Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
Surgeon Diagnosed With Incurable Prostate Cancer After Suffering Pain In Foot
Gareth Jones, a 55-year-old urologist, recalls the moment he saw a ‘field of red exclamation marks’ on his blood test results and found out that his spine and pelvis were ‘full of cancer’
A surgeon has recalled his experience of being diagnosed with incurable prostate cancer after complaining of a painful foot.
Gareth Jones was diagnosed with the disease in June 2021 and has faced a struggle to maintain his physical and mental health as he receives palliative care.
The 55-year-old urologist was into extreme fitness events prior to his diagnosis and spent many years taking part in Iron Man challenges.
He told Glasgow Live: “Through lockdown, I did lots of virtual events and my last was the virtual Manchester marathon. I was a reasonable runner.
“I first noticed my foot was sore, and although that wasn’t a new thing and I’ve been injured before, it wasn’t going away.
“In early 2021, I jumped off my bike because someone walked in front of me and twisted my back – things that have happened before but I wasn’t getting through it this time. My left leg also wasn’t working properly and I was tripping a lot.
“I was going home from work one day and it took me twice the time and I had abdominal pain. I knew something was wrong.”
Gareth initially went to his GP for blood tests before learning of his diagnosis while on call at work.
Gareth described the experience of being diagnosed as like being “hit by a bus”, saying he initially thought he would be dead within a year.
How Is Prostate Cancer Diagnosed
Doctors describe the growth and spread of prostate cancer in stages. Doctors use these stages as guides when choosing treatment options or offering prognoses to their patients.
Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests such as a digital rectal exam or prostate-specific antigen test and imaging studies like bones scans, MRIs, CT scans, and trans-rectal ultrasounds.
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Bone Loss From Prostate Cancer Treatment
Testosterone, the male sex hormone, fuels the growth of prostate cancer but it also is crucial to bone health. Treatment of prostate cancer with hormone therapy, also called androgen deprivation therapy , blocks the production of testosterone which stops or slows the growth of the cancer. Without testosterone, bones can become weak and break more easily. When a man is on ADT, recovery from a bone fracture takes longer than for other men. It is especially important for men taking ADT to speak with their doctor about how to plan for and manage the bone loss before a problem arises. Bone strength can also be decreased as a result of radiation and chemotherapy used to treat prostate cancer.
Fortunately there are ways to strengthen and repair your bones including medicines and lifestyle changes.
- Bisphosphonates can prevent the thinning of the bone and help make them stronger
- Oral bisphosphonates include Fosamax and Actonel
- The intravenous bisphosphonate is Zometa
- Strive for a healthy diet and make sure to get enough calcium and vitamin D
- When exercising, include weight bearing and muscle strengthening exercises
- Avoid tobacco and excessive alcohol
How Will My Cancer Be Monitored
Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.
You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.
You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.
Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.
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General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms male, female, or both to refer to sex assigned at birth. .
- neuroendocrine tumors
Experts believe some males can also have a mixed type, which combines a common and a rare type of prostate cancer. Rare forms of prostate cancer are more likely to metastasize.
Prostate cancer overall is the second most common cancer in males after skin cancer. Doctors discover most prostate cancers in the prostate or nearby tissues. However, about 16% of new cases spread into distant locations.
Between 2012 and 2018, about more cases of prostate cancer occurred in the United States.
Research has shown the incidence of prostate cancer for African American males is that of people who are white. Among African Americans, the cancer types tend to be more aggressive, and deaths are double compared with white Americans.
The differences in outcomes for African American males may originate from:
- Physical: Higher prostate-specific antigen levels in the blood.
- Genetic: Some African American males carry certain gene mutations or chromosomal abnormalities that can increase prostate cancer risk.
- Environmental: Social disparities may cause people from historically marginalized groups to live on a lower income and have limited access to healthy food.
- Social: Disparities in healthcare can limit genetic screening or disease treatment access, leading to underdiagnosis.
Other people should begin screening at the age of 50.
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What Happens If My Cancer Starts To Grow Again
Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.
You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:
Which treatments are suitable for me?
Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.
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Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
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Getting More Information About What To Expect
- National Institute for Health and Care Excellence. Palliative care for adults: strong opioids for pain relief. Clinical guideline 140. 2012.
- National Institute for Health and Care Excellence. Prostate cancer: Diagnosis and treatment. NICE clinical guideline 175. 2014.
- Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, DAndrea G, et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res CR. 2005 Jun 24:2037.
- Thompson JC, Wood J, Feuer D. Prostate cancer: palliative care and pain relief. Br Med Bull. 2007 83:34154.
- Vinjamoori AH, Jagannathan JP, Shinagare AB, Taplin M-E, Oh WK, Van den Abbeele AD, et al. Atypical Metastases From Prostate Cancer: 10-Year Experience at a Single Institution. Am J Roentgenol. 2012 Aug 199:36772.
- Kate Bullen, Head of School for Applied Social Science, University of Brighton, Brighton
- Jackie Dawson, Community Palliative Care Clinical Nurse Specialist, Guys and St Thomas NHS Foundation Trust
- Hazel Parsons, Palliative Care Nurse Specialists, Dorothy House Hospice, Winsley, Bradford on Avon
- Elizabeth Rees, Lead Nurse for end of life care, Leeds Teaching Hospitals
- Our Specialist Nurses
Stages Of Prostate Cancer
Any T, any N, M1
Any Grade Group
The cancer might or might not be growing into tissues near the prostate and might or might not have spread to nearby lymph nodes . It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs . The Grade Group can be any value, and the PSA can be any value.
Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.
While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.
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Questions To Ask Your Doctor Or Nurse
- What type of hormone therapy are you offering me and why?
- Are there other treatments I can have?
- What are the advantages and disadvantages of my treatment?
- What treatments and support are available to help manage side effects?
- Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
- How often will I have check-ups and what will this involve?
- How will we know if my cancer starts to grow again?
- What other treatments are available if that happens?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
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When Is The Right Time To Use Hospice Care
Many people believe that hospice care is only appropriate in the last days or weeks of life. Yet Medicare states that it can be used as much as 6 months before death is anticipated. And those who have lost loved ones say that they wish they had called in hospice care sooner.
Research has shown that patients and families who use hospice services report a higher quality of life than those who dont. Hospice care offers many helpful services, including medical care, counseling, and respite care. People usually qualify for hospice when their doctor signs a statement saying that patients with their type and stage of disease, on average, arent likely to survive beyond 6 months. More information about hospice can be found below in the Related Resources section of this fact sheet.
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 .
What Is Stage 4 Prostate Cancer
The fourth stage of prostate cancer defines a tumor that has progressed to other regions of the body, such as the lymph nodes, lungs, liver, bones, or bladder. The 5-year survival rate for these tumors is 29 percent.
Keep in mind that each case is unique, and figures like these are merely suggestions. As advances in prostate cancer treatment become more common, your odds of surviving this disease improve.
In general, prostate cancer has a very good survival rate one of the greatest of any cancer type. Because prostate cancer is frequently a slow-moving disease, the majority of men diagnosed with it will die from an unrelated reason.
Stage 4 prostate cancer means the cancer has spread to lymph nodes or to other parts of the body. It is further divided into two substages:
- Prostate Cancer Stage 4A Stage 4A: The cancer has spread to nearby lymph nodes but may or may not have spread to nearby tissues.
- Prostate Cancer Stage 4B Stage 4B: The cancer has spread to another area of the body, such as the bones or distant lymph nodes.
Charity Warns Of Prostate Cancer Diagnosis Postcode Lottery
Prostate cancer patients across the UK are facing a postcode lottery of care, a charity has warned.
Prostate Cancer UK said the proportion of patients diagnosed with the disease when it is too advanced to treat varies significantly depending on where patients live.
In Scotland, more than a third of men are only diagnosed when the disease is classed as stage 4 which means the cancer has spread to another part of the body and is also known as metastatic cancer.
This is compared to just 12.5% of men in London.
1 in 8 men will get prostate cancer. If youre over 50, or youre black, or your dad or brother had it, youre at even higher risk.Check your risk in 30 seconds:
Prostate Cancer UK
Prostate Cancer UK used various data sets to find out the proportion of patients diagnosed with metastatic prostate cancer which in most cases is too advanced to cure.
The charity found the proportion of men diagnosed at stage 4 was:
35% in Scotland. 20.1% in the North East and Yorkshire. 20% in Northern Ireland. 19% in Wales 17.8% in the Midlands. 17.1% in the North West. 16.8% in the South West. 15.6% in the East. 14.7% in the South East. 12.5% in London.
The data suggests men from deprived areas are at higher risk of being diagnosed at a later stage of the disease, the charity added.
This postcode lottery for cancer diagnosis simply isnt fair, and the picture in Scotland is particularly shocking
Laura Kerby, Prostate Cancer UK
What Is Prostate Cancer
Growth in the prostate can be of two types
Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.
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What Is The Life Expectancy For Stage 4 Prostate Cancer
Prostate cancer life expectancy is determined using five-year survival rates. This is the percentage of people who may still be alive five years after being diagnosed.
The five-year survival rate for men with localized prostate cancer, where there is no evidence of cancer spreading outside the prostate, and regional prostate cancer, when cancer has migrated outside the prostate to adjacent structures or lymph nodes exclusively, is approximately 100 percent.
When prostate cancer reaches stage 4 and has spread to other organs such as the lungs, liver, or bones, the five-year survival rate falls below 30%. At stage 4, prostate cancer is unlikely to be cured, although with effective therapy, many people can live for several years. The patients life expectancy is determined by the precise characteristics of his cancer.
However, thanks to routine screening procedures, prostate cancer is often discovered early, before it has spread to other organs, and it is usually not fatal. When diagnosed early, there are several treatment options available, as well as a good likelihood of a cure.