Wednesday, February 1, 2023

What Options Are Available For Prostate Cancer

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Joining A Clinical Trial

What treatment options are available for prostate cancer? Penn State Health St. Joseph Cancer Center

Clinical trials are medically supervised, carefully controlled patient studies that attempt to determine whether a proposed new treatment is both safe and effective. Clinical trials also look at whether a new treatment can lead to better outcomes than existing treatments. These studies may involve researchers from a variety of disciplines, such as general medicine, medical specialties, genetics, biology, chemistry, engineering and psychology. Clinical trials are conducted at medical centers around the country, and participants are often actively recruited.

New treatments are continually being developed for prostate cancer. Many prostate cancer trials are designated for patients with a rising PSA after local treatment or for those with advanced, metastatic cancers. However, there are also many trials for men with less aggressive cancer, such as the active surveillance trials at UCSF. We also conduct trials of neoadjuvant treatment, which are medications given before surgery for higher-risk prostate cancer. Several new treatments and approaches show promise some as simple as lifestyle changes in diet and exercise.

Funding sources for clinical trials include the National Cancer Institute, Department of Defense, universities and medical centers, private research foundations, pharmaceutical and biotechnology companies, and various combinations of these groups.

Clinical trials usually occur in phases:

Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment

If your prostate-specific antigen blood level or another test shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment you’ve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.

Hormone Therapy With Radiation

Prostate cancer cells need testosterone to grow. Hormone therapy aims to drastically lower testosterone levels to slow the cancer’s progression. Although it does not cure the cancer on its own, hormone therapy improves the effectiveness of radiation for high-risk disease and is often recommended in conjunction with radiation therapy for men with intermediate- or high-risk localized disease. However, hormone therapy may have significant side effects. These include loss of libido , hot flashes , changes in mood or memory, loss of bone and muscle density, body fat gain, and adverse effects on sugar or cholesterol metabolism. When offered as short-term therapy in conjunction with radiation, it is often well tolerated. How long a patient should receive hormone therapy remains controversial and depends on how aggressive his cancer is.

Learn more about hormone therapy.

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How Is Prostate Cancer Treated

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.
  • Remission And The Chance Of Recurrence

    Urology

    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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    Expert Review And References

    • American Cancer Society. Treating Prostate Cancer. 2019: .
    • American Society of Clinical Oncology. Prostate Cancer. 2020: .
    • Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
    • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
    • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
    • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
    • Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
    • Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatmentand follow-up. Annals of Oncology. 2020: 31: 1119-1134. .

    What Surgical Techniques Are Available

    There are several types of minimally invasive techniques and surgeries:

    • Endoscopic surgery: This procedure involves a number of minimally invasive techniques using an endoscope. An endoscope is a miniature camera. Essentially, doctors use endoscopic surgery to perform various other procedures. For example, cystoscopy and ureteroscopy. Doctors perform thousands of these procedures every year, they are very safe and minimally invasive.
    • Laparoscopic surgery: This surgery makes small openings in the abdominal and pelvic cavity. This procedure avoids large incisions and involves procedures used to treat kidney and adrenal glands.
    • Laser surgery: This tool is often used to treat kidney stones and BPH. These might include, for instance, GreenLight laser and Holmium laser treatments.
    • Robotic surgery: This particular procedure is very effective to treat prostate, kidney, ureter and bladder conditions. Some institutions, for instance Mount Sinai Urology perform over 700 robotic procedures a year. It is a very effective form of surgery for prostate and kidney cancer.

    These are some of the procedures available today to treat conditions such as prostate cancer. Check our resources section for further information. Where you can also find inspiration from success and survival stories, or we can help you connect with a prostate cancer survivor.

    Man Cave Health, Inc. is a Non-Profit Organization recognized via IRS Code 501 Tax ID 30-1046542

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    So I Set Out To Find A Cure

    I pored over hundreds of scientific studies, dove deep into everything from conventional drug research to ancient Ayurvedic scrolls and other Eastern medicine traditions.I spoke to prostate cancer specialists, doctors, researchers, pharmaceutical reps and men enduring a terrible quality of life all in pursuit of a cure.Fast Forward To Today…And I’ve helped Over ONE MILLION MEN Solve Their Prostate Problems.Using the Same All Natural Method I Created 20 Years Ago.

    Side Effects Of Chemotherapy

    Prostate cancer treatment options – Penn State Cancer Institute

    Side effects of chemotherapy are common and may include:

    • Digestive issues such as nausea, vomiting and diarrhea

    While on chemotherapy, patients are also susceptible to infections because their white blood cell counts are lower. Other common side effects include bruising or bleeding due to fewer blood platelets and fatigue due to the lowered red blood cell count.

    Its also possible to experience a severe allergic reaction to some of the drugs used to treat prostate cancer, especially Taxotere® and Jevtana® . The patients care team may recommend medicines before each session to help prevent a reaction.

    The prostate chemotherapy drug mitoxantrone may cause leukemia later in life, but this is rare. The prostate chemotherapy drug Emcyt® may increase the risk for blood clots.

    During chemotherapy, doctors may also offer supportive care services to help ease side effects. For example, naturopathic providers may suggest supplements to reduce nausea. Also, a mind-body therapist may recommend techniques to help the patient relax and feel less anxious during prostate cancer chemotherapy treatments.

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    What Options Are Available For High Psa Levels Post

    Continuing on from last week, we are discussing options for post-prostate cancer treatment when PSA levels remain high or increase. In the case, that following surgery your PSA levels are 0.2ng/mL or higher, or following radiation therapy 2ng/mL or higher, its important to consider options.

    These could be signs of prostate cancer returning or having spread to another part of the body. Its important to undergo an evaluation if these results surface, your doctor would recommend this if this was the case.

    So if this does happen, what are our options?

    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.

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    Considering Prostate Cancer Treatment Options

    For most men diagnosed with prostate cancer, the cancer is found while it’s still at an early stage — it’s small and has not spread beyond the prostate gland. These men often have several treatment options to consider.

    Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors such as your age and general health, and the likelihood that the cancer will cause problems for you to consider before deciding what to do. You should also think about the possible side effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side effects such as incontinence or erection problems for as long as possible. Other men are less concerned about these side effects and more concerned about removing or destroying the cancer.

    If you’re older or have other serious health problems and your cancer is slow growing , you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may think more about watchful waiting or active surveillance, and less about treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best reason for your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.

    Treatment Options For Advanced Prostate Cancer

    Prostate Cancer

    Its rare for prostate cancer to metastasize, or spread to other parts of the body. In about 90 percent of all cases, this type of prostate cancer is diagnosed in its early stages, when the disease is confined to the prostate. However, when the disease metastasizes, prostate cancer cells tend to spread to the brain, bones, lungs and liver. Metastatic prostate cancer cells may also be found in lymph nodes outside the pelvis.

    In some cases, the treatment options for advanced prostate cancer may be considered palliative, used to relieve symptoms and improve quality of life. Treatment options include:

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    Prostate Cancer Caregiver Podcast Series

    We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.

    Prostate Cancer And Other Common Prostate

    Early prostate cancer is often asymptomatic, but a possible sign is usually an enlarged or hard and nodular prostate.

    In the later stages, you may also experience bone pain, weight loss and decreased appetite, adds Dr Lim.

    However, other prostate-related conditions also have similar urinary symptoms such as benign enlargement of the prostate. Here are the differentiating symptoms between prostate cancer and these other conditions.

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    What Active Surveillance Means

    For many men, prostate cancer never affects their lives, said Christopher L. Runz, DO, attending urologist at University of Maryland Shore Regional Health. Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.

    Active surveillance requires regular prostate specific antigen screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 .

    Many Treatment Options Are Available

    Prostate cancer treatment options

    So what are the facts?

    First of all, it’s not a one size fits all approach and there are many prostate cancer treatment options available, depending on the stage and grade of a cancer diagnosis. Tests and scans can help doctors understand everything they can about a cancer diagnosis and help inform and guide what treatment options would be best for that patient.

    For some, treatment might not even be necessary right away as prostate cancer is typically slow growing.

    For others, the broad treatment options include surgery, radiotherapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, and more. These can be used on their own or together at the same time, or one after another.

    Also, there are lots of different types of radiotherapy techniques, chemotherapy drugs, etc., each with their own considerations to be discussed when planning what treatment is best for a patients individual needs.

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    Accessing Clinical Trials At Ucsf

    UCSF is currently conducting research in four main areas:

    • Identification of genetic and lifestyle factors that predispose men to clinically significant prostate cancer
    • Discovering alterations in genes and proteins to improve current prostate cancer treatment
    • Developing new therapies for men with recurrent widespread prostate cancer
    • Preventing progression of early-stage untreated disease

    To learn more, search for a trial or contact us, visit Cancer Clinical Trials at UCSF.

    Options For Dealing With Recurrence

    With a persistently increasing PSA, the suspicion for recurrence increases. The most important factor in assessing your long-term outcome is determining the location of the prostate cancer cells producing the PSA. Advanced imaging techniques, such as MRI and PSMA PET/CT, are often helpful in learning where the cancer is located, and in the case of post-radiation recurrence, repeat biopsy may be required.

    If a man underwent surgery as an initial treatment, revisiting the post-operative pathology report may help to identify what contributed to the recurrence. If there was still cancer present , the cancer was aggressive , or genomic profiling of the tumor showed high-risk features, several options are available:

    • EBRT to the prostate bed with or without the pelvis.
    • EBRT accompanied by hormone therapy. The duration of hormone therapy will depend on the PSA level just prior to radiation and to a lesser extent on the Gleason score and staging of the cancer.
    • Systemic treatment using hormone therapy, other treatments for those at risk for metastatic disease, or a combination.
    • Active surveillance if the remaining cancer appears insignificant. You and your doctor can decide whether to intervene more aggressively and, if so, when.

    If you’re seeking additional or different approaches, you may be eligible to participate in an appropriate clinical trial . You can research this with the help of your doctor.

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    What Treatment Options Are Available For Prostate Cancer

    Prostate cancer is among the most common cancers that affect men. A cancer that occurs in the prostate, the small seminal fluid producing gland, prostate cancer can vary in terms of severity. While some prostate cancers may require minimal treatment and grow slowly, others may grow very quickly and require aggressive treatment to prevent spreading.

    Modern Advances Improve Outcomes

    Tables

    At GenesisCare, we have pioneered the use of modern prostate cancer treatments that not only aim to treat the cancer, but also minimise the side effects and impact on quality of life.

    Here are some examples of the treatment options that we provide, all designed to improve outcomes for men with prostate cancer. Some of these treatments are exclusively available in the UK at GenesisCare.

    MRIdian MRI-guided radiotherapy

    The MRIdian MR Linac is an advanced radiotherapy technology that combines high-resolution magnetic resonance imaging scanning techniques with extremely powerful radiotherapy beams to treat tumours more accurately and quicker than conventional radiotherapy.

    The MRIdian is considered especially ground-breaking because it turns on the radiation beam only when the tumour is positioned precisely in the treatment window and turns off the beam in an instant if the tumour moves even by a fraction helping to protect surrounding healthy tissue and organs from unnecessary radiation exposure, leading to fewer side effects.

    It also provides a safe and effective treatment option for men who experience a recurrence of their prostate cancer following previous prostate radiotherapy.

    Stereotactic ablative radiotherapy

    Stereotactic ablative radiotherapy is a specialist non-invasive treatment technique that treats tumours safely and effectively.

    Spacers for prostate cancer radiotherapy

    Minimising side effects is often just as important to consider as treating the actual cancer.

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