Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
Types Of Chemotherapy Drugs
The most common chemotherapy drug for prostate cancer is docetaxel , which is usually given with prednisone, a steroid medicine. After starting docetaxel, many men experience the improvements in disease-related symptoms, including pain, fatigue and loss of energy.
If docetaxel does not work or stops working, cabazitaxel may be used.
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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How Is Prostate Cancer Diagnosed
Prostate cancer may be suspected based on your symptoms or the results of a screening test.
Screening is when your doctor looks for cancer before you have any symptoms. This can help find cancer at an early stage when it may be easier to treat. Two of the most frequently used screening tests used today include the digital rectal exam and the prostate-specific antigen test.
- A digital rectal exam is an exam of the rectum where the doctor inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or enlargement in the prostate gland.
- A prostate-specific antigen is a blood test that measures levels of PSA in your blood. However, PSA is reasonably nonspecific and high levels may be associated with prostate cancer, prostatitis , or an enlarged prostate gland. Very high levels of PSA .
There is controversy over whether screening tests should be used at all. The USPSTF recommends men aged 55 to 69 have a discussion with their doctor about the pros and cons of PSA screening to determine if it is an appropriate preventive test for them. For men aged 70 and older, the USPSTF does not recommend PSA screening.
The American Cancer Society, recommends early-detection screening starting at age 40 or 45 if men are at high risk or age 50 in men at average risk.
In some cases, a prostate biopsy or imaging test like an ultrasound or magnetic resonance imaging may also be used to rule out cancer.
Study Of Pembrolizumab Plus Docetaxel Versus Placebo Plus Docetaxel In Chemotherapy
Merck is conducting this clinical trial to find out if the investigational medication pembrolizumab in combination with docetaxel and prednisone is safe and works to slow down or stop the growth of metastatic Castrate Resistant Prostate Cancer compared to docetaxel and prednisone alone. Pembrolizumab is a type of immunotherapy, which may help the bodys immune system attack cancer cells. To be eligible for this trial, patients with mCRPC must not have received chemotherapy for mCRPC and have received prior treatment with either abiraterone acetate or enzalutamide . Additional eligibility criteria will apply. Click here to learn more about this trial on the sponsors website.
To learn more about this study and to find out if you may be eligible, please visit:
ClinicalTrials.gov Identifier: NCT03834506
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What Can We Do For You
Scientists at Creative Biolabs are experts in antibody/protein development and antibody/protein-drug conjugation. At present, we provide a full range of ADCs design and construction services against prostate cancer. Our best-quality services include specific antibody development, potent drug or linker-payload production and effective bio-conjugation with unbeatable rapid turnaround times. Targets of ADC development for prostate cancer:
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Surgery For Prostate Cancer
If the cancer has not spread in your body, the whole prostate gland can be surgically removed. This is called a radical prostatectomy.
During the surgery, your surgeon will try to save the two bundles of nerves attached to the prostate that help you get erections. This is only possible if the cancer is not in or close to these nerves.
Sometimes lymph nodes are also removed during the surgery if the cancer has a higher risk of spreading.
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Steroids For Metastatic Prostate Cancer
Steroids can help to reduce the amount of testosterone made in your adrenal glands or they may help to reduce the side-effects of certain drug treatments.
Side-effects from steroids include an increased appetite and mood changes. They can also cause bone thinning, a higher risk of diabetes, fluid retention, and other body changes. Your doctor will check for these side-effects regularly.
Read more about steroids.
What Can Be Done To Treat Or Reduce Side Effects
Once chemotherapy treatment is complete, its side effects will typically cease. However, steps can be taken to combat any side effects as they occur. For instance, medications can help prevent nausea and vomiting, laxatives or stool-binding medications can manage constipation or diarrhea, respectively, and numbing gel can soothe mouth sores. Additionally, chemotherapy dosages can be changed or alternative chemo drugs can be considered, if appropriate.
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Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
Expert Review And References
- American Cancer Society. Treating Prostate Cancer. 2019: .
- American Society of Clinical Oncology. Prostate Cancer. 2020: .
- Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
- Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
- Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatmentand follow-up. Annals of Oncology. 2020: 31: 1119-1134. .
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Duke Cancer Center Offers New Treatment For Metastatic Prostate Cancer
Terence Wong, MD, PhD, and Stacy Wood, a Duke Health nuclear medicine technologist, provides treatment to a patient.
Men with advanced metastatic prostate cancer that has not responded to other treatments may now benefit from a new radiopharmaceutical treatment called PLUVICTOTM . Duke is one of the first cancer centers in the Southeastern region to offer PLUVICTOTM following its FDA approval in March 2022. Studies show it can extend the lives of people with this aggressive form of prostate cancer, even in the late stages, said Terence Wong MD, PhD, a nuclear radiologist at Duke Health.
New Treatment Approved For Late
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
In late March, the FDA approved a new therapy for advanced prostate cancer that is metastasizing, or spreading, in the body. Called Pluvicto , and delivered by intravenous infusion, the treatment can seek out and destroy tumors that are still too small to see with conventional types of medical imaging.
Pluvicto is approved specifically for men who have already been treated with other anticancer therapies, including chemotherapy and hormonal therapies that block the tumor-promoting hormone testosterone. The drug contains two parts: one that binds to a protein on prostate cancer cell surfaces called PSMA, and a radioactive particle that kills the cancer cells. Most normal cells do not contain PSMA, or do only at very low levels. This allows Pluvicto to attack tumors while sparing healthy tissues.
To confirm whether a man is eligible for the drug, doctors first inject a radioactive tracer that travels the bloodstream looking for and then sticking to PSMA proteins. Cancer cells flagged by the tracer will show up on a specialized scanning technology called positron-emission tomography. About 80% of prostate cancer patients have PSMA-positive tumors for those who do not, the treatment is ineffective.
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Can I Take Nubeqa If I Have Liver Or Kidney Problems
Yes, but your doctor may prescribe a lower dosage of Nubeqa. The dosage will depend on the condition of your kidneys or liver.
Your kidneys and liver help remove Nubeqa from your system. So if you have certain kidney or liver problems, your body may not be able to remove the drug as well as usual. Examples of these problems include chronic kidney disease and hepatitis.
Before you start taking Nubeqa, tell your doctor if you have any kidney or liver problems. Your doctor may order a blood test. This will check the function of your kidneys and liver to see whether its safe for you to take Nubeqa.
For more information, see the Nubeqa precautions section below. If you have other questions about whether Nubeqa is right for you, talk with your doctor.
Medications For Prostate Cancer
Other names: Cancer, Prostate Carcinoma of Prostate
Prostate cancer is a cancer that occurs in the prostate, which is a small, walnut-sized gland that is located just below the bladder in men and which surrounds the urethra .
Prostate cancer is common, and many men have a slow-growing form of prostate cancer. Death, when it happens, is usually from other causes rather than the cancer itself. However, some prostate cancers are aggressive and can quickly spread outside the confines of the prostate. These are associated with a lower rate of survival.
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Stages Of Prostate Cancer
If cancer is found in the prostate, the doctor needs to know the stage or extent of the disease.The most widely used staging system is the AJCC TNM staging system. This is based on five key pieces of information:
Prostate cancer staging can be complex, and you should ask your doctor or somebody on your cancer care team to explain it to you in an easy-to-understand way.
Side Effects Of Chemotherapy
All chemotherapy drugs work in slightly different ways, making it challenging to predict side effects for individual patients. Dosages, drug combinations and drug responses will vary from patient to patient.
The American Cancer Society lists the following as the most common side effects of chemotherapy:
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Increased risk of infections
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Easy bruising or bleeding
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Treatment To Lower Androgen Levels From Other Parts Of The Body
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.
Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.
Abiraterone can be used in men with advanced prostate cancer that is either:
- Castration-resistant
This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.
Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.
Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .
Chemo Drugs Used To Treat Prostate Cancer
For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer include:
In most cases, the first chemo drug given is docetaxel, combined with the steroid drug prednisone. If this does not work , cabazitaxel is often the next chemo drug tried .
Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They may slow the cancers growth and also reduce symptoms, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.
Other chemo drugs being studied for use in prostate cancer include carboplatin, oxaliplatin, and cisplatin.
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Side Effects Of Parp Inhibitors
Side effects of these drugs can include nausea, vomiting, diarrhea, fatigue, loss of appetite, low red blood cell counts , constipation, skin rash, abnormal liver blood tests, low blood platelet counts, cough and shortness of breath. Rarely, some people treated with these drugs have developed a blood cancer, such as myelodysplastic syndrome or acute myeloid leukemia. Some men taking olaparib had problems with blood clots in the lungs or legs.
Possible Side Effects Of Chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Some common side effects can include:
- Increased chance of infections
- Easy bruising or bleeding
These side effects usually go away once treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.
Along with the risks above, some side effects are seen more often with certain chemo drugs. For example:
- Docetaxel and cabazitaxel sometimes cause severe allergic reactions. Medicines are given before each treatment to help prevent this. These drugs can also damage nerves , which can cause numbness, tingling, or burning sensations in the hands or feet.
- Mitoxantrone can, very rarely, cause leukemia several years later.
- Estramustine carries an increased risk of blood clots.
If you notice any side effects while getting chemo report them to your cancer care team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.
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Side Effects Of Hormonal Therapy
Side effects can happen with any type of treatment for cancer, but everyones experience is different. Some people have many side effects. Other people have few or none at all.
If you develop side effects, they can happen any time during, immediately after or a few days or weeks after hormonal therapy. Sometimes late side effects develop months or years after hormonal therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of hormonal therapy will depend mainly on the type of hormonal therapy, the dose of a drug or combination of drugs and your overall health.
It is important to report side effects and your concerns about side effects to the healthcare team. Doctors may measure how severe certain side effects are. Sometimes hormonal drug therapy may need to be adjusted if side effects are severe.
The following are the most common side effects that people tend to experience with hormonal therapy.