Biochemical Recurrence Without Metastatic Disease After Exhaustion Of Local Treatment Options
Prognosis
4. Clinicians should inform patients with PSA recurrence after exhaustion of local therapy regarding the risk of developing metastatic disease and follow such patients with serial PSA measurements and clinical evaluation. Clinicians may consider radiographic assessments based on overall PSA and PSA kinetics.
5. In patients with PSA recurrence after exhaustion of local therapy who are at higher risk for the development of metastases , clinicians should perform periodic staging evaluations consisting of cross-sectional imaging and technetium bone scan.
6. Clinicians may utilize novel PET-CT scans in patients with PSA recurrence after failure of local therapy as an alternative to conventional imaging or in the setting of negative conventional imaging.
Treatment
7. For patients with a rising PSA after failure of local therapy and no demonstrated metastatic disease by conventional imaging, clinicians should offer observation or clinical trial enrollment.
8. ADT should not be routinely initiated in this population . However, if ADT is initiated in the absence of metastatic disease, intermittent ADT may be offered in lieu of continuous ADT.
Surgery To Remove The Testicles
Your testicles make most of your testosterone. Surgery to remove the testicles is a type of hormone therapy because it quickly cuts your testosterone levels.
This operation used to be common, but most men with prostate cancer don’t get it any more. Instead, they take medicines that lower hormone levels while leaving the testicles in place.
If you do get the surgery, it’s an “outpatient” procedure, which means you won’t have to stay in the hospital. Your doctor may also give you anti-androgen therapy.
Advanced Prostate Cancer Life Expectancy And Prognosis
Typically, each stage of prostate cancer has different prognosis. In general, the advanced stages of the disease are much more difficult to treat than when the disease is still at early stage not yet spread. What are factors that affect the outlook and life expectancy of patient? The following are some statistics for each stage of this disease.
You might also like to know more about how fast prostate cancer spreads and what are the most common sites /organs of the body for the metastasis of this cancer in this section, before continuing
One thing you need to clearly understand that there is no any statistic that can be detail enough to tell you about what will happen. In other words, this statistic is only purposed for general information! In fact, each case of cancer is unique. So, there is always a chance and a hope for anyone who diagnosed with cancer.
Advanced prostate cancer symptoms
The symptoms of the disease are more likely to occur when the disease at advanced stage. This is the most challenging for doctors, because the early warning signs that are more likely to not occur will increase the number of patients diagnosed with the disease at later stages.
Once the cancerous tumor is bigger in size and also spreads to nearby sites or even other distinct organs of the body, there will be more complications that can be generated. These may include:
Understanding n-years survival statistics
The major factors that affect the outlook of patients
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Treatments For Prostate Cancer Spread To Bones
If prostate cancer spreads to other parts of the body, it nearly always goes to the bones first. Bone metastasis can be painful and can cause other problems, such as fractures , spinal cord compression , or high blood calcium levels, which can be dangerous or even life threatening.
If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.
Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause.
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The Latest Treatment Methods For Advanced Prostate Cancer
At Docrates Cancer Center we offer you the latest treatment methods and a team of leading prostate cancer experts providing personalized care for your unique situation. The key to treating patients with advanced prostate cancer is an individualized treatment program.
Today there are more and more effective treatment options available for advanced prostate cancer. The front-line treatment always includes medical treatments, most commonly hormone therapy and/or chemotherapy. Radiotherapy can be included in the treatment with special techniques, even if there are extensive metastases.
When the traditional first-line treatments are no longer efficient, we can offer targeted therapies like radionuclide treatments, which have been found to be both effective and safe options . In addition, we can analyze cancer genome to look for targetable vulnerabilities in cancer cells and consider immuno-oncological treatments. These new forms of treatments are becoming more common and are being used in combination with the traditional ones.
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Intermittent Versus Continuous Therapy
The common complications of androgen deprivation therapy include sexual dysfunction, mood disturbance, change in body composition and osteoporosis.2,3 In view of these adverse effects intermittent dosing has been considered. This is a period of androgen deprivation therapy followed by a break until disease progression, if a good response was attained. The optimal duration of androgen deprivation therapy is fairly arbitrary as the studies have looked into various periods ranging from three months to three years.
In patients with PSA relapse only , intermittent therapy has been shown to be non-inferior to continuous dosing. There was also a better quality of life with intermittent dosing.4
In patients with objective metastases, intermittent androgen deprivation therapy had numerically worse outcomes than continuous treatment, but the study was statistically inconclusive. There was less sexual dysfunction and better mental health in the intermittent group, but this effect disappeared by 15 months when most people were back on continuous treatment.5 If short-term quality of life is important, even at the risk of possible worse survival, intermittent therapy is a reasonable approach.
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What Does It Mean For Prostate Cancer To Spread
Cancer cells can spread to other parts of the body. Doctors say the cancer has âmetastasizedâ or spread if this occurs.
Prostate cancer can spread to:
- pale skin due to anemia
These symptoms can also occur with aging and an enlarged prostate. As a result, some people may ignore them instead of seeking medical attention.
According to the Prostate Cancer Foundation, age is the biggest contributing factor to prostate cancer risk. Doctors diagnose an estimated of all prostate cancers in males older than 65 years of age.
It states that additional risk factors for prostate cancer include:
- Family history: People with a close relative who has had prostate cancer may be twice as likely to get prostate cancer as those who do not.
- Race: Males of African descent are about 75% more likely to develop prostate cancer than white males and more than twice as likely to die from the condition.
- Smoking: A history of smoking is associated with a higher risk of aggressive prostate cancer.
Researchers are also studying a link between diet and increased prostate cancer risk. Diets high in calcium or low in vegetables an increased risk of aggressive prostate cancer.
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Surgery In Metastatic Disease
Physicians have suggested that the benefits seen from radiation to the prostate point to the benefits of local therapy, raising the question of whether radical prostatectomy might have the same results. Trials are ongoing, and at present the use of surgery should be considered investigational and conducted only within the context of a trial. However, transurethral resection is sometimes needed in men who develop obstruction secondary to local tumor growth. Bilateral orchiectomy can be used to produce androgen deprivation in patients with widely advanced and metastatic prostate cancer.
Since the introduction of LHRH agonist and antagonist therapies, surgical intervention has been practiced less often. An indication for immediate bilateral orchiectomy is spinal cord compression, because it avoids the potential flare response that can occur during the first 3 weeks of treatment with an LHRH agonist.
Recurrence Of Prostate Cancer Life Expectancy
According to the table above, when the prostate cancer recurrence rate is low, then life expectancy generally is 10 years or higher. When calculating life expectancy to a prostate expectancy too.
Meanwhile, if the recurrence rate is high, then most probably the tumor will involve the adjacent areas. And often the recurrence seems to occur after 6-8 years of radical prostatectomy.
In cases of metastastasis, it is difficult to assess the period of relapse. This is actually considered as very high risk zone.
Sometimes, the actual cause is not the prostate cancer, but some other associated problems. Thats why, it is highly recommended regular annual check-ups not only to tackle prostate cancer, but also a scheduled check-up to detect its recurrence and related problems too.
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What Else Do People Living With Metastatic Prostate Cancer Need To Know About Their Treatment Options
I cannot stress enough the importance of picking the righttreatment for each individual. Side effects and the expectations for diseaseresponse should be clearly discussed and understood.
Statistically, about one-third of people with metastatic prostate cancer will live more than 5 years. Understanding where your disease is on that continuum can be important for both treatment and lifestyle decisions.
That said, I am consistently amazed by what we as a medical and scientific community can do together. The huge efforts being applied to prostate cancer research hold significant promise for new and better treatment options in the near future.
Dr. Joseph Brito provides general urologic care with a special focus on minimally invasive surgical techniques and urologic oncology. Dr. Brito received his MD from George Washington University School of Medicine and Health Sciences. Dr. Brito completed a residency in urology at Rhode Island Hospital and Alpert Medical School of Brown University and trained at Yale School of Medicine in clinical oncology. Dr. Brito is a member of the American Urological Association.
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Determination Of Evidence Strength
Based on assessments of the domains described above, the methodology team graded the strength of evidence for each intervention as high, moderate, low, or very low. Randomized controlled trials of interventions start as high strength of evidence and are graded down based on the presence and severity of shortcomings in each domain. A high grade indicates high confidence that the evidence reflects the true effect and that further research is very unlikely to change confidence in the estimate of effect. A moderate grade indicates moderate confidence that the evidence reflects the true effect and further research may change the estimate. A low grade indicates low confidence that the evidence reflects the true effect and further research is likely to change the confidence in the estimate of effect and could increase the confidence in the estimate. A very low grade indicates evidence either is unavailable or is too limited to permit any conclusion due to extreme study limitations, inconsistency, imprecision, or reporting bias.
The AUA employs a three-tiered strength of evidence system to underpin evidence-based guideline statements. In short, high certainty by GRADE translates to AUA A-category strength of evidence, moderate to B, and both low and very low to C.
| Table 1: Strength of Evidence Definitions | |
|---|---|
| AUA Strength of Evidence Category | GRADE Certainty Rating |
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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, treatment and follow-up . Annals of Oncology . 2020 : 31: 1119-1134 .
Different Approaches To Starting Hormone Therapy
Experts debate how early treatment with hormone therapy should be started. Some argue that the benefits of hormone therapy for prostate cancer should be offered to men earlier in the course of the disease. Others assert that theres little evidence that getting treatment early is better than getting it later.
Unfortunately, there are still some doctors who are offering hormonal therapy earlier in the course of the disease than is commonly recommended, Brooks says. Given that the side effects can be serious, Brooks argues that starting treatment with hormone therapy so early may not be a good idea.
However, Holden argues that early treatment may be helpful. I think one of the reasons that the death rate from prostate cancer is going down is that were using hormone therapy early, he tells WebMD. We havent proved that early treatment improves overall survival yet, but I think we will.
Researchers are also looking at intermittent therapy, starting and stopping hormone treatment for months at a time. The big advantage is that men could go off therapy temporarily and thus be free of the side effects. Early study results have been promising.
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Multidisciplinary Nature Of Treatment In Todays Advanced Prostate Cancer Care Paradigm
As the therapeutic landscape evolves to include increasingly complex combinations of systemic therapies with or without local therapies, advances in imaging, and germline and somatic genetic testing, treating men with advanced prostate cancer is increasingly one that must embrace multidisciplinary management approaches. Team members should include urologists, medical oncologists, and radiation oncologists at a minimum when supporting treatment decisions for advanced disease. Additional specialists may also include genitourinary pathology, genetic counseling, palliative care, and holistic specialists, as appropriate, in addition to primary care. Best practices must also include clinicians comfortable describing the use of germline and somatic genetic testing, and when advanced imaging techniques could be optimally used or avoided. Radiologists and nuclear medicine specialists are valuable in helping to accurately interpret scans. Palliative care team members may also play a key role when treating men with symptomatic metastatic disease. Palliative care itself is an interdisciplinary, holistic approach to managing an advanced disease such as prostate cancer with a guarded prognosis. It can include controlling symptoms that are physical, psychological, spiritual, and social. The goal of palliation is to prevent and relieve suffering and to support the best possible QOL for the patient and family.
Survival Statistics For Prostate Cancer
Survival statistics for prostate cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular personâs chances of survival. In general, most men diagnosed with prostate cancer do not die from the disease itself and will die from other causes.
There are many different ways to measure and report cancer survival statistics. Your doctor can explain the statistics for prostate cancer and what they mean to you.
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Quality Of Life With Advanced Stage Prostate Cancer
Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.
Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.
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Radiation As Adjuvant Or Salvage Therapy After Surgery
Several randomized trials have evaluated the use of adjuvant radiation therapy to the prostatic bed following surgery for patients at high risk of recurrence . Those include EORTC 22911, SWOG 8794, ARO 96-02/AUO AP 09/95, and FinnProstataX, as well as the ongoing RAVES, GETUG-AFU 17, and RADICALS-RT studies. Recent research has further highlighted the role of early salvage radiation therapy with concomitant ADT for those with biochemical recurrence after prostatectomy, to avoid overtreatment associated with adjuvant radiotherapy. This is reflected in the current AUA/ASTRO guidelines.
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How Is Advanced Prostate Cancer Treated
There are a variety of treatment options available for men with advanced prostate cancer. Some approaches aim to slow the cancer’s growth or lessen the symptoms. Others are used to treat aggressive forms of cancer that don’t respond to prostatectomy or radiation therapy.
Our prostate cancer specialists will work closely with you to guide you through your options and help you decide what treatment, or combination of treatments, will provide the best outcome for you.
Some of the treatments of early stage prostate cancer may be part of the regimen your doctor recommends for you.
Other options that are typically used for late stage prostate cancer include: