Standard Treatment Options For Stage Iii Prostate Cancer
Standard treatment options for patients with include the following:
External-beam radiation therapy with or without hormonal therapy
EBRT alone, luteinizing hormone-releasing hormone agonist, or orchiectomy, in addition to EBRT, should be considered. Definitive radiation therapy should be delayed until 4 to 6 weeks after transurethral resection to reduce the incidence of stricture.
Hormonal therapy should be considered in conjunction with radiation therapy especially in men who do not have underlying moderate or severe comorbidities. Several studies have investigated its utility in patients with locally advanced disease.
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Standard Treatment Options For Stage Ii Prostate Cancer
Standard treatment options for patients with include the following:
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent. .
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Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radical prostatectomy may be difficult after a transurethral resection of the prostate .
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What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
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Prostate Cancer Risk Assessment
Prostate cancer represents a wide spectrum of disease. Some prostate cancers progress and need treatment, while others grow slowly, if at all, and can be managed conservatively with a system of careful monitoring called active surveillance. It is important to learn the characteristics of your cancer before making treatment decisions. There are many ways to determine prostate cancer risk, most of which incorporate information from several parameters, including the PSA, Gleason score and tumor extent .
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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Stage Ii Of Prostate Cancer:
In this stage, the cancer has spread within the prostate involving one or both the lobes of the prostate. These cancers do not spread beyond the prostate to nearby lymph nodes or other organs. Stage II of prostate cancer is broadly categorized into three further stages:
Stage IIA:
Here, the cancer has spread upto one complete lobe of the prostate. The Gleason score of these cancer is 6 or less than 6 and PSA levels are between 10 and 20.
When the cancer is found during biopsies, and not through general diagnostic tests, it is staged as cT1, N0, M0 Grade Group 1.
When the cancer can be found to be confined to one half of a lobe of the prostate, through screening or physical examinations and has not metastasized, it is staged as cT2a or pT2, N0, M0, Grade Group 1.
If the cancer is contained in more than half of one lobe of the prostate, but has not spread, it is staged as cT2a or pT2, N0, M0, Grade Group 1.
Stage IIB:
In this stage, the cancer has not spread beyond the prostate, but is contained in more than one lobe of the prostate, with a Gleason score of 7 and PSA levels up to 20. It is staged as T1 or T2, N0, M0, Grade Group 2.
Stage IIC:
This stage of stage II cancer is staged as T1 or T2, N0, M0, Grade Group 3 or 4 with a Gleason score of 7 or 8 and PSA levels less than 20. They are spread within the prostate, with the cancer contained in both the lobes.
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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How Is Prostate Cancer Treated
In many cases, treatment is not immediately necessary.
If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted. This involves carefully monitoring your condition.
Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy.
Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.
All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary incontinence. For this reason, many people choose to delay treatment until there is a risk the cancer might spread.
Newer treatments, such as high-intensity focused ultrasound or cryotherapy, aim to reduce these side effects. Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy. However, the long-term effectiveness of these treatments are not yet known.
Read more about treating prostate cancer
Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
- a chemotherapy nurse
- a diagnostic radiographer
- a therapeutic radiographer
- other health professionals, such as a dietitian or physiotherapist.
Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.
Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.
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Hormone Therapy For Prostate Cancer
Also known as androgen suppression therapy, the purpose of hormone therapy is to mitigate the influence of any prostate cancer. What happens is that prostate cancer cells are feeding on male hormones in order to grow. Using hormone therapy, the body puts a stop on supplying cancer with what it requires in order to grow.
Nonetheless, hormone therapy is not a cure for prostate cancer. Doctors can recommend this procedure when the cancer has spread too far or before chemotherapy in order to shrink the tumor and maximize the efficiency of the treatment.
Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.
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Does It Matter Where Treatment Is Performed
A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We don’t have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.
White Patients Derive A Larger Conditional Mortality Benefit Than Non
In order to determine whether race interacted with survival, we repeated our initial analyses after stratifying by race and by modeling an interaction term. Among patients with M1 disease, conditional mortality was similar between white and non-white patients . However, among patients with N1 disease, non-white patients did not have a significant reduction in conditional mortality at 5, 10, or 15 years of survival compared to diagnosis , while white patients had similar mortality as the overall cohort, with adjusted hazard ratios of 1.10 , 0.898 , and 0.712 , respectively. While non-white patients with T4 disease had improved 5-year PCSM after having survived 5, 10, or 15 years, their improvements were 20-39 % smaller than those of white patients .
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Grade: How Aggressive Is The Cancer
The pathology team will take a biopsy sample and prepare it with chemicals, then make extremely fine slices of the tissue to examine under the microscope. If prostate cancer is found when looking at biopsied tissue under a microscope, the pathologist assigns a grade to the cancer. There are 2 grading systems currently in use, which can be confusing for patients.
The classical grading system for prostate cancer is called the Gleason score, which ranges from 6 to 10 .
In 2014, the World Health Organization reorganized the Gleason score with the simpler Grade Group system, ranging from 1 to 5 .
Many medical centers report both the Gleason score and the Grade Group, but there may be some that still only report the old Gleason system.
Both systems attempt to communicate a variety of factors in a way that allows the medical team to communicate and compare cases and strategize treatments.
Standard Treatment Options For Stage I Prostate Cancer
Standard treatment options for patients with include the following:
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Evidence :
Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radicalprostatectomy may be difficult after a transurethral resection of the prostate .
Because about 40% to 50% of men with clinically organ-confined disease are found to have pathologic extension beyond the prostate capsule or surgical margins, the role of postprostatectomy adjuvant radiation therapy has been studied.
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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.
Immunotherapy For Prostate Cancer
Immunotherapy is a cure for prostate cancer in the shape of a vaccine. This treatment relies on training the patients white cells into recognizing and fighting prostate cancer cells.
On the other hand, this care plan is not an ideal fit for any stage of prostate cancer. On the contrary, immunotherapy usually works by increasing the survival span in patients with advanced cases where the symptoms are sparse or none at all.
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Hormone Therapy With Radiation
Prostate cancer cells need testosterone to grow. Hormone therapy aims to drastically lower testosterone levels to slow the cancer’s progression. Although it does not cure the cancer on its own, hormone therapy improves the effectiveness of radiation for high-risk disease and is often recommended in conjunction with radiation therapy for men with intermediate- or high-risk localized disease. However, hormone therapy may have significant side effects. These include loss of libido , hot flashes , changes in mood or memory, loss of bone and muscle density, body fat gain, and adverse effects on sugar or cholesterol metabolism. When offered as short-term therapy in conjunction with radiation, it is often well tolerated. How long a patient should receive hormone therapy remains controversial and depends on how aggressive his cancer is.
Learn more about hormone therapy.
Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
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