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What Is Non Aggressive Prostate Cancer

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After A Diagnosis Of Prostate Cancer

Aggressive Treatment of Aggressive Prostate Cancer ~ A/Prof Henry Woo

After finding out you have prostate cancer, you may feel shocked, upset, anxious or confused. These are normal responses. Talk about your treatment options with your doctor, family and friends. Ask questions and seek as much information as you need. It is up to you as to how involved you want to be in making decisions about your treatment.

After non-melanoma skin cancer, prostate cancer is the most common cancer in Australia. In 2016, 19,305 Australian men were diagnosed with prostate cancer.

Prostate cancer is unusual in that it is slow growing in some men and not a threat, but for others the cancer can be aggressive. Cure rates for prostate cancer are improving, however side-effects of treatment may affect your lifestyle including sexual function and continence.

To ensure that you receive the best care, your specialist will arrange for a team of health professionals based on your needs and preferences

Learn more about the best prostate cancer care for each step of your treatment:

Are There Other Treatment Options

There hasn’t been enough good research on other treatments such as “high intensity focal ultrasound” , cryotherapy or hyperthermia treatment . Because of this, medical societies in Germany don’t recommend using them in the treatment of prostate cancer, or only recommend using them for research purposes.

Risk Groups For Localised Prostate Cancer

Doctors divide localised prostate cancer into 3 risk groups depending on how likely it is that the cancer will grow quickly or spread.

Your risk group depends on:

  • the size of your tumour
  • how the cells look under the microscope and the pattern of the cells in the prostate tissue
  • your prostate specific antigen blood test

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Basal Cell Prostate Cancer

You might hear this described as adenoid cystic prostate cancer, or basaloid carcinoma. These can be mixed with common prostate cancer.

Basal cell prostate cancer is very rare and we dont know very much about it.

Basal cells dont produce PSA, and most men with basal cell prostate cancer have normal levels of PSA in their blood. This means that a PSA test probably wont help to diagnose basal cell prostate cancer.

Basal cell cancer can grow big enough to cause the urethra to narrow. This can cause difficulty urinating and blood in your urine. So basal call prostate cancer is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems, as the tissue removed during surgery is looked at under the microscope.

We dont know how aggressive it is. Some studies suggest it isnt very aggressive. But other studies suggest it might be more aggressive than common prostate cancer.

You may be offered surgery, chemotherapy or radiotherapy to treat basal cell prostate cancer. Your treatment options will depend on how much the cancer has grown and whether it has spread to other parts of the body.

Your doctor or nurse will tell you what treatment options are available to you. Read more about how these cancers are treated below.

Reducing Overtreatment For Prostate Cancer

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Patients who carried four or all five of the SNPs had a 50% higher risk of dying from their cancer than patients who had two or fewer of the SNP variants.

The next step is to confirm the findings in different groups of patients and to determine if these five SNPs or any of the other identified gene variants are useful for predicting death from prostate cancer, Stanford says.

The study was published online today and will appear in the September issue of Cancer Epidemiology, Biomarkers and Prevention.

Phelps says finding better tests to identify patients who will benefit from therapy is an important goal for reducing the harms from prostate cancer overtreatment, along with finding more effective targeted therapies that do not have life-altering side effects.

“There has been an explosion of research examining targeted cancer therapies, and while we haven’t struck pay dirt in prostate cancer yet, I think it’s just a matter of time,” he says.

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Staging Of Prostate Cancer

Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .

The stage of the cancer will determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

What Does Watchful Waiting Mean

In men who are older or have serious illnesses, the risks and distress associated with surgery or radiotherapy can outweigh the possible benefits of this treatment. Some men also say that they dont want to have a distressing treatment. Watchful waiting is then an option. In this approach, the cancer isnt treated with the aim of curing it. Instead, you may have treatment to control the cancer and manage the symptoms if you start to get symptoms.

One big difference to active surveillance is that you dont need to have distressing check-ups in the watchful waiting approach. Watchful waiting is mainly considered in men whose prostate cancer isnt likely to shorten their life in the next ten years. Their prostate cancer isnt likely to grow much during that time.

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Not All Prostate Cancers Are Equally Aggressive

Researchers found that aggressive Gleason grade group 5 prostate cancer has different subtypes with varying risks.

Considered the most aggressive grade of prostate cancer, Gleason grade group 5 is made up of four different subtypes, researchers reported in the journal European Urology. Because not all of these subtypes are equally aggressive, they may require differently targeted treatments.

Prostate cancer is the most common form of solid tumor among men in the United States. Gleason grade group 5 prostate cancer is most likely to lead to metastasis and death. Across the board, people with this type of prostate cancer are subject to intensive treatments. But clinical outcomes are not consistent, and treatment can result in adverse effects.

Amar Kishan, MD, of the University of California, Los Angeles, and colleagues set out to probe the reasons for the variability of treatment response among men with Gleason grade group 5 prostate cancer. They analyzed genetic data from 2,138 people with this type of cancer who had undergone a prostatectomy and looked for specific patterns.

Next, the team went on to validate its findings in two different cohorts with 1,921 and 201 participants, respectively. They identified similar clusters, with varying risks, within the former cohort. These subgroups had genetic patterns that matched those from the first cohort.

to read the study abstract in European Urology.

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Is Active Surveillance The Best Treatment For My Prostate Cancer

11-11-2021 Health: Study Links Gut Microbiome and Aggressive 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.

  • Vigilant monitoring
  • A compliant patient who is compulsive about follow-up
  • Which patients are good candidates for active surveillance?

    How is prostate cancer grade determined?

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    Where Can I Get Support

    Being diagnosed with any kind of prostate cancer can be frightening and overwhelming. If you are told you have a rare prostate cancer you may worry about what this means, and feel frustrated that there isnt much information available about your diagnosis and treatment.

    No matter what youre feeling or thinking, there is support available if you want it. You can speak to our Specialist Nurses, in confidence, or chat with them online. Our information on Dealing with prostate cancer looks at things you can do to help yourself and people who can help.

    Prostate Cancer Risk Groups

    In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.

    Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

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    Is It Linked With Prostate Cancer

    The answer, according to the latest studies as of 2018, is no. In fact, finasteride reduces the risk of getting a low-grade prostate cancer. One study did show it may cause a more aggressive form of prostate cancer if you were to get it, but later studies have shown the numbers behind this are not statistically significant.

    The authoritative source for this conclusion is the Prostate Cancer Prevention Trial conducted in 1993 with follow up studies in 2013 and 2018. It was a randomized clinical trial designed to see whether the drug finasteride could prevent prostate cancer in men aged 55 and older. The participants were in good health and did not show any symptoms or signs of prostate cancer. The trial was placebo controlled. Participants who didnât get finasteride got a dummy pill. None of the patients knew whether they were taking real finasteride or a dummy pill.

    How Do The Treatment Options Compare

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    A study known as the ProtecT trial is the most important study on treatments for low-risk prostate cancer so far. ProtecT stands for prostate testing for cancer and treatment. This trial compared three treatment options: active surveillance, external radiotherapy and surgery to remove the prostate. A total of 1,643 men between the ages of 50 and 69 took part in the trial. They all agreed to be randomly assigned to one of the three treatment groups. About two thirds of them had low-risk prostate cancer. The treatment outcomes were recorded over an average of ten years, and then compared with each other at the end of the trial.

    The following was found over a period of ten years:

    • no difference in mortality rate between the active surveillance, radiotherapy and surgical removal groups,
    • a somewhat higher risk of metastases in the active surveillance group,
    • a much higher risk of accidental urine leakage in men who had surgery,
    • a much higher risk of erection problems in men who had radiotherapy or surgery .
    • a somewhat higher risk of accidental stool leakage in men who had radiotherapy.

    Based on the results of this trial and other research, we have developed a decision aid that can help men who have low-risk prostate cancer to weigh the pros and cons of the various treatment options for example, together with their friends, family and doctors.

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    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.

    What Are The Most Common Symptoms Of Prostate Cancer

    Urination issues, such as frequency, slower stream, or loss of pressure Loss of bladder and bowel function Blood present in semen and/or urine Erectile dysfunction Pain, weakness, or numbness in your feet or legs Pain in your hips, back, chest and surrounding areas discomfort can radiate outward in advanced cancer thats spread

    Many of these symptoms can coincide or present like other non-cancer conditions. Its best to have your doctor perform a physical exam or blood tests to rule out other contributing factors too.

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    Small Cell Prostate Cancer

    Small cell prostate cancer is a subset of neuroendocrine cancer. It is made up of small round cells.

    It is a high-grade malignant neoplasm, which is rare and affects less than 1% of the population. It is extremely lethal.

    It is one of the most aggressive malignancies of the prostate with a survival rate of 1-2 years from the time it is diagnosed.

    Myth Or Fact: Can Finasteride Cause Prostate Cancer

    What is advanced prostate cancer?

    Finasteride, an anti-androgenic medication is an oral tablet used to treat male pattern hair loss. It slows down the process of hair loss by inhibiting the formation of excess androgens. Studies have proven that finasteride 1mg meaningfully improves hair count, hair thickness, colour, and length for people who use it regularly.

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    Dont Rush To Get Treatment

    If you are diagnosed with prostate cancer, you should discuss treatments and quality-of-life issues with your cancer care team.

    Your team should include a urologist and a radiation oncologist. You can also get helpful advice from a medical oncologist.

    Common treatments are surgery and radiation. However, there is another approach to learn about. Its called active surveillance or watchful waiting. Its for men with low-risk prostate cancer. In active surveillance, your team watches your condition closely. If tests show that its getting worse, you will get treatment. Discuss active surveillance with your team. Heres why:

    How To Do Active Surveillance Right

    After a diagnosis of low-risk prostate cancer, you may be presented with a range of treatment options. Considering the slow progress of most prostate cancer, active surveillance is a reasonable choice for many men. Even if you live a long time after your diagnosis, your cancer may neverbecome aggressive and cause harm. Often, low-risk prostate cancer hardly progresses at all, even over decades.

    If you choose to go the active surveillance route, do it the smart way. Dr. Hu recommends that for the first two years after your diagnosis

    • Get a PSA test every six months.
    • Have an office visit that includes a digital exam every six months.
    • Within the first two years after diagnosis, get at least one follow-up biopsy as well as magnetic resonance imaging and precision medicine tests to reduce the risk of missing more aggressive cancer.

    What happens next depends on those first two years. If it looks like your cancer is stable and not progressing, your doctor may suggest less frequent follow-ups. But if there is evidence that the cancer is becoming more aggressive, then you can decide at that time whether radiation, surgery, hormone therapy or some combination of these treatments is right for you. You may never need treatment, but if you do, youll get it when its still highly effective.

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    Active Surveillance May Help Your Quality Of Life

    With this approach, you have regular checkups, including a PSA test and rectal exam. Youll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.

    Active surveillance is a good choice for many men with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.

    Etiology And Risk Factors

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    The etiology of prostate cancer is the subject of numerous studies and remains largely unknown compared to other common cancers. The well-established prostate cancer risk factors are advanced age, ethnicity, genetic factors and family history . Other factors positively associated with prostate cancer include diet , obesity and physical inactivity, inflammation, hyperglycemia, infections, and environmental exposure to chemicals or ionizing radiation .

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    About Rare Prostate Cancers

    Although prostate cancer is a common cancer in men, there are different types of prostate cancer, and some of these are rare. Because they are rare, we dont know as much about them. If you are diagnosed with one of the cancers mentioned here, speak to your doctor or nurse about what that means and what treatments are suitable for you.

    Like most things in our body, the prostate is made up of different types of cells . The type of cancer that develops depends on the cell it starts in.

    The most common type of prostate cancer starts in some of the cells that line the prostate, called glandular epithelial cells. There are two types of gland cells basal cells and luminal cells . Prostate cancer can develop in either of these cells.

    When we talk about common prostate cancer here, we mean this type of prostate cancer. You may hear it called adenocarcinoma or acinar adenocarcinoma or see this written in your biopsy results .

    Rarer types of cancer can also develop from gland cells, or from other types of cells in the prostate.

    Some men have more than one type of prostate cancer. For example, they may have some common prostate cancer as well as a rare cancer.

    Some of the rare cancers may be more aggressive than common prostate cancer. This means they may grow faster and are more likely to spread outside the prostate.

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