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Can Stage 4 Prostate Cancer Be Treated

What Are Prostate Cancer Survival Rates By Stage

How is stage 4 prostate cancer treated? – Dr. Anil Kamath

Staging evaluation is essential for the planning of treatment for prostate cancer.

  • A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
  • Further testing and calculations may be performed to best estimate a patientâs prognosis and help the doctor and patient decide upon treatment options.

Prognosis refers to the likelihood that the cancer can be cured by treatment, and what the patientâs life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.

If a cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If the cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival based again on group statistics for people who have been in the same situation.

Nomograms are charts or computer-based tools that use complex math from analysis of many patientsâ treatment results.

The prognosis for prostate cancer varies widely, and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and the cancerâs responsiveness to treatment, among other factors.

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Intermediate Risk Group Treatment Options

Intermediate-risk prostate cancer refers to tumors that havent spread outside the prostate, but have a Gleason score of 7 and medium PSA levels . Treatment aims to reduce the risk of metastasis to other parts of the body. In this risk group, treatment options include:

  • Radiation therapy or brachytherapy, often with ADT
  • Radical prostatectomy with pelvic lymph node dissection
  • Active surveillance, though the risk for cancer spreading is higher than in very low and low risk groups, so many doctors discourage this option

Patients will be monitored closely with PSA testing if levels rise, radiation therapy may be recommended.

Prostate Cancer Stage I Treatment Options

Stage I prostate cancer is often called localized, meaning it has not spread and remains contained within the prostate, usually taking up less than one half of one side of the gland. It is probably slow growing and cannot be felt by the doctor with a digital rectal exam . The cancer cells resemble healthy cells and PSA levels remain normal.

Treatment options for stage I prostate cancer includes:

  • Prostatectomy, which is surgery to remove the prostate gland.
  • Radiation therapy, which uses targeted high-energy beams to kill prostate cancer cells. Often combined with a hormone treatment called androgen deprivation therapy .
  • Brachytherapy, in which radioactive pellets are implanted in the prostate gland to kill cancer cells.
  • Active surveillance, an alternative chosen by a growing number of men, who elect to forego immediate treatment. Instead, a man who chooses active surveillance is closely monitored by a doctor, who uses frequent PSA tests and other exams to monitor his health and determine if a tumor has begun to grow or spread. If so, the man can opt to receive prompt treatment.

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How Is A Recurrence Detected

After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.

When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.

Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.

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Prostate Cancer Stages

Current expert guidelines for treatment of localized prostate carcinoma recommend potentially curative therapy for patients whose life expectancy is at least 10 years., Patients with limited life expectancy are more likely to die from health conditions other than prostate cancer. Men with a life expectancy of more than 10 years are more likely to die from progressive prostate cancer. This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.,

Conservative management proved to be an acceptable treatment option for men with low-grade Gleason scores, clinically localized disease, and life expectancies of less than 10 years. Increasing age was described as a risk factor for receiving inadequate treatment for prostate cancer. Thus, older men have been shown to receive potentially curative therapy less often than younger men., Radical prostatectomy is preferred treatment in men younger than 70 years, whereas radiation therapy is applied predominantly in patients older than 70 years. Conservative therapy such as watchful waiting or androgen deprivation by luteinizing hormone-releasing hormone analogs is preferentially applied in men older than 80 years. Watchful waiting or hormonal therapy is used to treat 82% of men older than 80 years.

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Prostate Cancer Risk Group Treatment Options

When prostate cancer is still in the early stages and has not spread throughout the body, doctors sometimes use risk groups to guide decisions about testing and treatment. Risk groups incorporate information about a tumors growth, PSA level, Gleason score , and prostate biopsy results to classify the extent of the disease. Prostate cancers can be categorized in one of the following risk groups:

Treatments For Stage 4 Prostate Cancer:

Stage-4 prostate cancer is not curable for most patients as the cancer cells spread to other organs and lymph nodes. But it can decrease the signs of ailment and increase the life span of patients. Patients usually live for 4-5 years if prostate cancer has reached the 4th stage before diagnosis.

The following treatments are available which are suggested to different patients depending upon their condition.

Hormone therapy:

Hormone therapy is the most used treatment for stage-4 prostate cancer. In this treatment, the body of the patient is compelled not to produce hormones like testosterone. Prostate cancer cells get help from testosterone to grow and spread in the body. Therefore, it becomes important for the doctors to reduce the production of testosterone by using different medicines.

Hormone therapy for stage-4 prostate cancer may be combined with other treatments like chemotherapy or radiation therapy. It is rarely followed by the surgery. Doctors decide the combination depending on the health of the patient.

The following types of treatments are included in Hormone therapy.

Radiation therapy:


It is not a commonly used treatment for stage-4 prostate cancer. It is rarely suggested by doctors. Surgery is recommended to those patients who are experiencing symptoms like difficulty in the urine. It includes the following treatments.

Radical prostatectomy:

Removal of a lymph node:

Palliative care:


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What Happens To Palliative Care In Stage 4 Cancer Treatment

Palliative medicine is medical care that provides pain relief and other symptoms associated with severe illnesses. Palliative care specialists will work with your family and other doctors to offer additional support. Stage 4 cancer treatment and diagnosis are essential before palliative care.

Every cancer patient shall take palliative care during the cancer treatment. Palliative care services are provided by specially trained nurses, doctors, and other professionals. Palliative care teams help to improve the quality and life of people living with cancer and their families.

Survival Of Prostate Cancer

Living with advanced prostate cancer

Survival depends on many factors. No one can tell you exactly how long you will live.

Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.

Survival for prostate cancer is generally good, particularly if you are diagnosed early.

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What Is Prostate Cancer Immunotherapy Is Prostate Cancer Immunotherapy Available In Delhi India

Immunotherapy works by stimulating the bodys own immune system to kill cancer

Immunotherapy is a new revolution in cancer treatment. Immunotherapy works by stimulating the bodys own immune system to kill cancer cells. This allows it to exert powerful action with minimum side-effects. Thus one can produce dramatic results even in hopeless cases. This is an area of furious research in prostate cancer. At present immunotherapy is generally used in patients with limited options. This is expected to change rapidly in future.


Treatments For Prostate Cancer

If you have prostate cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for prostate cancer, your healthcare team will consider:

  • the type and stage of the cancer
  • the grade or Gleason score
  • prostate-specific antigen levels
  • possible side effects of treatments
  • your personal preferences
  • your overall health and any existing medical conditions
  • your age and life expectancy
  • whether you have symptoms

Prostate cancer treatments can seriously affect your quality of life and cause side effects such as erectile dysfunction and incontinence . Many prostate cancers grow slowly and cause no symptoms or problems.

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What Is Chemotherapy Is It Useful In Prostate Cancer

Chemotherapy is drugs that directly kill cancer cells. Chemotherapy is very effective in prostate cancer. In fact, just a few months of chemotherapy can sometimes control stage 4 prostate cancer for many years. Prostate cancer chemotherapy generally does not have many side effects and is safe and effective even for elderly men.

First Line Treatment For Advanced Prostate Cancer

Prostate cancer metastasis  Stock Vector © natsuk77 #9627572

The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.

There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.

Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.

Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.

Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.

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Treatments To Control And Prevent Symptoms Caused By The Spread Of Prostate Cancer To The Bones

Palliative External beam radiotherapy

Radiopharmaceuticals: Strontium-89 , samarium-153

Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment.

Zolidronic acid a bisphosphonate given by a 15 minute intravenous infusion every 34 weeks. It reduces the risk of bone complications, including pain and fractures.

Xgeva : this is a newly licensed drug available at BPC.

Pain medications

Surgery may be undertaken to treat bone fractures or to relief the pressure on the spinal cord by bone metastases.

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Eight Types Of Standard Treatment Are Used:

Watchful waiting or active surveillance

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.

Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.

Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.

Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.


Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:

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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.

Experimental Treatments For Advanced Prostate Cancer

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Researchers are currently testing many new approaches and treatments for prostate cancer, including new medications. These include the following:

Immune checkpoint inhibitors

The immune system uses âcheckpointsâ to stop it from attacking the bodyâs healthy cells. These checkpoints are proteins on immune cells.

Cancer cells often use these checkpoints to keep the immune system from attacking them.

Immune checkpoint inhibitors are drugs that can these checkpoints on cancer cells. Inhibiting these checkpoints can allow a personâs immune system to attack the cancer cells.

Chimeric antigen receptor T cell therapy

This treatment involves taking immune cells from the personâs blood. A scientist then alters these cells in a lab to have receptors called chimeric antigen receptors on their surface.

These receptors help the cells attach to proteins on the surface of prostate cells. A scientist then multiplies these altered T cells in a lab before putting them back into the personâs blood.

Scientists hope these T cells can then find prostate cancer cells and launch a targeted immune attack.

However, this treatment is complicated and may have some serious side effects. This means it is currently only available as part of clinical trials.

Targeted drug therapies

Targeted drug therapies can act on specific parts of cancer cells and the environments surrounding them.

These drugs

Two possible targeted therapy treatments are:

Treating prostate cancer that has spread to the bones

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Metastatic Prostate Cancer Symptoms

With metastatic prostate cancer, you may notice different symptoms than those generally associated with other stages of the disease. Some of the most frequently occurring symptoms include:

  • Bone pain, particularly in the pelvis, ribs, skull and spine
  • Unexplained weight loss
  • General feeling of being unwell
  • Changes in urinary habits, such as needing to go more often
  • Cough, breathlessness or other changes involving your lungs and chest

Not everyone with metastatic prostate cancer will experience each of these symptoms, but you should speak with your care team if you notice any such changes.

Surgery For Metastatic Prostate Cancer

Unlike with localized prostate cancer, surgery isnt usually used to treat metastatic cancer. However, it may be used in some cases if it can help improve a patients quality of life, often to resolve urinary problems or stop bleeding.

If your cancer is locally advanced and hasnt spread far, a radical prostatectomy may still be an option. A radical prostatectomy is a surgical procedure in which the prostate is removed, along with any nearby tissue that contains prostate cancer cells.

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What Is Prostate Cancer

Prostate cancer is cancer that affects the prostate gland in men. Prostate cancer is the second-leading cause of cancer deaths for men in the US.

Growth in the prostate can be of two types

  • Benign growths: These are noncancerous growths and are rarely a threat to life. For example, benign prostatic hyperplasia.
  • Malignant growths: These are cancerous growths that can sometimes be life-threatening.
  • 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.

    What Are Next Steps

    Prostate Cancer Stages Treatment

    Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But its important to remember that the numbers are only statistics.

    The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.

    Everyones cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.

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