 patients included had a lasting complete PSA remission after a median follow-up of 24 months. Preliminary results from a small study on stereotactic radiotherapy for isolated LN relapses diagnosed with 11C-choline PET-CT have also been published recently. Total doses ranged from 20 to 45 Gy given in 25 fractions. Rates of toxicity were low. After 19 months of follow-up, 8 of the 14 patients had no evidence of disease. Patients with progression had no in-field relapse. These pioneering results need to be confirmed, but are extremely promising. However, until more data on radiotherapy or surgery for recurrent LN disease are available, aggressive regional approaches should be considered investigational.
What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
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Technical Considerations In Radiation Oncology: The Case For Map
Theoretically, if daily repositioning is performed on the bony anatomy, wider margins should be considered around the prostate to take into account daily variations of prostate position . If daily repositioning is performed on the prostate or on implanted fiducial markers in an attempt to protect mostly the rectum, then margins around the pelvic and/or paraaortic nodes should be increased. Real-time re-planning of dose distribution based on daily CBCT, which would take into account the position of both volumes, would be ideal but remains time-consuming. To circumvent this obstacle, we have proposed an alternative strategy that can be used in routine practice. This is referred to as multiple adaptive plans IMRT. Without requiring any additional hardware or software, the MAP strategy is to choose a plan from the pool that most closely matches the prostate position of the day. This position can be determined by dual imaging registrations: one aligned to the implanted markers in the prostate and the other aligned to the pelvic bones. Because the number of possible prostate positions for each patient could be very large, we created a pool of five plans based on a planning CT to compensate for the most significant prostate movements. With this strategy, we showed that the daily dose received by 95% of the target volumes was > 95% of the prescribed dose in 100% of the treatment days for the lymph node volume and 65% of the treatment days for prostate volume.