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.
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
Diagnostic Advances In Prostate Cancer
Prostate cancer diagnosis is followed by staging of the cancer. If theres no evidence of metastasis of the original prostate tumor, meaning the cancer hasnt spread to other parts of the body, your cancer will also be assigned to a risk stratification group, also known as a risk group. The risk group attempts to predict the likelihood that the disease has spread microscopically outside the prostate. We informally refer to three risk groups: low risk, intermediate risk and high risk, although as many as six different groups exist.
The specific stage and/or risk stratification of your cancer may determine your treatment options. In general:
Depending on your specific diagnosis, you may have two or more good treatment choices that have similar outcomes, and you probably have time to investigate those options.
Recent areas of advancement in oncology may provide a more accurate picture of your specific diagnosis, directing you and your doctor to more appropriate treatment options. Two specific developments include prostate-specific PET scan agents that may allow us to get more accurate imaging than we could before and the results of advanced genomic testing, which may help identify more aggressive cancers that are less suitable for active surveillance.
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New Radiation Therapy For Prostate Cancer Reduces Deaths Study Shows
By the time Michael Rosenblums prostate cancer was discovered, it was already at a late stage. Hed initially sought medical help because of excruciating back pain, but, during an exam, doctors found a tumor on his spine and tests revealed a skyrocketing prostate-specific antigen, or PSA, score. Chemotherapy didnt help much, so when doctors offered the opportunity to be in a clinical trial for a new experimental treatment, Rosenblum jumped at it.
The trial was investigating a new, potentially groundbreaking type of treatment for prostate cancer, a therapy that specifically targets a protein on the cancer cells. The treatment, part of a new class of liquid radiation drugs, obliterates most prostate cancer cells without hurting the surrounding tissue.
Its wonderful. I have no symptoms or anything, said Rosenblum, a 75-year-old retiree, who was diagnosed four years ago. He participated in the clinical trial at Memorial Sloan Kettering Cancer Center in New York. “My PSA went from 100 … to zero.
Higher PSA levels suggest that prostate cells are growing, which may indicate cancer.
Results from the trial Rosenblum participated in were released Thursday ahead of the annual meeting of the American Society of Clinical Oncology. The study finds that the new drug reduced the risk of death by 38 percent in patients with advanced prostate cancer. Progression of the disease was reduced by 60 percent.
The patients who received the new drug got it intravenously once every six weeks.
Treatment For Prostate Cancer
Because every patient is different, there are several ways to approach prostate cancer treatment. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health.
Some of the more common treatments that you and your doctor may discuss include:
- Surgery. Partial or complete removal of the prostate is commonly used as either the only treatment or in combination with chemotherapy, hormone therapy, radiation therapy or other treatments. Johns Hopkins surgeons are experts in minimally invasive surgical approaches, including robotic-assisted laparoscopic prostatectomy.
- Active surveillance. Patients with localized, slow-growing, low-risk tumors may opt to delay treatment, instead having periodic testing to monitor for disease progression.
- Radiation therapy. Radiation can be used alone or in conjunction with other treatments. It is used to slow tumor growth or destroy tumors in both localized and advanced cancer that has spread to other areas of the body.
- Chemotherapy. Chemotherapy drugs can be used to improve outcomes following surgery or to help relieve symptoms in advanced disease.
- Hormone therapy. This approach deprives cancer cells of the hormones they need to thrive. Though commonly used in metastatic prostate cancer, it is increasingly used in early-stage disease to help shrink the tumor before other treatments
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Treating Prostate Cancer That Has Spread To The Bones
Doctors are studying the use of radiofrequency ablation to help control pain in men whose prostate cancer has spread to one or more areas in the bones. During RFA, the doctor uses a CT scan or ultrasound to guide a small metal probe into the area of the tumor. A high-frequency current is passed through the probe to heat and destroy the tumor. RFA has been used for many years to treat tumors in other organs such as the liver, but its use in treating bone pain is still fairly new. Still, early results are promising.
Future Directions For Genetic Testing
Simmons Cancer Center offers comprehensive integrative care for all oncology patients, including the latest advances in genetic testing. One area of active research at Simmons is evaluating the utility of genetic testing to assess the hereditary risk of cancer. Several gaps in genetic testing exist today, including gender inequities, such as the ratio of women to men acquiring testing . Other gaps include African American men having a higher lifetime risk of developing prostate cancer, and lack of education among patients and referring physicians on the availability and costs of testing. Around 90% of patients who meet their insurance criteria for testing end up paying less than $100 out-of-pocket, and the cost is only $250 for patients who pay 100% out-of-pocket.
The most significant risk factors for contracting prostate cancer are age, race, and family history, and there are several key reasons to have genetic testing performed based on these risk factors. Primarily, having a first-degree relative with prostate cancer will put men in the same family at about a 30% higher risk of developing the malignancy. Additionally, outcomes for patients could be improved if they better understand their genetic risk, often allowing them to adopt lifestyle changes based on results. Lastly, genetic testing may help inform selection of specific gene therapies.
Footnotes
1. How common is prostate cancer? Cancer.org website. Updated January 8, 2020. Accessed July 28, 2020.
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Prostate Cancer: Why Choose Johns Hopkins
- The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a team-based approach to care, meeting with newly diagnosed patients in a single room, on a single day, for a comprehensive evaluation and consultation.
- As a Precision Medicine Center of Excellence for Prostate Cancer, our team uses precision medicine technology to provide the right level of management for each patient leading to better outcomes and a higher value of overall care.
- Our urologic surgeons have extensive experience performing robotic-assisted radical laparoscopic prostatectomies , including nerve-sparing techniques. These procedures provide patients with less pain, a shorter hospital stay and an earlier return to daily activities.
- Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and clinical trial opportunities.
Prostate Cancer | Q& A
Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins.
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This championship swimmer sought a second opinion at Johns Hopkins. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool.
How Is Prostate Cancer Treated
Through a virtual conversation, Nathan can help you get ready to talk to your doctor about treatment options.
Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are
- Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
- Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
- Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
Other therapies used in the treatment of prostate cancer that are still under investigation include
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No Definitive Cure For Nmcrpc
Though the spread of cancer is not detectable in nmCRPC patients, studies have shown that in the absence of additional treatment, the cancer will continue to grow. Without treatment, the spread is usually detected within one-and-a-half years, says Dr Tan.
There is currently no definitive cure for nmCRPC. We would say that the cancer is back because the patients blood test marker is positive, but there is no cure because scans are unable to detect the area of recurrence to specifically target treatment, explains Dr Tan.
However, he adds that studies involving patients with an aggressive form of nmCRPC have shown that those who undergo new standard-of-care treatments survive for an average of five years after developing the condition.
A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.
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New Treatments And Clinical Trials
Research has increased our overall understanding of prostate cancer and new treatments are being tested in patients. Clinical trials primarily involve patients who have rising PSAs after treatment or who have more advanced, metastatic cancers. A number of new agents may eventually provide more treatment options for new and recurring cancers. But at this time, none of them are regarded as cures, or even as replacements for surgery, radiation or hormone therapy.
Generally, patients being treated with these new approaches have experienced fewer side effects than patients receiving more traditional treatments.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
Seven Types Of Standard Treatment Are Used:
Watchful waiting or active surveillance
Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.
Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.
Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.
Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.
Surgery
Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:
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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.
Your Lifestyle And Dietary Habits
According to a recent study, men with localized prostate cancer, and were undergone only lifestyle
changes intensive therapy, not the medications, their prostate growth, was reduced. In this study they were put in a vegan diet, with no dairy products, fish, eggs, or meat together with regular exercise.
They were included in some support groups also for about one year. After that, their PSA level is measured and resulted to be slightly lower.
However, scientists are not sure, if this regimen will have further success or not, since they had only one year follow-up. What is more, this strict regimen may seem too difficult to follow for some people.
Another new finding has come out from a recent s study In men who still have high PSA levels after performing radiation or/and surgery treatment.
They were put on a pomegranate juice regimen, and resulted that this reduced the time for PSA to duplicate. However, this is still to confirm and other bigger studies are involved.
Flaxseed supplements when given daily have shown effective to reduce the rate of duplication of prostate cancer cells. Since this was a small study, new researches are recalled for confirmation.
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Patients On Active Surveillance
A critical need exists to develop effective nontoxic compounds that slow prostate cancer growth. One promising agent is curcumin, which is a widely reviewed nutraceutical that has previously been considered safe to consume.
Evidence from early phase clinical trials suggests curcumin might prolong survival among prostate cancer patients. The agent has shown early promising activity in preclinical prostate cancer cell lines.
UT Southwestern is the sponsor of the phase three Randomized, Double-Blinded, Placebo-Controlled Trial of Curcumin to Prevent Progression of Biopsy Proven, Low-Risk Localized Prostate Cancer in Patients Undergoing Active Surveillance. The primary outcome of the study is the number of patients who have progressed at 24 months of follow-up, defined using standard criteria for progression.
The reason we were attracted to curcumin is because of the interesting data in cell lines, but animal models have also shown it has potential to slow the growth rate of prostate cancer, says Dr. Lotan, who treats patients with bladder, prostate, kidney, ureteral, and testicular cancer. His nationally recognized research on urine and molecular markers helps to identify patients who are at higher risk for recurrent cancer.