Table : Predictors Of Biochemical Recurrence At Time Of Diagnosis
Although a number of clinical factors contribute to your risk of relapse after treatment, the parameters below provide a simpler assessment of your chances of biochemical recurrence, based on your clinical profile at the time of diagnosis. For more sophisticated estimates, based on specific risk factors, see Figures 1 through 3.
Low risk Gleason score less than or equal to 6and Cancer stage T2c or more
What If You Have Metastatic Castration
This means you have a type of metastatic prostate cancer thatâs able to grow and spread after you had hormone therapy to lower your testosterone levels.
Still, most people with mCRPC stay on androgen deprivation therapy because it might still be effective against some prostate cancer cells.
Your doctor may recommend adding other treatments like:
- Chemotherapy
- Treatments to ease symptoms like pain
You could also find out if a clinical trial might be right for you.
Some people with mCRPC simply choose to try active surveillance or watchful waiting.
What Is A Prostatectomy
A prostatectomy is a major procedure, carried out by a urological surgeon , in which all or part of the prostate gland is removed in men. It can be ordered by your doctor to treat prostate cancer and as part of treating some of the other types of cancer that can affect the pelvic region.
A prostatectomy can often cure prostate cancer if it has not spread outside the prostate gland. Prostatectomies are also performed in the treatment of non-cancerous conditions affecting the prostate, such as:
- Benign prostatic hyperplasia , when the gland becomes enlarged and causes urinary problems
- Prostatitis, in which it becomes inflamed
There are several different types of prostatectomy. The prostate surgery option used depends on why the procedure is being performed:
- A radical prostatectomy will be carried out as a treatment for malignant cancer. The surgeon will remove the entire prostate gland as well as the vas deferens, the duct which conveys sperm from the testicals to the urethra, and the seminal vesicles, the glands which hold the liquid which mixes with sperm to make semen.
- A simple prostatectomy, in which only part of the prostate is removed, will be carried out to treat a more benign condition, such as BPH.
Removal of the prostate may result in complications, including impotence, which in most cases is temporary. Several different types of treatment exist to help correct erectile dysfunction after the operation. This is called penile rehabilitation therapy.
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Preservation Of Bone Health In Pca Patients Treated With Adt
Medically induced hypogonadism leads to bone loss and increased risk of fractures. All patients on long-term ADT should therefore be screened for bone mineral density and vitamin D levels should be measured. Daily supplementation of calcium and vitamin D is strongly suggested. Patients should be encouraged to eliminate risk factors for osteoporosis such as smoking and alcohol abuse and to exercise regularly for prevention of bone loss. A phase III trial demonstrated that the use of denosumab significantly increased bone mineral density and reduced the risk of fractures in men under ADT . Similar effects have been shown for the bisphosphonates zoledronate, pamidronate and alendronate, albeit in smaller trials.
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 Are The Chances Of Getting Metastatic Prostate Cancer
About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.
A small percentage of men aren’t diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it’s metastatic cancer when they take a small sample of the tissue and study the cells.
Why Is Radical Prostatectomy Done
Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.
For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:
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Should I Make Any Lifestyle Changes Including In My Diet Or Physical Activity
Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. Both diet and exercise, he says, are things that are under a mans direct control.
A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.
While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.
If youre not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancers growth and keeping you as healthy as possible.
As an oncologist, Tagawa says he concentrates on treating the cancer itself, but hes aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.
And if youre on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.
Should You Worry About An Elevated Psa After Prostate Removal
PSA stands for prostate-specific antigen and is often a very good indicator of how effective treatment has been, in case of prostate removal or other prostate surgeries.
After prostate surgery, the PSA level gets very low, but this result isnt always reliable. Thats why the patient should discuss the expected PSA levels after prostatectomy with their doctor.
A lower PSA level following the removal of the prostate gland is only a part of the overall picture. There are many factors to monitor closely after prostate surgery.
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Medicines To Help Bone Loss
Bones naturally break down and repair themselves. Hormone treatment can make bones break down faster than they are repairing themselves. This makes them weaker.
You might have bisphosphonates if you have cancer that has spread to other parts of your body to help with:
- bone pain
- to help prevent bone thinning
You might also have bisphosphonates if you have osteoporosis and are having hormone therapy to help.
Bisphosphonates move calcium cells from your blood stream into your bone. This helps to keep the bone strong. As you need to keep some calcium in your blood stream, your doctor may give you calcium tablets.
Bisphosphonates include:
- risedronate tablets
- zoledronic Acid – this is a drip that you have into your bloodstream
Denosumab is a different type of drug. It works by stopping the activity of bone cells called osteoclasts. Denosumab can increase bone density to help strengthen the bone. It can be used instead of bisphosphonates to help to reduce fractures in people whose cancer has spread.
Additional Treatment After Surgery
Additional treatment can come with one of two approaches: treatment given as adjuvant therapy , or as salvage therapy . In the modern era, most additional treatment is given as salvage therapy because firstly this spares unnecessary treatment for men who would never experience recurrence, and secondly because the success rates of the two approaches appear to be the same.
Regardless of whether an adjuvant or salvage therapy approach is taken, the main treatment options following biochemical recurrence are:
- Radiotherapy this is the commonest approach. Because scans dont show metastatic deposits until the PSA is more than 0.5 ng/ml and because radiotherapy is more effective when given before this level is reached, the radiotherapy energy is delivered to the prostate bed. This is because we know that this is the commonest site of recurrence in most men, and that 80% of men treated in this way will be cured.
- Active surveillance this is appropriate for a very slowly-rising PSA in an elderly patient who has no symptoms.
- Hormonal therapy in many ways this is the least appealing option as it causes symptoms but does not cure anyone, although it does control the recurrence and lower the PSA.
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Nutrition And Dietary Supplements
Some studies have linked eating a diet that is high in added sugars, meat, and fat to a higher chance of dying from prostate cancer. But eating a Mediterranean diet pattern with foods such as fruits, vegetables, and whole grains, has been associated with a lower chance of dying. So eating a diet rich in fruits and vegetables and lower in animal fats might be helpful, but more research is needed to be sure. We do know that a healthy diet can have positive effects on your overall health, with benefits that extend beyond your risk of prostate or other cancers.
So far, no dietary supplements have been shown to clearly help lower the risk of prostate cancer progressing or coming back. In fact, some research has suggested that some supplements, such as selenium, might even be harmful. This doesnt mean that no supplements will help, but its important to know that none have been proven to do so.
Dietary supplements are not regulated like medicines in the United States they do not have to be proven effective before being sold, although there are limits on what theyre allowed to claim they can do. If you are thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that could be harmful.
If The Cancer Comes Back
If your prostate cancer comes back at some point, your treatment options will depend on where the cancer is, what types of treatment youve already had, and your health. See Treating Prostate Cancer that Doesn’t Go Away or Comes Back After Treatment. For more general information on recurrence, see Understanding Recurrence.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
Keeping Up With Appointments And Screenings
Attending your doctors appointments after youve entered remission is very important. If you need to skip an appointment, you should make another appointment as soon as possible.
Use these appointments as a time to discuss any concerns you may have with your doctor. Your doctor can also conduct tests to check for the cancers return during these appointments.
Two tests to detect recurrent prostate cancer include a digital rectal exam and a PSA blood test. During a DRE, your doctor will insert a finger into your rectum. If your doctor detects something unusual, theyll likely ask for additional follow-up tests. These tests may include bone scans and imaging studies, such as an ultrasound or MRI.
Men often experience side effects from their prostate cancer treatments. Some of these side effects may be immediate and temporary. Others may take several weeks or months to show up and never fully disappear.
Common side effects from prostate cancer treatment include:
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Imaging And Theranostic Of Skeletal Metastasis
The skeletal compartment is the most frequent site of metastases in PCa patients . Bone metastases occupy a nutrient-rich niche that enhances the treatment-resistance of disseminated PCa . Approved agents for palliative therapy of PCa patients with bone metastasis include beta-emitting particles such as strontium chloride and samarium-153-ethylene-diamine-tetra-methylene-phosphonate . However, both options did not improve overall survival and demonstrated limited tolerability due to side effects on the bone marrow and hematopoietic system. On the other hand, alpha-emitting particles including agents such as radium-223 dichloride revealed overall survival benefit and reduced symptomatic skeletal events . The ALSYMPCA trial reported that the application of 223RaCl2 increases median overall survival from 11.3 to 14.9 months and time to develop skeletal-related events from 9.8 to 15.6 months .
How To Handle A Relapse After Treatment For Prostate Cancer
Am I going to die? This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen level has risen after he has already undergone treatment for prostate cancer . The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan.
Thats usually of small comfort to the patient whose PSA has risen. Its emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, its as if theyre dealing with another diagnosis of cancer, except this time its much worse because there is less likelihood of getting cured. A mans confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly.
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How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer: