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Current Treatments For Prostate Cancer

If Treatment Does Not Work

Webinar: Current Treatments in Advanced Prostate Cancer

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

What Tests Check For Prostate Cancer

Common tests to check for prostate cancer include:

  • Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
  • PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
  • A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.

If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.

Note

Prostate Specific Antigen Test

A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by

  • Certain medical procedures.

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Access The Right Treatments At The Right Time

When it comes to treating prostate cancer, it is important to have access to the best expertise possible so you can receive the right treatments at the right time. The University of Maryland Cancer Network gives you the opportunity to connect with the best treatment options available.

Led by the University of Maryland Greenebaum Comprehensive Cancer Center , the UM Cancer Network provides you access to nationally renowned experts, the latest treatments, and promising clinical trials close to home. When you work with a UM Cancer Network cancer center, your community hospital will work in partnership with UMGCCC to help you beat cancer.

Find out more about prostate cancer treatments.

Find an UMMS cancer center near you.

Gleason Score And International Society Ofurological Pathology 2014 Grade

IJMS

In the original Gleason grading system, 5 Gleason grades based on histological tumour architecture were distinguished, but in the 2005 andsubsequent 2014 International Society of Urological Pathology Gleason score modifications Gleason grades 1 and 2 were eliminated . The 2005 ISUP modified GS of biopsy-detected PCa comprises theGleason grade of the most extensive pattern, plus the second most common pattern, if two are present. If one pattern is present, it needs to be doubledto yield the GS. For three grades, the biopsy GS comprises the most common grade plus thehighest grade, irrespective of its extent. The grade of intraductal carcinoma should also beincorporated in the GS . In addition to reporting of thecarcinoma features for each biopsy, an overall GS based on thecarcinoma-positive biopsies can be provided. The global GS takes into account the extent ofeach grade from all prostate biopsies. The 2014 ISUP endorsed grading system limits the number of PCa grades,ranging them from 1 to 5 , in order to:

1.align thePCa grading with the grading of other carcinomas

2.eliminatethe anomaly that the most highly differentiated PCas have a GS 6

3.to furtherdefine the clinically highly significant distinction between GS 7 and 7 PCa .

Table 4.2: EAU risk groups for biochemical recurrence of localised andlocally advanced prostate cancer

Definition

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Radiation Therapy Versus Surgery

In 2014, the Agency for Healthcare Research and Quality found insufficient evidence to determine whether any type of radiation therapy results in fewer deaths or cancer recurrences than radical prostatectomy does in patients with clinically localized prostate cancer. The importance of dose escalation in disease control complicates the extraction of meaningful conclusions from current radiation therapy treatments .

Brachytherapy has also been compared with surgery in the management of early-stage disease. Direct comparisons are not readily available, but preliminary data from most centers suggest that permanent prostate implants yield comparable local control and biochemical disease-free rates.

Valid comparisons of surgery and radiation therapy are impossible without data from randomized studies that track long-term survival rather than PSA recurrence. Variation in radiation techniques and dosage administered the variable use of androgen ablation, which improves survival in intermediate- and high-risk disease and the variable impact on the quality of life complicate comparison using uncontrolled studies.

What Should I Think About When Deciding On Treatment

There are several things to think about when deciding which treatment is right for you. You may want to talk with your doctors about:

  • How likely your cancer is to grow, spread, or cause other problems in your lifetime
  • Which type of treatment might be best for you
  • The trade-offs between possible benefits and possible side effects of the treatments
  • Discussing treatment options with your partner or other family members
  • How often you will need to see your doctor for treatment

Ask your doctors

  • How long may I live with my cancer?
  • How likely is my cancer to grow and spread?
  • Is watchful waiting or active surveillance an option for me?
  • If I use active surveillance, how often should I come in for checkups? What will we do if the cancer starts to grow or spread?
  • Which treatment do you think might be best for me based on my age, risk level, and other health issues?
  • What is the chance that the treatment might help me to live longer?
  • What will my quality of life be with the treatment?
  • What side effects of treatment should I watch for and how will they be managed?
  • How might treatment affect my sex life?
  • If I have surgery to remove my prostate gland, how long might it take to recover?
  • Are there local support groups I can join?

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Genetic Testing For Prostate Cancer

You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.

Chemotherapy For Prostate Cancer

How Theranostics Differs From the Current Prostate Cancer Treatment Options

https://www.youtube.com/embed/O24t-bbE1k4 The decision on when to start chemotherapy is difficult and highly individualized based on several factors: What other treatment options or clinical trials are available. How well chemotherapy is likely to be tolerated. What prior therapies you have received. If radiation is needed prior to…

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Castrate Resistant Prostate Cancer

Eventually, almost all metastatic prostate cancers become resistant to androgen ablation. In patients with castrate serum testosterone levels , castrate-resistant prostate cancer is defined as 2-3 consecutive rises in PSA levels obtained at intervals of greater than 2 weeks and/or documented disease progression based on findings from computed tomography scan and/or bone scan, bone pain, or obstructive voiding symptoms.

Rarely, a rise in PSA may reflect failure of LHRH treatment to control testosterone secretion, rather than the development of castrate-resistant disease. Therefore, the testosterone level should be measured when the PSA rises. If the serum testosterone level exceeds castrate levels, changing the antiandrogen therapy may drop the PSA and delay the need for other therapy.

Prior to the development of the most recent therapies, the median time to symptomatic progression after a rise in the PSA level of more than 4 ng/mL was approximately 6-8 months, with a median time to death of 12-18 months. Since then, however, the latter figure has increased.

Little information is available about the impact of maintaining hormone suppression when androgen-independent progression occurs, but the general consensus among specialists is that the treatment should continue. The reasoning is that tumor cells are still hormone sensitive and may grow faster if the testosterone is permitted to rise.

  • Megestrol
  • Suramin
  • Estrogen

Docetaxel

Prostate Cancer Clinical Trials

As one of the worlds leading cancer centers, MD Anderson is home to many clinical trials for prostate cancer patients. Your care team may discuss clinical trials with you if they believe they offer you a better outcome than standard treatments.

Trials are designed to improve prostate cancer survival rates, minimize treatment side effects and support a higher quality of life for patients. They may include new drugs or drug combinations, new approaches to prostate cancer surgery, different forms of radiation therapy, or some combination of all three. Learn more about clinical trials.

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What Is Focal Therapy

This novel approach to treating prostate cancer destroys the tumor within the prostate. Not all prostate cancers can be treated safely with focal therapy, and this is an ongoing area of research. We do know that high-quality imaging is critical. By visualizing the tumor with precision on MRI scans or other imaging tests, surgeons can use various sources of energy to get rid of the tumor. These include cryoablation , laser ablation, or high frequency ultrasound. High-intensity frequency ultrasound can also destroy the tumor without harming the prostate.

Focal therapy can successfully remove the prostate cancer without damaging the rest of the prostate gland, thus minimizing the risk of urinary or sexual side effects.

What Are The Symptoms Of Prostate Cancer

Castrate Resistant Prostate Cancer Treatment

Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:

  • Frequent, sometimes urgent, need to urinate, especially at night.
  • Weak urine flow or flow that starts and stops.
  • Painful urination .
  • Painful ejaculation and erectile dysfunction .
  • Blood in semen or urine.
  • Lower back pain, hip pain and chest pain.
  • Leg or feet numbness.

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Early Versus Delayed Treatment

In the years following the introduction by Huggins and Hodges of hormone therapy for prostate cancer, early institution of such treatment was recommended, based on comparison with historical controls. Later, the Veterans Administration Cooperative Urology Research Group studies resulted in the recommendation to defer hormone therapy until symptomatic progression occurred this was thought to avoid the promotion of early androgen resistance in prostate tumors.

Subsequently, the controversy of the appropriate timing of ADT was renewed because of the advent of an LHRH antagonist and LHRH agonists. Laboratory studies demonstrated that early hormone therapy does not confer early resistance. Moreover, clinical trials found that it provided significantly longer survival with fewer complications than did deferred treatment.

Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.

Denosumab, a monoclonal antibody, may be used to preventbone metastases.

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Seven 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.

Surgery

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:

How Can I Choose From Among The Options

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In addition to talking with family and friends, you will need a team of physicians to help advise you. It is advisable that you meet with all of the specialists involved in your cancer treatment planning prior to making a decision regarding treatment, including:

  • your primary care physician as well as a urologist to discuss surgery
  • a radiation oncologist to discuss radiation therapy.

Once you have met with these doctors, you will be able to make a more informed decision regarding your treatment options. If you have an early-stage cancer or moderately advanced cancer and there is no evidence of spread to other organs , the two major options for treatment are surgery or radiation therapy .

If your cancer is advanced and you require hormonal suppression therapy or chemotherapy, then you will also need a medical oncologist, who administers these drugs. Hormone-ablation therapy, which is often used to treat more advanced prostate cancer by suppressing your androgen hormones since most prostate cancer growth is stimulated by androgen or testosterone. The androgen suppression treatment can be administered by your internist, urologist, radiation oncologist or medical oncologist. Depending on the stage of the cancer, hormone suppression therapy may be used in addition to radiation therapy to help control the cancer. Hormone suppression therapy may be administered for as little as four to six months, or for as long as two to three years.

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How Common Is Prostate Cancer

Prostate cancer is the most common cancer in men other than skin cancer.

Who is at risk for prostate cancer?

  • Men aged 50 years or older have a higher risk of prostate cancer.
  • Prostate cancer is more common in African Americans.
  • The risk of prostate cancer is higher for men with a history of prostate cancer in their family.

British Columbia Specific Information

Prostate cancer is a cancer of the prostate gland, which is a gland that produces the milky liquid found in semen. Patients with low-risk prostate cancer have a 10-year cancer survival rate of over 99%.

You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.

Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency – Prostate.

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

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