Watchful Waiting And Active Surveillance
Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities.26,27 Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery.26 For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.
Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression.27,28 This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.
Screening For Prostate Cancer
At UCSF, we believe in testing men so they know if they have prostate cancer, but that doesn’t mean every man diagnosed should have aggressive treatment. Screening is the only way to detect high-risk, potentially life-threatening prostate cancer early, while it can still be cured.
Most prostate cancers in the U.S. are identified through the following screening tests:
- Prostate-specific antigen . This simple blood test checks levels of prostate-specific antigen, a protein produced by prostate cells. The higher the PSA level, the more likely prostate cancer is present. But PSA elevations can also occur in benign conditions, most commonly benign prostatic hyperplasia, in which the prostate enlarges, as occurs in most men over their lifetime.
- Digital rectal exam . For this physical examination, your doctor inserts a lubricated gloved finger into your rectum to feel for any irregular or abnormally firm areas. While most prostate cancers are detected by PSA screening, some cancers produce little PSA but are detected by DRE.
In some circumstances, your doctor may order a repeat PSA or other tests to help determine whether a benign condition led to an elevated PSA. These tests may include:
- Multiparametric MRI
An MRI exam of the prostate is helpful and can allow for a more targeted biopsy.
What Is The Life Expectancy Of Someone With Prostate Cancer
Rasheeda Slaydon asked, updated on May 1st, 2022 Topic:
The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with prostate cancer is 98%. The 10-year survival rate is also 98%.
At any event, does anyone survive stage 4 prostate cancer?
The survival rate in most people with advanced prostate cancer is 30 percent at the fifth year of diagnosis. This means around 70 percent of the diagnosed men are not alive in the fifth year after diagnosis. Most advanced-stage prostate cancer is diagnosed in older men.
In addition to this, how long can a man live with prostate cancer without treatment? The life expectancy is as follows: Almost 100% of men who have early-stage prostate cancer will survive more than 5 years after diagnosis. Men with advanced prostate cancer or whose cancer has spread to other regions have lesser survival rates. About one-third will survive for 5 years after diagnosis.
For this reason, is Stage 3 prostate cancer a death sentence?
Itâs bad news, but it isnât likely to be a death sentence. Thanks to widespread screening, nearly 90 percent of prostate cancers are detected before they spread beyond the gland. At this point, the disease is highly curable, meaning that after five years men who have undergone treatment remain cancer-free.
Is stage 5 prostate cancer bad?
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Is Prostate Cancer Curable
Prostate cancer is the most common type of cancer among men, second only to skin cancer. Learning that one has any type of cancer isnt easy, but the first question on most patients minds after diagnosis is, is prostate cancer curable?
The short answer is yes, prostate cancer can be cured, when detected and treated early. The vast majority of prostate cancer cases are discovered in the early stages, making the tumors more likely to respond to treatment. Treatment doesnt always have to mean surgery or chemotherapy, either. Non-invasive radiation therapy can effectively treat prostate cancer in the case of Pasadena CyberKnife, radiosurgery treatment generally takes less than a week, and you can typically resume your normal activities the same day you receive treatment.
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Outlook For Locally Advanced Prostate Cancer
Many men with locally advanced prostate cancer have treatment that aims to get rid of their cancer. For some men, this treatment can be very successful and they may live for many years without their cancer coming back or causing them any problems. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment. Read more about the risk of your cancer coming back.
Some men with locally advanced prostate cancer will have treatment that aims to help keep their cancer under control rather than get rid of it completely. For example, if you have hormone therapy on its own, it can help to keep the cancer under control, usually for several years. And there are other treatments available if your hormone therapy stops working.
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How Long Can You Live Without Prostate Cancer Treatment Topic Guide
How Long Can Someone Live With Stage 4 Cancer
Doctors usually describe a persons outlook using the 5-year survival rate. These are calculated based on data from thousands of other people with a similar cancer at a similar stage.
The original location of the cancer determines its type. Survival rates vary, depending on the type of cancer and how far it has spread within the body.
Below, we describe the survival rates for some of the most common forms of cancer in stage 4:
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Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men withstress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. Itâs usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
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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Take Time To Make A Treatment Decision
Most prostate cancers grow relatively slowly, so immediate treatment is rarely necessary. Many men can safely take months to decide what to do. The decision process can be complicated. The chosen treatment can significantly affect your life, which makes it especially important to take time to educate yourself and confidently choose the approach that is most appropriate for you.
How Common Are Prostate Problems
A mans prostate is prone to several problems, especially as men get older. Heres a brief look at each one:
- Benign prostatic hyperplasia
One common problem is a noncancerous condition called benign prostatic hyperplasia or BPH. As men age, the prostate grows larger, putting pressure on the urethra and causing annoying urination issues. By age 60, BPH will affect about half of all men, and by age 85, nearly 90% of men will develop it. If the prostate becomes too large, men will have symptoms such as urinary urgency and frequency, nighttime trips to the bathroom, and possibly erectile dysfunction.
Prostatitis is an inflammation or infection of the prostate gland and is also considered a benign condition. However, it is another common prostate issue affecting up to half of all men during their lifetime. Prostatitis can affect men at any age, but it mainly affects men aged 50 or younger.
- Prostate Cancer
The most worrisome and potentially life-threatening problem affecting the prostate is prostate cancer. Annually, close to 270,000 men will be diagnosed with prostate cancer making it the second most common cancer found in men, after skin cancer. About 1 in 8 men will receive a prostate cancer diagnosis over their lifetime. Prostate cancer primarily affects men age 65 and older and is rarely found in men younger than 40.
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Survival Rates By Tnm Stage
The first approach is based on the TNM stage statistical survival times are matched to the stage of the disease.
| TNM Lung Cancer Stage | |
|---|---|
| M1c | 6.3 months |
By contrast, the one-year survival rate for stage 4 lung cancer was reported in one study to be between 15% and 19%, meaning this portion of patients with metastatic disease lived for at least a year.
What Is My Outlook
If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.
While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.
No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.
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What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.
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Dealing With Bladder Removal
Removal of the bladder will affect your normal pattern of life. There will be changes in the way that you will pass urine. You may also experience problems such as incontinence at night or leaking of urine at any time of the day. Living without a bladder may not only affect your social life but may also affect your sexual life.
Make sure that you will master the techniques on how to properly manage yourself when it is time to pass urine. Learn how to appropriately use the pouches and carefully follow the steps to carry out the urine draining procedures. In addition, you can improve your sexual life through the following ways:
- Empty the pouch and fixing it correctly before sexual intercourse.
- Use a pouch cover.
- Choose sex positions that will keep your partners weight from overlying the pouch.
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Staging Spread And Survival Rates
As with all cancers, doctors use the term stage to describe the characteristics of the primary tumor itself, such as its size and how far prostate cancer has spread when it is found.
Staging systems are complicated. The staging system for most cancers, including prostate cancer, uses three different aspects of tumor growth and spread. Its called the TNM system, for tumor, nodes, and metastasis:
- T, for tumor describes the size of the main area of prostate cancer.
- N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
- M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.
Using the TNM system, each mans prostate cancer can be described in detail and compared to other mens prostate cancer. Doctors use this information for studies and to decide on treatments.
As far as survival rates for prostate cancer go, however, the staging system is pretty simple. As weve mentioned, in terms of survival rates, men with prostate cancer can be divided into two groups:
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About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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Focal Ablation And Active Surveillance May Control Prostate Cancer
Organ-sparing surgery for prostate cancer has the potential to circumvent the side effects of radical prostatectomy, but whether it would control disease has been unclear, since prostate cancer is typically multifocal. A team led by Dr. Lepor has recently demonstrated that in select patients, focal ablation may achieve an acceptable level of disease control when paired with careful postsurgical monitoring.
The study, published online in Urology in October 2017, relied on rigorous MRI-guided prostate mapping to identify 59 men who were candidates for focal ablation but chose radical prostatectomy between 2012 and 2016. The criteria included a single reported MRI lesion concordant with a biopsy Gleason score less than eight, no gross extraprostatic extension on MRI, no GS above six or six with a core length greater than five millimeters contralateral to the reported MRI lesion.
Skeptics of focal ablation should remember that more than half of men whose low-risk disease is managed with active surveillance have undiagnosed Gleason pattern 4 disease, says Dr. Lepor. Ultimately, the efficacy of focal ablation will need to be confirmed through randomized control studies comparing it with other treatment options, he adds.
Advanced MRI identifies optimal cases for focal ablation.
Psa And Gleason Score
Two other important factors that doctors and specialists use to assess cancer cells are the prostate specific antigen and the Gleason score.
PSA levels: PSA is a protein that appears in higher levels in the bloodstream when there is a problem with the prostate. Normally, PSA levels in the blood are very low, and a test cannot detect them. However, in some circumstance, such as prostate cancer, PSA levels start to rise.
Screening for prostate cancer uses a blood test for PSA. If PSA levels are high, the doctor may recommend further tests to see if prostate cancer is present.
There are various other reasons why PSA levels may rise, including sexual stimulation or an infection.
The grade and Gleason score: Different types of cancer cell act differently. Some types, or grades, are more aggressive and can spread more easily. The Gleason score and grade are different measures, but they both reflect how likely it is that a tumor will spread, and how quickly it will do so. Either a biopsy or surgery can determine the types of cancer cells present in the prostate tissues.
Nearly 50% of males have a condition known as prostatic intraepithelial neoplasia by the time they are 50 years old. PIN is when there are changes in the cells that line the prostate gland.
High grade PIN is not cancer, but the cells can become cancerous in the future. For this reason, a doctor may recommend treatment to remove the cells.
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