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What Is The Most Successful Prostate Cancer Treatment

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How Often Should Men Be Screened

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Experts say that most men should be getting regular prostate cancer screenings between the ages of 55 to 69, as this is the time when men are most likely to get cancer. This is also when the benefits of treatment will outweigh the risks of side effects. Men should have a conversation with their doctors to decide how often to be screened, but on average, every two to three years may be sufficient .

In 2018, the U.S. Preventive Services Task Force recommended that African-American men receive regular screenings. This is because Black men are 50% more likely to develop prostate cancer, and twice as likely to die from it . They also recommended against screenings for men 70 years of age or older. This is because the benefits of screenings do not outweigh the risks, according to their findings.

If you are a male who falls into the recommended age categories for prostate screenings, or if you have any of the risk factors associated with prostate cancer, it’s recommended that you consult with your doctor about prostate screenings as soon as possible.

Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

Watchful Waiting Or Active Surveillance

Your doctor might suggest waiting to see if your tumor will grow or spread before you treat it. Most prostate cancer grows slowly. Some doctors think itâs better not to treat it unless it changes or causes symptoms. In watchful waiting, your doctor will closely track how the disease makes you feel. With active surveillance, youâll also get regular tests to check on the cancer.

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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?

How Is Prostate Cancer Treated

The Problem with PSA Screenings, Prostate Cancer and Risk

Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.

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.
  • Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.
  • Radiation therapy. Using high-energy rays to kill the cancer. There are two types of radiation therapy
  • External radiation therapy. A machine outside the body directs radiation at the cancer cells.
  • Internal radiation therapy . Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.
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    Considering Complementary And Alternative Methods

    You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

    Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.

    Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.

    How Is Radiation Therapy Used To Treat Cancer In Dogs

    To protect normal cells, veterinarians carefully limit the doses of radiation and spread the treatment out over time. They also shield as much normal. tissue as possible while they aim the radiation at the site of the cancer. There are two approaches for using radiation therapy in dogs curative and palliative.

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    Cancer That Is Thought To Still Be In Or Around The Prostate

    If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.

    After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.

    After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.

    Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.

    Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.

    How Far Your Prostate Cancer Has Grown And Spread

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    The stage refers to the size of the tumour in your prostate and how far it has grown- that is whether it is completely inside the prostate gland or if it has spread outside the prostate. The treatment the doctors choose will be different depending on the stage of the cancer. The diagram below shows a cancer contained within the prostate. There is detailed information about staging prostate cancer in this section.

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    Surgically Removing The Prostate Gland

    A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

    Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.

    In extremely rare cases, problems arising after surgery can be fatal.

    It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

    Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

    You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .

    Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation

    Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.

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    When To Talk To Your Doctor About Screenings

    According to the American Cancer Society, men should begin to have conversations with their doctor about prostate cancer screenings starting at age 50 if they have an average risk of prostate cancer and expect to live at least 10 more years. If they are at a higher risk, screenings should begin at age 45. Those in the highest risk category have had more than one first-degree relative with prostate cancer, such as both a father and brother or multiple siblings. This makes age 40 the ideal time to begin screening.

    While there is no specific screening for prostate cancer, there are two tests commonly used to screen for prostate cancer. The first is a blood test known as a prostate-specific antigen test. PSA is a protein made by the prostate, and elevated levels in the blood can be an indication of cancer. However, other factors can also affect the PSA level, such as a prostate infection or certain medications, like cholesterol-lowering statins and nonsteroidal anti-inflammatory drugs .

    The second screening a doctor will generally perform is a digital rectal examination . During a DRE, a doctor will insert a lubricated finger into the patient’s rectum to feel for any abnormalities. Because a doctor can only feel the back wall of the prostate via a DRE, it is best to perform this test in conjunction with a PSA test .

    How Does External Beam Radiation Therapy Work

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    External beam radiation therapy, or EBRT, uses a machine to direct high-energy X-rays at the cancer in daily doses. The radiation beam is generated by a machine called a linear accelerator or LINAC. Using treatment planning computers and software, your treatment team controls the size and shape of the beam as well as how it is directed at your body to most effectively treat your tumor and minimize damage to surrounding normal tissue.

    To minimize side effects, the treatments are typically given five days a week over a six-to-nine week period. The break in days allows the doctors to get enough radiation into the body to kill the cancer while giving healthy cells time to recover.

    Watch our expert medical oncologist, Dr. Alicia Morgans from Vanderbilt-Ingram Cancer Center, discuss external beam radiation therapy:

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    What About My Physical And Emotional Wellness

    Eating a healthy diet including a variety of foods, will ensure you have what your body needs to cope with treatment and recovery. Regular physical activity can improve your cancer recovery and reduce side effects such as fatigue.

    • Don’t be afraid to ask for professional and emotional support.
    • Consider joining a cancer support group.
    • Learn to ignore unwanted advice and “horror stories”.
    • Live day-to-day and remember that every day is likely to be different.

    Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life or reduce pain. There is no evidence that these therapies can cure or prevent cancer. Some have not been tested for side-effects, may work against other medical treatments and may be expensive. Talk to your doctor about using complementary therapies.

    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.

    Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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    What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer

    Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.

    There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective

    Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.

    High Risk Localised Prostate Cancer

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    High risk prostate cancer may start to grow or spread within a couple of years. Doctors usually suggest surgery to remove the prostate gland or external radiotherapy to the prostate. They dont often use internal radiotherapy for high risk prostate cancer. The cancer cells may have spread slightly away from the prostate gland and internal radiotherapy may not reach them all. Men who have radiotherapy also have hormone therapy before, during or after the treatment.

    For men who are not well enough to have radiotherapy or surgery, doctors may recommend monitoring the cancer or hormone therapy on its own.

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    Living With Prostate Cancer

    Receiving a prostate cancer diagnosis can be stressful. Even though most people who receive a diagnosis of prostate cancer live for many years after receiving the diagnosis, treatment can be exhausting and cause side effects that impact your quality of life.

    Many resources are available to help you get through these difficult times:

    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.

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