Early Stage Prostate Cancer Treatment

Causes Of Early Prostate Cancer

Certain things called risk factors may increase the risk of developing prostate cancer. If you are Black, you have a much higher risk of developing prostate cancer. You are also more likely to develop it at a younger age. Having a strong family history of prostate cancer is also a risk factor.

We have more information about the risk factors of prostate cancer.

Related Stories & Media

You usually start by seeing your GP to have your symptoms checked. Your GP usually arranges some tests. The first tests used to diagnose prostate cancer are:

• Rectal Examination

  The doctor gently inserts a gloved finger into your back passage . The rectum is close to the prostate gland so your doctor can feel for anything unusual in the prostate. A rectal examination test is quick and it should not be painful. It is also sometimes called Digital Rectal Examination .

• PSA test

  The PSA test is a blood test to measure the level of prostate-specific antigen in your blood. Prostate cancer often causes a raised level of PSA. But different things such as non-cancerous prostate conditions and getting older can also increase your PSA.

If your PSA level is raised or your rectal examination is unusual your GP refers you to a specialist doctor . Your GP may test your PSA level again if it is raised but your prostate feels normal.

Complementary And Alternative Care Approaches

In addition to standard types of prostate cancer treatments, there are other approaches that patients may choose during their treatment for their disease.

Some of these treatments are called complementary treatments and may help with control of symptoms or problems the patient may be experiencing. Examples of these include acupuncture for pain control, yoga and meditation for relaxation, as well as guided imagery, aromatherapy, and other techniques. Tell your doctors about all treatment approaches you are engaged in. These approaches usually will be of no harm to you, and may be very beneficial. Knowing what you are doing may help your doctor to better understand and coordinate your treatments and medications.

Herbal therapies have been demonstrated in the lab to affect prostate cancer cells, but in many cases, have not been proven to be clinically effective. PC-SPES is an herbal therapy that has been used in the past for prostate cancer, for example. It was associated with an increased risk of blood clots. Thus, prior to taking this or other herbal therapies, discuss these therapies with your doctor.

Prostate cancer patients, like all cancer patients, are frightened. Discuss your anxiety and concerns with your primary care doctor, urologist, and radiation and medical oncologists. They have many ways to help.

Observation And Active Surveillance Of Prostate Cancer

These two options are not the same. Both observation and active surveillance therapies share in common the decision up front to hold on treatment of the cancer and to follow the cancer periodically to determine if there is progression. Observation involves monitoring the course of the prostate cancer with the goal of treating the cancer with palliative care for the development of symptoms or changes in physical examination or PSA, that suggest that symptoms will develop soon. Observation treatment is not trying to cure the cancer, rather to treat symptoms of cancer progression. Thus, observation treatment is preferred for men with low-risk prostate cancer and with a life expectancy of less than 10 years.

Active surveillance involves actively monitoring the course of the prostate cancer with the intent to intervene, with the intention to cure if the cancer appears to be progressing. Active surveillance is preferred for men with very low risk prostate cancer and a life expectancy of < 20 years. Cancer progression may have occurred if a repeat biopsy shows a high Gleason score or if cancer is found in a greater number of the biopsies or a greater extent of the core compared to prior biopsy.

Observation has advantages and disadvantages. From an advantage standpoint, observation avoids/delays the possible side effects of treatment. There is, however, the risk of troubles urinating or bone fractures occurring before treatment is started.

Recommended Reading: Side Effects Of Having Prostate Removed

How Is Prostate Cancer Treated

Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are

• Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
• Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
• Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.

Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.

Radiation therapy. Using high-energy rays to kill the cancer. There are two types of radiation therapy

External radiation therapy. A machine outside the body directs radiation at the cancer cells.

Internal radiation therapy . Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.

What About Trans People

People born with a prostate can develop prostate cancer. Individuals born without a prostate cannot develop prostate cancer.

Trans women who use hormone therapy such as estrogen may have a lower risk, but the risk is still present.

Anyone born with a prostate should speak to their doctor about screening for prostate cancer.

Read Also: Prostate Cancer Prognosis By Age

Chemotherapy For Prostate Cancer

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 …

Get the Free Prostate Cancer Patient Guide here

Enter your email address to get the free pdf

Advances In Radiation Therapy For Prostate Cancer

The last 20 years have brought significant improvements in the ability to deliver radiation therapy in ways that spare normal tissues from radiation exposure, while reducing toxicities caused by treatment.

The delivery of external beam radiation therapy , the most commonly used radiation therapy, is more precise today than ever. Technological developments, such as image guidance and intensity modulated radiation therapy , allow us to closely target cancerous tissue while avoiding healthy tissue. Increasing the intensity of radiation at the same time translates into a shorter course of radiation treatment. A typical course of treatment used to require 40-45 daily treatments. Now, 25-28 is a common number.

Internal radiation therapy, known as brachytherapy, allows radiation to be delivered from inside the body using devices placed inside and/or close to the prostate. High-dose rate brachytherapy uses a single radioactive pellet inserted via catheters to deliver high doses of radiation in a few treatments. Low-dose brachytherapy is usually a one-time, outpatient procedure for eligible prostate cancer patients. This therapy delivers a course of radiation through tiny, permanent implants over a period of several weeks.

Also Check: How Accurate Is A Psa Test For Prostate Cancer

What Is The Best Treatment For Early Stage Prostate Cancer

Filed in Treatment

Many of our patients have their prostate cancer diagnosed early, giving them an extremely high chance of a long-term cure with limited side effects, if any. Once they are diagnosed and they have come to terms with their condition, their mind soon turns to the best way to treat it. There is a lot of information out there on what treatment is best, so I thought it sensible to compile a list of the key points for such a patient to consider.

In order of most important first, the answer to this question depends on a number of factors:

Tumour grade: the Gleason grade assigned by a pathologist denotes its aggressiveness. The scale goes from Gleason 6 to Gleason 10 and is made up of 2 numbers. The first is what most of the cancer is composed of and the second number is what the second most common appearance of the cells is. So, for instance, a Gleason 3+3 or Gleason 6 tumour, which is the lowest grade or the least aggressive prostate cancer, would normally be managed by active surveillance. This involves checking the PSA level every 3 months, repeating the MRI scan every year and repeating the prostate biopsy every 2 years. More aggressive tumours are better managed by active treatment because of their greater tendency to spread outside the prostate and to grow faster.Key point: aggressive cancers need active treatment to target the cancer directly.

out of the 82,429 men enrolled, only 1% died of prostate cancer

The Ajcc Tnm Staging System

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.

The TNM system for prostate cancer is based on 5 key pieces of information:

• The extent of the main tumor *
• Whether the cancer has spread to nearby lymph nodes
• Whether the cancer has spread to other parts of the body
• The PSA level at the time of diagnosis
• The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .

*There are 2 types of T categories for prostate cancer:

• The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
• If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.

Also Check: Where Does Prostate Cancer Metastasis To First

Advances In Surgery For Prostate Cancer

A radical prostatectomy, the surgical removal of the prostate, may be a treatment option for localized prostate cancer. Common short- and long-term side effects of the surgery include erectile dysfunction and urinary incontinence.

Robot-assisted surgery is a minimally invasive alternative to open surgery for a radical prostatectomy. This system requires only a few small incisions in the abdomen rather than the larger incisions required for open surgery. The systems instrumentation and high-definition camera allow for greater surgical precision and the improved ability to spare surrounding tissue and nerves.

While robotic surgery may not improve long-term disease control, studies show its benefits may include a lower risk of infections or complications, less loss of blood during surgery, less scarring, shorter hospital stays, a faster recovery time and a reduction in the severity and duration of erectile dysfunction and urinary incontinence.

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.

You May Like: Hormone Therapy For Advanced Prostate Cancer

Treatments May Have Side Effects

The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.

Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.

If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.

Hormonal Therapy And Its Complications

Several different hormonal approaches are used in the management of various stages of prostate cancer.

These approaches include the following:

• Abiraterone acetate .
• Aminoglutethimide.

Abiraterone acetate

Abiraterone acetate has been shown to improve OS when added to ADT in men with advanced prostate cancer who have castration-sensitive disease. Abiraterone acetate is generally well-tolerated however, it is associated with an increase in the mineralocorticoid effects of grade 3 or 4 hypertension and hypokalemia compared with ADT alone. It may also be associated with a small increase in respiratory disorders.

Bilateral orchiectomy

Benefits of bilateral orchiectomy include the following:

• Ease of the procedure.
• Immediacy in lowering testosterone levels.
• Low cost relative to the other forms of ADT.

Disadvantages of bilateral orchiectomy include the following:

• Psychological effects.

Bilateral orchiectomy has also been associated with an elevated risk of coronary heart disease and myocardial infarction.

Estrogen therapy

Estrogens at a dose of 3 mg qd ofdiethylstilbestrol will achieve castrate levels of testosterone. Likeorchiectomy, estrogens may cause loss of libido and impotence. Estrogens also cause gynecomastia, and prophylactic low-dose radiation therapy to the breasts is given to prevent this complication.

Luteinizing hormone-releasing hormone agonist therapy

Evidence :

Antiandrogen therapy

ADT

Evidence :

Antiadrenal therapy

Don’t Miss: How Do You Keep Your Prostate Healthy

Treatment Choices For Men With Early

This booklet is for men with early-stage prostate cancer who are facing a decision between active surveillance or treatment with surgery or radiation. While it is good to have choices, the decision can be hard to make. This booklet can help you learn the facts and help you think about what is important to you.

• Covers information about the prostate and basics about early-stage prostate cancer
• Covers facts about active surveillance, surgery, and radiation therapy
• Helps you compare your choices

This booklet has information that can help you talk with your doctor and discuss your decision with loved ones and other men who have been in your shoes. Learning the facts and talking with others can help you make a choice you feel good about.

The information in this booklet was last updated in January 2011.

Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation

Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.

Recommended Reading: Best Prostate Doctor In Usa

Choosing The Best Treatment

It can be difficult to choose the best treatment for you. Your doctor and specialist nurse will explain the different treatment options and help you make a decision. The Predict Prostate tool can also help you decide between monitoring and radical treatment. We have more information about this tool further down this page.

A UK trial showed that there can be very little difference in survival between the treatments especially if you are diagnosed with early prostate cancer.

The table below shows how many men survive different treatments for CPG 1, 2 and 3 localised prostate cancer after 10 years.

Treatment

A Note About Sex And Gender

Sex and gender exist on spectrums. This article will use the terms, male, female, or both to refer to sex assigned at birth. .

will depend on the cancer stage, among other factors, such as the Gleason score and PSA levels. It is also worth noting that many treatment options may be applicable, regardless of the stage of cancer.

In the sections below, we list some for prostate cancer and explore what treatment may mean for fertility.

You May Like: How To Reach Your Prostate

Advances In Targeted Therapy

PARP inhibitors are a type of targeted therapy drug designed to prevent the DNA of cancer cells from repairing the damage caused by cancer treatment. In May 2020, the FDA approved two PARP inhibitors, rucaparib and olaparib, to treat patients with metastatic castration-resistant prostate cancer whose cancer tumors have certain homologous recombination repair genetic mutations and who meet other treatment-related criteria. These drugs are the first of their type to be approved by the FDA to treat prostate cancer.