What Is Considered Advanced Prostate Cancer

Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.

Denosumab, a monoclonal antibody, may be used to preventbone metastases.

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 diagnostic radiographer
• a therapeutic radiographer
• 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.

When Prostate Cancer Risk Is All In The Family

Your familial risk of prostate cancer is greatest if you have a first-degree relative who had the disease, especially if they were diagnosed at a relatively young age. Having multiple first degree relatives with prostate cancer also increases risk. Having multiple second-degree relatives and third-degree relatives adds to the risk, Carroll explains. Its more concerning when we see all cancers on one side of the family, in one blood line, she adds.

In one study, researchers found that men with a brother who had prostate cancer were more than twice as likely as men in the general population to be diagnosed with the disease themselves, and they faced nearly twice the risk of developing aggressive prostate cancer by age 75. Also, men with both a father and brother who had prostate cancer faced about a threefold greater risk of prostate cancer and developing aggressive disease by age 75 compared with the general population.

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Stage 2 Prostate Cancer

In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still .

The PSA score for stage 2 is less than 20 ng/mL.

Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:

• Gleason score: 6 or less

Eating And Digestion Problems

Treatments such as radiation, chemotherapy, hormone therapy, or surgery can make it hard to eat or digest food normally. You may feel nauseated, throw up, or have loose stools or diarrhea.

You can:

• Take anti-nausea medications recommended by your doctor.
• Drink lots of liquids.
• Eat several small meals each day instead of a few big ones.
• Avoid foods that make you queasy or irritate your tummy, like caffeine, spicy foods, very sweet foods, and fried or greasy foods.

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Managing Symptoms Of Advanced Prostate Cancer

Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.

You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.

Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.

Prognosis For Prostate Cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.

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Bladder And Urinary Troubles

A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.

One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.

Some symptoms your bladder and urethra are being affected by cancer include:

• urinating more frequently
• getting up in the middle of the night to pee
• feeling like you have to urinate often and not actually passing anything

Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.

Symptoms of cancer thats spread to the bowels include:

Stage 1 Prostate Cancer

Stage 1 is the least advanced form of prostate cancer. Cancer in this stage is small and hasnt spread past the prostate gland. Its characterized by a PSA of less than 10 ng/mL, a grade group score of 1, and a Gleason score of 6.

Stage 1 prostate cancer has a 5-year survival rate of nearly 100 percent.

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The Grade Group And Psa Level Are Used To Stage Prostate Cancer

The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.

The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.

• Grade Group 1 is a Gleason score of 6 or less.
• Grade Group 2 or 3 is a Gleason score of 7.
• Grade Group 4 is a Gleason score 8.
• Grade Group 5 is a Gleason score of 9 or 10.

The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.

When To Call A Doctor

Be sure to follow your doctor’s instructions about calling when you have problems, new symptoms, or symptoms that get worse.

if you:

• Are completely unable to urinate.
• Have painful urination and a fever, chills, or body aches.

• Dull, aching pain in your lower back, pelvis, or hips.
• Swollen in the groin area. These nodes are usually not tender.

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What Happens If My Cancer Starts To Grow Again

Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.

You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:

• clinical trials

Which treatments are suitable for me?

Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.

What Causes Prostate Cancer

The exact cause of prostate cancer is not known. The tumor arises from cells with abnormal deoxyribonucleic acid changes in the prostate. These abnormal cells rapidly grow and divide, invading surrounding structures and can spread to other parts of the body .

Risk factors

There are certain factors that can increase the risk of prostate cancer. These include

• Age: The risk of prostate cancer increases with age and is most commonly seen after the age of 50.
• Race: African American men have a higher risk of prostate cancer than men of other ethnicities. Cancer in African Americans is also more likely to be aggressive.
• Family history: If a blood relative has prostate cancer, it increases the risk as well. Having a family history of genes that increase the risk of breast cancer or a very strong family history of breast cancer also increases the risk of developing prostate cancer.
• Obesity: Obese people have a higher risk of developing prostate cancer, which is also more likely to be aggressive and recurrent despite treatment.

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How Will My Cancer Be Monitored

Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.

You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.

You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.

Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.

Trying New Potential Treatments

You may also want to talk to your doctor about taking part in a clinical trial. These are studies that test treatments to see if theyâre safe and if they work. They might be new drugs or a mix of treatments that haven’t been used together before. You could also be part of the “control” group and not get the new treatment at all. Clinical trials offer you early access to brand new treatments, but itâs also important to remember that they may not work. Youâll want to talk with your doctor to make sure you understand the pros and cons of a research study before you join one. To find clinical trials, ask your doctor or search the National Institutes of Health database at www.clinicaltrials.gov.

At some point, your treatment may stop working. If that happens, you can still get care to ease symptoms like nausea, pain, and tiredness. Even though it may not cure your cancer, the goal is to make you feel better.

Show Sources

American Cancer Society: “Hormone therapy for prostate cancer,” “Preventing and treating prostate cancer spread to bones,” “Vaccine treatment for prostate cancer,” “What is metastatic cancer?” “When Cancer Doesn’t Go Away,” âUnderstanding Advanced and Metastatic Cancer,â âWhatâs New in Prostate Cancer Research?â

Prostate Cancer UK: âWhat is locally advanced prostate cancer?â

ClinicalTrials.gov: “Learn About Clinical Studies.”

National Cancer Institute: “Cancer Vaccines.”

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Regionally Advanced Prostate Cancer

Posted by A. Edward Yen, MD | Oct 2019

A. Edward Yen, MD, presented Regionally Advanced Prostate Cancer during the 24th Annual Innovations in Urologic Practice on September 13, 2019 in Santa Fe, New Mexico.

How to cite: Yen, A. Edward. Regionally Advanced Prostate Cancer September 13, 2019. Accessed Oct 2022. https://grandroundsinurology.com/regionally-advanced-prostate-cancer/

How Prostate Cancer Is Treated

In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.

The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.

Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.

Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:

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Locally Advanced Prostate Cancer

For all types of cancer, the term âlocally advancedâ means the cancer has spread beyond the body part where it started but only to nearby tissues, organs, or lymph nodes. Your prostate is a walnut-sized gland that is below your bladder. A locally advanced prostate cancer means that the cancer cells have broken out of your prostate or moved to just outside of it.

Your doctor may refer to locally advanced prostate cancer as stage T3 or T4 prostate cancer. âAdvanced cancerâ usually refers to cancer that canât be cured. But some locally advanced prostate cancers are curable.

Gleason Score Vs Grade Groups

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:

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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Initial Treatment Of Prostate Cancer By Stage

The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.

For prostate cancers that havent spread , doctors also use risk groups to help determine treatment options. Risk groups range from very low risk to very high risk, with lower risk group cancers having a smaller chance of growing and spreading compared to those in higher risk groups.

Other factors, such as your age, overall health, life expectancy, and personal preferences are also taken into account when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.

You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here.

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.

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