What Is The Source Of The Information
Researchers funded by the Agency for Healthcare Research and Quality, a Federal Government research agency, reviewed studies on treatments for localized prostate cancer published between January 1, 2007, and March 7, 2014. The report included 52 studies and was reviewed by health care professionals, researchers, experts, and the public.
After A Diagnosis Of Prostate Cancer
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:
What Is Localized Prostate Cancer
Localized prostate cancer is cancer that is only inside your prostate gland and has not spread to other parts of your body. The prostate is a gland in men about the size of a walnut. It makes and stores the liquid that carries sperm.
The prostate is near the bladder and rectum . It is just below the bladder and surrounds the upper part of the urethra .
Most men with localized prostate cancer have few or no symptoms. Possible symptoms can include:
- Problems when you urinate
- Pain in your lower back
- Pain when you ejaculate
- Blood in your urine
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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.
How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
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Dr Ernest W Ramsey Manitoba Prostate Centre
The Dr. Ernest W. Ramsey Manitoba Prostate Centre at CancerCare Manitoba is the provincial centre for prostate disease. The centre provides timely access to diagnosis and therapy of both benign and malignant diseases of the prostate. You may be referred to the centre by your urologist or family physician for assessment and diagnosis by our health-care team.
Our multidisciplinary team of urologic surgeons, radiation oncologists, medical oncologists, nurses, a psychosocial clinician and registered dietitian offer assessment, diagnostics and treatment for men with prostate disease.
Patients and their families also receive education and supportive care, as well as co-ordinated access to additional resources as necessary.
If you are diagnosed with prostate disease, there are a number of treatments available and our team will help you to decide which is best for you.
How Prostate Cancer Is Treated
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
The treatment options for prostate cancer can vary based on many factors, including the aggressiveness of the tumor, the stage of the disease, personal preferences, and more. Curative options may include surgery or radiation therapy. With less aggressive tumors, watchful waiting with treatment begun only if the cancer progresses may be an option. There are also a number of different therapies that can be used to control the growth of these cancers, including hormone therapies, chemotherapy, and newer treatments such as immunotherapy. In addition, many alternative treatments are being evaluated in clinical trials.
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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.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
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.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
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Several Treatments Available For Prostate Cancer
Men of America, September is a good time to get the latest information about prostate health and disease, and the most effective treatments available for prostate cancer.
A man’s prostate produces the seminal fluid that nourishes and transports sperm. Symptoms of prostate cancer include difficulty with urination, but sometimes there are no symptoms at all.
Some types of prostate cancer grow slowly, and monitoring is recommended. Other types are aggressive and require more a more intense treatment approach.
Addressing prostate health and disease begins with a conversation between you and your healthcare provider.
Two tests are commonly used to screen for prostate cancer:
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others. So your provider is the best person to interpret your PSA test results. Only a biopsy can diagnose prostate cancer for sure.
Treatment Choices For Prostate Cancer That Has Spread
If your prostate cancer has spread to other parts of your body, it cannot be cured. But it can be controlled by lowering the level of testosterone in your body with hormone therapy. You can have hormone therapy as
- Tablets you take each day
- Injections each month or every 3 months or 6 months.
- Tablets for a few months, then a break, followed by more tablets, and so on
Another way of reducing testosterone levels is removing the testicles. This is called surgical castration or orchidectomy. It quickly lowers the testosterone levels and can control the cancer very well.
Orchidectomy or hormone therapy can control the cancer for a few years in many men. When the cancer starts to develop again, your doctors may suggest treatment with chemotherapy or steroids. These can control or shrink the cancer for some time. Chemotherapy can work well at controlling advanced prostate cancer in some men.
If your cancer has spread to your bones and is causing you pain, your specialist may suggest radiotherapy to the affected areas of bone. Radiotherapy for bone pain can work very well to strengthen the bone and relieve pain. The damaged bone begins to repair itself after radiotherapy treatment. Bisphosphonate treatment can also reduce bone pain and help to reduce the risk of bone fracture.
For more information on Thrombosis which may occur during / after chemo click here
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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.
Low Risk Localised Prostate Cancer
Low risk localised prostate cancer is very unlikely to grow or develop for many years. Your doctor is likely to suggest monitoring your cancer. This is called active surveillance and involves keeping an eye on the cancer to see whether it begins to develop. Doctors choose to do this because your prostate cancer may grow so slowly that it never causes any symptoms.
Treatments for prostate cancer can cause long term side effects, so doctors try to avoid giving treatments if they can safely do so. If the cancer starts to develop while you are having active monitoring, your doctor will offer you surgery to remove the prostate gland or radiotherapy to the prostate. You may have hormone therapy as well as radiotherapy.
A Cochrane review in 2011 looked at research comparing different treatments for localised prostate cancer. This review found that after 5 years of follow up, internal radiotherapy worked as well as surgery to remove the prostate gland. You can see the prostate cancer treatment review on the Cochrane Library website. There is a plain English summary at the bottom of the review.
In men younger than 65, the risk of cancer growing within their lifetime is higher. So doctors may offer treatment with surgery to remove the prostate gland or radiotherapy to the prostate at an earlier stage than in older men.
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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.
How Far Your Prostate Cancer Has Grown And Spread
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.
Other Items To Consider:
Should I choose surgery or radiation for my prostate cancer?
For men deciding between surgery and radiation for prostate cancer treatment, that may help you weigh the pros and cons of each option.
Genomic testing and prostate cancer
Genomic tests can help determine how aggressive your prostate cancer is, and this may influence your treatment decisions. Genomic testing can also help you and your doctor learn more about how your cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively, therefore influencing treatment decisions.
Cancer Cells Under A Microscope
If you have had a biopsy,the biopsied tissue is sent to a laboratory where a doctor called a pathologist will look at the cells in the tissue under a microscope. When healthy cells become cancerous, their appearance begins to change. The more changed the cells look, the more dangerous the cancer is likely to be.
The results from a prostate biopsy are usually given in the form of the Gleason score. On the simplest level, this scoring system assigns a number to describe how abnormal the cells appear under a microscope. Grade 1 and 2 are thought of as normal prostate cells. Grades 3 5 are thought of as cancer cells, with grade 5 being the most abnormal.
The doctor will take more than one sample when you have a biopsy. This is because there may be more than one grade of cancer in the tumour. The pathologist works out an overall Gleason score by adding together the two most common Gleason grades.
For example, if the most common grade of the samples is grade 3 and the second most common is grade 4 then the overall Gleason score is 7. Some doctors write the two scores separately, for example 3 + 4, instead of 7.
The grade can only ever give a doctor an idea of how a cancer might behave. It cannot definitely predict what will happen. Most cancers will behave as expected, but not all.
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What If My Biopsy Shows Cancer
If the biopsy shows prostate cancer, your doctor will determine how likely your cancer is to grow quickly and spread. Sometimes, prostate cancer grows slowly over many years. But other times, it grows quickly.
Your doctor can use your PSA level, Gleason score, and tumor score to determine your risk level. The following pages give more information about Gleason score, T-score, and prostate cancer risk levels.
The Gleason score is a common scale used to determine how fast your prostate cancer is likely to grow. Gleason scores can range from 2 to 10, but most often range from 6 to 10. The higher the Gleason score, the more likely your cancer is to grow and spread.
The T-score tells how far your prostate cancer has grown.
- T1: The cancer is too small to be felt during a digital rectal exam or seen in an imaging test . The cancer is found from a biopsy done after a man has a high PSA level or has surgery for problems urinating. The cancer is only in the prostate gland.
- T2: The cancer can be felt during a digital rectal exam and may be seen in an imaging test. The cancer is still only in the prostate gland.
- T2a: The cancer is in one-fourth of the prostate gland .
- T2b: The cancer is in more than one-fourth of the prostate gland , but has not grown into the other side of the prostate gland.
- T2c: The cancer has grown into both sides of the prostate gland.
- Hormone therapy
What Have Researchers Found About How These Treatments Compare With Each Other
Researchers found that for some men:
- The risk of the cancer spreading to other parts of the body is much lower with surgery to remove the prostate gland than with watchful waiting.
- Surgery to remove the prostate gland appears to increase the chance of surviving the cancer more than external-beam radiation therapy.
- A combination of 3D-CRT and hormone therapy appears to increase the chance of surviving the cancer more than 3D-CRT alone.
Research is only one source that helps guide doctors when they treat localized prostate cancer. Doctors also rely on their experience and on guidelines for treatment based on evidence and recommendations by experts.
When thinking about what treatment may be best for you, your doctor will consider several things, including:
- Your age
- Other health problems you may have
- How long you are expected to live
- Your preferences
Your doctor will also discuss possible side effects to help you decide about treatment. Talk with your doctor about your options and the trade-offs between possible benefits and side effects. Usually, you have time to think about your options before making a decision.
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