Most Patients Did Not Progress
With active surveillance, the patients had physical exams and PSA tests every six months, with biopsies recommended every one to two years.
Over an average of two and a half years of follow-up, 43 of the study participants showed evidence of cancer progression and received treatment.
In two patients, cancer spread beyond their prostate.
The study is published in the April issue of the Journal of Urology.
The findings support the idea that some men with prostate cancer may not need treatment, American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, tells WebMD.
He says the addition of a second biopsy should help refine the search for men who are appropriate candidates for active surveillance, but he also agrees that the strategy of watchful waiting is not without its risks.
âThe real advance will be when we have tests that will tell us with a high degree of accuracy when treatment is needed and when it is not,â he says.
A great deal of research is being done to identify genetic tests or tumor markers that can do this, but Lichtenfeld says it will be years before these tests are validated.
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First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
Could You Live With Untreated Prostate Cancer
Any diagnosis of cancer is frightening, but men with prostate cancer face some particularly difficult choices. Many prostate tumors are slow-growing so much so that theyâll never get big enough to cause any harm. You can see this from autopsy results. About 60 in 100 men have cancer cells in their prostate when they die, although many of these men will have died of something else.
For early stage prostate cancer, doctors increasingly recommend a wait-and-see approach, which they call active surveillance . You have regular tests, and if your cancer becomes more aggressive, you start treatment. If it doesnât, you avoid the side effects of surgery or radiation therapy. However, this approach does mean living with untreated cancer. Even the bravest of men could be forgiven for finding that idea frightening.
The study suggests that most men who choose active surveillance cope well, although itâs worth remembering that the men were taking part in a clinical trial, so probably got closer attention than a typical patient. This might mean they had fewer anxieties about their care. In fact, some men said that filling in the questionnaires made them feel better, because they appreciated that the researchers were interested in their feelings.
What you need to know.
Philip Wilson, patient editor, BMJ Group
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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
Who Uses Cam Instead Of Medicine
So how would a decision to accept no treatment, or to only use alternative medicine, compare to conventional cancer care ? And what about delaying conventional cancer care to allow a trial of alternative medicine does it have a measurable effect? Answering this question isnt straightforward. In cancer research, new drugs are typically added to, or follow, established therapies, so all patients receive standard treatment options as part of their care. So we cant ethically randomize patients to nothing, when established treatments exist. But we can answer this question in a different way: Patients that voluntarily opt out of cancer treatment can be followed, and compared to patients that do take cancer treatment. While it isnt a prospective randomization, which would be the gold standard, its the best we can get. But even this approach is difficult. Most patients who decide to opt-out of cancer treatment, also opt-out of any follow-up evaluation. So tracking down patients, and their outcomes, is essential.
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How Is Prostate Cancer Diagnosed
There are several tests your doctor may perform to check your prostate:
- Digital rectal examination : Your doctor inserts a gloved, lubricated finger into your rectum to feel the prostates size and check for anything unusual.
- Prostate Specific Antigen test: A simple blood test to measure a protein produced by your prostate. A high PSA might be a sign of prostate cancer, or another condition.
- MRI scan: A detailed scan of your prostate to help identify signs of cancer.
While these tests are helpful, a prostate biopsy is the only way to confirm a diagnosis of prostate cancer. A urologist, who your doctor will refer you to, removes some cells from your prostate using a thin, hollow needle. The cells are then examined under a microscope to check for cancer.
Confirmed prostate cancer is graded on a scale of 1 to 5 , based on how likely the cancer is to grow and spread to the rest of the body. Grade groups 4 to 5 are considered high risk.
An older system of grading, known as the Gleason score, grades the cancer from 1 to 10. A Gleason score of 8 to 10 is considered high risk.
Treatment Options After Recurrence
After surgery to remove your prostate
PSA levels are usually extremely low about a month after surgery. You may hear your doctor saying that your PSA level is undetectable . If your PSA level starts to rise, this might mean the cancer has come back.
Your doctor might recommend:
- hormone treatment
After external beam radiotherapy
PSA levels usually get lower slowly over months or years. Defining the limit for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence, or 3 increases in a row .
Your treatment options may be:
- surgery to remove your prostate
- hormone treatment
- high frequency ultrasound
After internal beam radiotherapy
PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence.
After hormone treatment
If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static. If it rises this may suggest the cancer is becoming resistant to the hormone treatment.
If hormone treatment is no longer controlling your cancer, your doctor may suggest:
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How Is Prostate Cancer Treated
Treatment options for prostate cancer depend on several factors:
- whether the cancer is high risk
- the stage of the cancer whether it is only found in the prostate or has it spread to elsewhere in the body?
- the PSA level and how fast it might be changing
- age and general health
Your doctor will recommend one or more of the following options if you have prostate cancer:
What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life, making healthy choices and feeling as good as you can.
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Castrate Refractory Prostate Cancer: A Wider Range Of Options
In this section, we explain the treatments available at Birmingham Prostate Clinic for patients once their disease becomes resistant to hormone treatment, called castrate refractory prostate cancer. Two types of treatments are needed to:
- Control the cancer and prevent further spread of cancer
- Control or prevent the symptoms caused by the spread of prostate cancer to the bones
Common Thoughts And Feelings
You may feel all sorts of things after you finish treatment. Some men are relieved and feel ready to put the cancer behind them and get back to normal life. But others find it difficult to move on. Adjusting to life after cancer can take time.
For some men, the emotional impact of what they have been through only hits them after they have finished treatment. You might feel angry for example, angry at what you have been through, or about the side effects of treatment. Or you might feel sad or worried about the future.
Follow-up appointments can also cause different emotions. You might find it reassuring to see the doctor or nurse, or you may find it stressful, particularly in the few days before your appointments.
Worries about your cancer coming back
You may worry about your cancer coming back. This is natural, and will often improve with time. There are things you can do to help manage your concerns, such as finding ways to reduce stress. Breathing exercises and listening to music can help you relax and manage stress. Some people find that it helps to share what theyre thinking with somebody else, like a friend. If you are still struggling, you can get help for stress or anxiety on the NHS you can refer yourself directly to a psychological therapies service or ask your GP.
If youre worried about your PSA level or have any new symptoms, speak to your doctor or nurse. If your cancer does come back, youâll be offered further treatment.
Feeling isolated
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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
Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
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What Is Prostate Cancer
Prostate cancer is cancer that affects the prostate glands present in men. Prostate cancer is the second-leading cause of cancer deaths for men in the United States.
Growth in the prostate can be of two types:
- Benign growths: These are noncancerous growths and are rarely a threat to life .
- Malignant growths: These are cancerous growths that are potentially life-threatening.
What Treatments Are Available
If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.
Before you start treatment
Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.
If you have any questions, speak to our Specialist Nurses.
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What Can Happen If Colon Cancer Is Left Untreated
Cancer is deadly. In many cases if cancer is found early it is treatable. If a patient leaves his or her colon cancer untreated a variety of things can happen to them. Dr. Mark Gimbel goes over what can happen without treatment in this video. Given enough time, colon cancer will progress to many other parts of the body. This is a scary proposition and can be deadly. Some level of treatment is always an option. Talk to your doctor about the best approach to your treatment.
Video Transcripts
How Does The Doctor Know I Have Prostate Cancer
Prostate cancer tends to grow slowly over many years. Most men with early prostate cancer dont have changes that they notice. Signs of prostate cancer most often show up later, as the cancer grows.
Some signs of prostate cancer are trouble peeing, blood in the pee , trouble getting an erection, and pain in the back, hips, ribs, or other bones.
If signs are pointing to prostate cancer, tests will be done. Most men will not need all of them, but here are some of the tests you may need:
PSA blood test: PSA is a protein thats made by the prostate gland and can be found in the blood. Prostate cancer can make PSA levels go up. Blood tests will be done to see what your PSA level is and how it changes over time.
Transrectal ultrasound : For this test, a small wand is put into your rectum. It gives off sound waves and picks up the echoes as they bounce off the prostate gland. The echoes are made into a picture on a computer screen.
MRI: This test uses radio waves and strong magnets to make detailed pictures of the body. MRI scans can be used to look at the prostate and can show if the cancer has spread outside the prostate to nearby organs.
Prostate biopsy: For a prostate biopsy, the doctor uses a long, hollow needle to take out small pieces of the prostate where the cancer might be. This is often done while using TRUS or MRI to look at the prostate. The prostate pieces are then checked for cancer cells. Ask the doctor what kind of biopsy you need and how its done.
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For Connecting And Sharing During A Cancer Journey
Anyone with cancer, their caregivers, families, and friends, can benefit from help and support. The American Cancer Society offers the Cancer Survivors Network , a safe place to connect with others who share similar interests and experiences. We also partner with CaringBridge, a free online tool that helps people dealing with illnesses like cancer stay in touch with their friends, family members, and support network by creating their own personal page where they share their journey and health updates.