Does Overdiagnosis Lead To Overtreatment Of Older Men
The widespread use of PSA screening has led to an increase in the diagnosis and treatment of early localized prostate cancer. Data from the US Cancer of the Prostate Strategic Urological Research Endeavor database suggest a significant decrease in risk in the last 2 decades in the United States, with more patients being identified with low-risk disease at diagnosis,29 but the role of active treatment of low- and intermediate-risk disease in elderly men remains controversial.
The median time from diagnosis to death from prostate cancer for men with nonpalpable disease is approximately 17 years.30,31 Considering that the US male life expectancy at the age of 65 years is 16 years, aggressive therapy will hardly extend life expectancy of older men with no palpable prostate cancer at the time of diagnosis.32 Twenty to 30% of prostate cancers detected by PSA screening programs show Gleason scores of 6 or lower and, thus, are not poorly differentiated and have volumes smaller than 0.5 cm3.3335
Histologic evaluation of radical prostatectomy specimens demonstrated that about 20% to 30% of cancers are small volume, show low Gleason scores, and are consequently clinically harmless.35,36 Many of these cancers pose little threat to life, especially for older men. Has PSA screening resulted in prostate cancer overdiagnosis?
If Your Prostate Cancer Comes Back
If your cancer goes into remission but later returns, follow-up treatments will depend on where the cancer is located and which treatments youâve already tried.
- If the cancer is contained in your prostate, surgery or a second attempt at radiation is suggested. If youve had a radical prostatectomy, radiation therapy is a good option. If you had radiation, radical prostatectomy might be the best approach. Cryosurgery might also be an option.
- If the cancer has spread to other parts of your body, hormone therapy might be the most effective treatment. External or IV radiation therapy or bisphosphonate drugs can relieve your bone pain.
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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.
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Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment. If youre choosing a treatment, you might find it helpful to ask your doctor or nurse some of these questions.
- What treatments are suitable for me?
- How quickly do I need to make a decision?
- What are the advantages and disadvantages of each treatment? What are their side effects?
- How effective is my treatment likely to be?
- Can I see the results of treatments youve carried out?
- Is the aim to keep my prostate cancer under control, or to get rid of it completely?
- If the aim of my treatment is to get rid of the cancer, what is the risk of my cancer coming back after treatment?
- If the aim of my treatment is to keep the cancer under control, how long might it keep it under control for?
- What treatments and support are available to help manage side effects?
- Are all of the treatments available at my local hospital? If not, how could I have them?
- After treatment, how often will I have check-ups and what will this involve? How will we know if my cancer starts to grow again?
- If my treatment doesnt work, what other treatments are available?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
Watchful Waiting And Active Surveillance
Prostate cancer often grows very slowly. You might not need to treat it right away — or at all — especially if you’re older or have other health issues.
For some men, the treatments themselves have risks that are greater than the benefit of getting rid of the cancer. Watchful waiting may be an option in this case. It means you and your doctor will look out for symptoms and treat them if they start. The doctor may do tests from time to time to see if the cancer is growing.
Active surveillance might be a choice if the cancer is likely to grow very slowly, if at all, but you would still want to cure it if it does get worse. Your doctor will do tests, including PSA blood tests and rectal exams, usually about every 3-6 months to check on the cancer. You might also have a biopsy, where your doctor takes a small piece of tissue from your prostate and checks it under a microscope.
These options donât mean that you ignore your cancer. Your doctor will keep a close eye on your health to be sure the disease doesnât cause any problems for you. If it does, your doctor will talk to you about starting treatment.
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Treatments May Have Side Effects
The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.
Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.
If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.
Side Effects Of Hormone Therapy
Hormone therapy may cause side effects associated with low testosterone, such as hot flashes, sweating, weight gain, reduced sexual desire and depression. Some men also may experience swollen breasts, depression, memory loss and heart problems. Eventually, the cancer may become resistant to hormone therapy. If hormone therapy stops working, doctors may switch treatments.
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The Staging Guide Video Series
Hi, Im Dr. Scholz. Lets talk about prostate cancer.
Weve been going through a series of short videos about the management of Teal otherwise known as intermediate risk prostate cancer. In this video were going to cover the comparison of all the different treatment options for Teal, and try to give you a little hierarchygive you a kind of number 1, 2, 3 in terms of options that I would be thinking of if I was in this situation.
First, when youre talking about Teal you have to realize there are three subtypes, the Teal subtype we divide at PCRI into Low, Basic, and High. So when we talk about many options for treating teal, were really talking about Basic-Teal. Why is that? Well, Low-Teal those men are candidates for active surveillance. High-Teal are going to get better cure rates with combination therapythat is a seed implant plus IMRT and a short course of hormone blockade . For Basic-Teal were really talking about having a broad selection of therapy amongst surgery, radiation therapy which could be IMRT, proton therapy, SBRT stereotactic body radiation CyberKnife, two different types of seed implants, and even primary hormone blockade , or just TIP alone which was very popular before radiation technology got a lot better. So the remainder of the video is really going to be talking about options or Basic-Teal, comparing the pros and cons of all these different treatments.
So lets move on and talk about that, lets talk about discomfort and inconvenience.
Side Effects Of Radical Prostatectomy
The most common side effects of the procedure are incontinence and erectile dysfunction . The incontinence, though common early after surgery, usually goes away. Whether erectile function returns depends on whether the nerves surrounding the prostate can be spared at surgery, patient age and baseline function. Men who are older or already have erection problems are most likely to have erectile dysfunction afterward.
For more information on erectile dysfunction and treatment, see Managing Erectile Dysfunction A Patient Guide.
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
Whats The Recovery Time For Prostate Cancer Treatment Procedures In Georgia
After prostate cancer surgery, most men will get back to normal within six to eight weeks, but you may be able to go back to work within 3-4 weeks. After any type of therapy, you should be able to return to work the next day or if there are no symptoms that interfere with your ability to work. Make sure to ask your doctor how long until you can resume your normal activities, including exercises and heavy lifting.
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Radiation Therapy Oncology Group 94
This multi-institutional study was conducted to evaluate the effect of the addition of AST to RT on overall survival, freedom from biochemical failure, freedom from clinical progression, and disease-free survival in patients with localized prostate cancer in response to the positive effect on these parameters seen in RTOG 86-10. To this end, 1979 patients with T1bT2b prostate cancer and PSA less than 20 ng/ml were randomized to receive EBRT alone or in conjunction with 2 months of neoadjuvant and 2 months of concurrent goserelin and flutamide.
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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What Types Of Cancer Does Alternative Cancer Treatment Center Treat
Experienced doctors at Euromed Arizonas Alternative Cancer Treatment Center use integrated approach which helps your body kill the cancerous cells while at the same time restoring your bodys natural ability to heal – your immune system.
At Euromed we treat various types of cancer at different stages using a comprehensive cancer care program which is tailored specifically for each patient:
- Experienced and knowledgeable staff in alternative and conventional medicine
- 24/7 physician care
Please feel free to contact us for a free consultation to discuss your condition in more detail.
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.
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Initial Treatment Of Prostate Cancer By Stage And Risk Group
The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.
For prostate cancers that haven’t spread , doctors also use risk groups to help determine if more tests should be done and to help guide treatment options. Risk groups range from very-low-risk to very-high-risk, with cancers in the lower risk groups having a smaller chance of growing and spreading compared to those in higher risk groups.
Other factors, such as your age, overall health, life expectancy, and personal preferences are also important when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.
You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here. Taking part in a clinical trial of newer treatments is also an option for many men with prostate cancer.
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What Is Stage 2 Cancer
Stage 2 cancers are typically larger than stage 1 cancers and/or have spread to nearby lymph nodes. Like stage 1 cancers, stage 2 cancers are typically treated with local therapies such as surgery or radiation therapy.
Stage 2 cancer is determined in the five most common cancers in the following way:
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When Is Brachytherapy Alone The Right Choice
For a patient with disease that is confined to the prostate and not too aggressive, brachytherapy alone is a good option. With the use of sophisticated real-time computer-based planning, we can use brachytherapy to deliver radiation in an extraordinarily precise way, with minimal exposure to the surrounding normal tissues. It is also convenient for the patient as it is done in an outpatient setting and most people are able to get back to work the next day.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would also be very reasonable. At MSK, our philosophy is that when the disease is caught very early meaning a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease then it would be very appropriate to do active surveillance and hold off on treatment.
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Who Remained Prostate Cancer Free
Intermediate Risk patients experience a wider range of results and approaches due to the risk of disease beyond the prostate. When selecting a course of action, consultations are recommended with a urologist or surgeon, radiation oncologist and medical oncologist. Different treatments have different results and side effects. It is important to understand the potential impact each treatment can have on your quality of life after treatment.
Intermediate Risk patients are at a higher risk for cancer relapse or recurrence than Low Risk patients. That means patients in this risk group are more likely to have their cancer return following initial treatment, which may require additional treatment. To understand how effective the treatment or combination of treatments, are in keeping patients in remission, Doctors perform periodic monitoring or testing PSA levels, following treatment. It is very unlikely that the cancer will ever return, if you remain in remission for 10-15 years after prostate cancer treatment. Click on Get the Study, to obtain your copy of Foundations work. Share this Study with your Doctor as you select your treatment plan.
Intermediate Risk is any of the following:
PSA greater than 10 less than 20
Gleason Score is 7
How to Use the Graph
About the Data
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Can Adt Compensate For Dose Escalation
The Prostate Cancer Study III examined the addition of ADT to SDRT and DERT in intermediate-risk patients . The preliminary results of this trial have now been published in abstract form. A total of 600 patients were enrolled. Intermediate-risk prostate cancer was defined as T1/T2 disease, GS 6, PSA level 1020 ng/mL or T1/T2 disease, GS of 7, PSA level 20 ng/mL. Patients were randomly assigned to one of three arms: 6 months of ADT plus 70 Gy to the prostate , 6 months of ADT plus 76 Gy , or 76 Gy alone . ADT consisted of bicalutamide and goserelin for 6 months. RT was delivered using a 3D conformal technique and started 4 months after the beginning of ADT. Median follow-up was 6.75 years. Primary endpoints were biochemical failure and disease-free survival . Secondary endpoints included OS, as well as hormonal and radiation-related toxicities. Biochemical failure was defined as 2 ng/mL above the PSA nadir.