What To Expect During Hormone Therapy
As you go through hormone deprivation therapy, youâll have follow-up visits with your cancer doctor. Theyâll ask about side effects and check your PSA levels.
Doctors donât know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itâs a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.
Youâll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.
To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.
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.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
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External Beam Radiation Therapy
External Beam Radiation Therapy is a common type of radiotherapy used for cancer treatment. It is a painless procedure. In this type of radiation therapy, a machine present outside the body is used to focus high-energy rays/ particles of radiation on the region of the prostate with cancer.
New techniques of external beam radiation therapy techniques can also be used to treat prostate cancer. These new external beam radiation therapy techniques include
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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Are There Side Effects
The treatments for prostate cancer also can affect your body in other ways. Side effects can include:
- Loss of your ability to get a woman pregnant
- Leaky bladder or loss of bladder control. You might also need to pee a lot more often.
Side effects are another thing to think about when youâre choosing a treatment. If theyâre too tough to handle, you might want to change your approach. Talk to your doctor about what you can expect. They can also help you find ways to manage your side effects.
Treatment Options For Localized Or Locally Advanced Prostate Cancer
A man diagnosed with localized or locally advanced prostate cancer has 3 major treatment options: Active Surveillance, surgery, and radiation therapy. For patients whose cancer appears more aggressive, combination treatment may be recommended. For example, radiation therapy may be combined with hormone therapy, and surgery may be followed by radiation, sometimes with the addition of hormone therapy.
Choosing the best treatment for localized or locally advanced prostate cancer is generally based on age, the stage and grade of the cancer, the patients general health, and an evaluation of the risks and benefits of each therapy option.
Health care providers think about localized or locally advanced prostate cancer in terms of risk groups, which are assigned before the patient undergoes any treatment. There are 3 general risk groups based on the PSA, DRE, and biopsy, which can further be subdivided to better personalize treatment for each patient.
Learn more about Risk Groups.
The treatment options for each risk group have some differences ask your doctor which risk group you belong to so you can better understand the most appropriate next steps. Deciding between radiation and surgery? Dr. Dan Spratt offers 4 things to consider as you make your choice.
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The Cambridge Prognostic Groups
In the UK, doctors divide prostate cancer into 5 prognostic groups. This is the Cambridge Prognostic Group . The 5 groups are from CPG 1 to CPG 5. Your CPG depends on:
- the tumour stage. This is from the T stage from the TNM staging
- what the cancer cells look under a microscope. This is the Grade Group or Gleason score
- your PSA blood test level
The CPG helps your doctor recommend if you need treatment and the type of treatment you need. Doctors also consider other factors when recommending the best treatment for you:
- your age and general health
- how you feel about the treatment and side effects
If you cant have treatment because of your age or other health issues, your doctor might monitor the cancer with watchful waiting. They will only recommend treatment if the cancer starts to cause you symptoms.
Ultimate Outcomes Are Similar Regardless Of The Surgical Approach
In general, while each approach has its advantages, all have been shown to have similar outcomes, adds Dr. Sprenkle. There are no significant differences in outcomes for patients between the open surgery and robotic ones. There is less blood loss on average with robotic surgery, and in the hands of a good surgeon, continence and sexual preservation is the same, he says, adding that while it varies from patient to patient, average recovery time is six weeks. And cancer control is the same. Put another way: Its better to focus on finding the right surgeon rather than the approach or type of surgery.
As far as what that means for patients deciding on which surgery they should get, Dr. Sprenkle says that its important to take time to think about all of your options.
And ask a lot of questions, he says.
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Treating Stage Iv Bladder Cancer
These cancers have reached the pelvic or abdominal wall , may have spread to nearby lymph nodes , and/or have spread to distant parts of the body . Stage IV cancers are very hard to get rid of completely.
Chemotherapy is usually the first treatment if the cancer has not spread to distant parts of the body . The tumor is then rechecked. If it appears to be gone, chemo with or without radiation or cystectomy are options. If there are still signs of cancer in the bladder, chemo with or without radiation, changing to another kind of chemo, trying an immunotherapy drug, or cystectomy may be recommended.
Chemo is typically the first treatment when bladder cancer has spread to distant parts of the body . After this treatment the cancer is rechecked. If it looks like its gone, a boost of radiation to the bladder may be given or cystectomy might be done. If there are still signs of cancer, options might include chemo, radiation, both at the same time, or immunotherapy.
In most cases surgery cant remove all of the cancer, so treatment is usually aimed at slowing the cancers growth and spread to help people live longer and feel better. If surgery is a treatment option, its important to understand the goal of the operation whether its to try to cure the cancer, to help a person live longer, or to help prevent or relieve symptoms from the cancer.
Because treatment is unlikely to cure these cancers, many experts recommend taking part in a clinical trial.
How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
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Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment. If youre choosing a treatment, you might find it helpful to ask your doctor or nurse some of these questions.
- What treatments are suitable for me?
- How quickly do I need to make a decision?
- What are the advantages and disadvantages of each treatment? What are their side effects?
- How effective is my treatment likely to be?
- Can I see the results of treatments youve carried out?
- Is the aim to keep my prostate cancer under control, or to get rid of it completely?
- If the aim of my treatment is to get rid of the cancer, what is the risk of my cancer coming back after treatment?
- If the aim of my treatment is to keep the cancer under control, how long might it keep it under control for?
- What treatments and support are available to help manage side effects?
- Are all of the treatments available at my local hospital? If not, how could I have them?
- After treatment, how often will I have check-ups and what will this involve? How will we know if my cancer starts to grow again?
- If my treatment doesnt work, what other treatments are available?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
Clinical Trials For Prostate Cancer
Major pharmaceutical companies continually research and develop medications and treatments, which must be shown to be safe and effective before the FDA approves them and doctors can prescribe them to patients. Through prostate cancerclinical trials, researchers test the effects of new medications on a group of volunteers with prostate cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the drugs under development and measure how well they treat prostate cancer, their safety, and any possible side effects.
Some people with prostate cancer are reluctant to join clinical trials for fear of getting no treatment at all. This is not true. Youâll get the most effective therapy available for your condition, or you might receive prostate cancer treatments that are being evaluated for future use. These drugs may be even more effective than the current treatment.
These websites offer information and services to help you find a prostate cancer clinical trial that is right for you:
TrialCheck. This website, developed by the nonprofit Coalition of Cancer Cooperative Groups, is an unbiased cancer clinical trial matching and navigation service that lets you search for cancer trials based on disease and location.
National Cancer Institute. This website lists more than 6,000 cancer clinical trials and explains what to do when you find one that you think is right for you.
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Ask Your Prostate Surgeon The Right Questions
The choice of prostate cancer treatment depends on such factors as age and general health, as well as a patients risk categorization determined by their Gleason score. The Gleason score, a way of estimating how likely the cancer is to spread, is determined based on a biopsy sample. Gleason risk groups range from low/very low to intermediate to high/very high.
First, you need as much information as possible about your prostate cancer. Yale Medicine has an Active Surveillance Program that uses advanced imaging and real-time ultrasound to monitor and biopsy suspicious lesions. Many patients in the program who have a low-grade form of prostate cancer never need surgery, Dr. Sprenkle says.
For men who do need surgery, there are at least three questions they should be sure to ask the surgeon, he adds. The first is which surgical approach is going to provide the best control of the cancer? The second is which approach will have the fewest side effects? The third is which approach tends to have the swiftest recovery, the quickest hospital stay, and fastest return to function?
“Its better to focus on finding the right surgeon rather than the approach or type of surgery,” says Yale Medicine urologist Preston Sprenkle, MD.
Do You Need Surgery For Dcis Or Breast Cancer
Thats why treatment is recommended. A woman with DCIS does not need all the same treatment as a woman diagnosed with invasive breast cancer, but she does need surgery to remove the DCIS, and radiation to ensure that any stray, abnormal cells are destroyed. This lowers the risk that the DCIS will recur or that invasive breast cancer will develop.
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Box : Criteria For The Diagnosis Of Prostatic Adenocarcinoma9
Architectural: infiltrative small glands or cribriform glands too large or irregular to represent highgrade prostatic intraepithelial neoplasia
Nuclear atypia: nuclear and nucleolar enlargement
Before searching for these criteria, it is important to scan sections of the needle core tissue, at both lowpower and highpower magnification, in order to appreciate the architecture and cytological features of benign glands in the tissue. The arrangement of the benign glands and the nuclear appearances of the lining cells serve as important points of reference for comparison when evaluating atypical glands because there can be substantial variability between individual cases in histological characteristics because of differences in fixation, section thickness and H& E staining.
Figure 6Comedocarcinoma, highgrade Gleason pattern 5, with comedonecrosis.
Figure 8Penetration of smallgland prostatic adenocarcinoma into the seminal vesicle or ejaculatory duct wall. It is difficult to tell, on needle biopsy, whether this is definitely a seminal vesicle or an ejaculatory duct. Seminal vesicle or ejaculatory duct glands are crowded larger glands at lower right.
Figure 9Minimal adenocarcinoma. Compared with staining by haematoxylin and eosin , the 34E12 and p63 immunohistochemical stains highlight the invasion of the malignant glands, which lack basal cells .
Management Of The Side Effects
While side effects are common during radiation therapy, most of them start to get better after about two weeks of the treatment. There are certain things you can do to improve and manage the side effects of radiation therapy for prostate cancer. This includes the following
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