Active Surveillance For Prostate Canceractive Surveillance
Active surveillance focuses on avoiding or delaying progression to active cancer treatment by monitoring the growth and spread of low-risk prostate cancer which isnt causing symptoms. It typically involves additional tests to monitor the prostate cancer compared to watchful waiting, including PSA tests, digital rectal exams, MRI scans and biopsies. If the results show that your prostate cancer has begun growing and spreading, your doctor may recommend that you begin active treatment.
How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
The Facts About Prostate Cancer
Prostate cancer occurs when some of the cells in the prostate reproduce far more rapidly than normal, resulting in a tumour. Prostate cancer often grows slowly to start with and may never cause any problems. But some men have prostate cancer that is more likely to spread. These prostate cancer cells, if left untreated, may spread from the prostate and invade distant parts of the body, particularly the lymph nodes and bones, producing secondary tumours in a process known as metastasis.
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Key Points About Prostate Cancer
How The Study Was Performed
During the study, scientists randomized 1,071 men with intermediate- or high-risk localized prostate cancer into four groups. One group received radiation and six months of an anti-testosterone drug called leuporelin, and the second group received radiation plus 18 months of leuporelin therapy. Two other groups were treated with the same regimens of either radiation plus six or 18 months of leuporelin therapy, along with another drug called zoledronic acid, which helps to limit skeletal pain and related complications should cancer spread to the bones. Study enrollment occurred between 2003 and 2007 at 23 treatment centers across New Zealand and Australia.
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Symptoms Of Prostate Cancer
Early prostate cancer usually causes no symptoms. When symptoms do occur, they may include:
- difficulties starting and stopping urination
- pain or a burning sensation when passing urine
- urinating more often than usual, particularly at night
- the feeling that the bladder cant be fully emptied
- dribbling urine
- Unexpected weight loss.
Many of these symptoms can also be caused by conditions usually less serious than prostate cancer. Most enlargements of the prostate are benign, which means they are not cancer and can be easily treated. You should discuss any symptoms with your doctor.
Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you produce.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you don’t want to have injections or tablets.
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When Is Hormone Therapy Used
Hormone therapy may be used:
- If the cancer has spread too far to be cured by surgery or radiation, or if you cant have these treatments for some other reason
- If the cancer remains or comes back after treatment with surgery or radiation therapy
- Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment
- Before radiation to try to shrink the cancer to make treatment more effective
Hormone Therapy With Radiotherapy
You have this if:
- your cancer hasnt spread to other parts of the body but is at a high risk of coming back, eg the cancer has grown through the covering of your prostate
- you have a very high prostatic specific antigen level
- you have a high Gleason score
You might have hormone therapy before, during and after radiotherapy. Doctors usually recommend that you have the treatment for between 3 months and 3 years. How long depends on the risk of your cancer coming back and how many side effects you get.
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What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
Sexuality And Prostate Cancer
Most treatments for prostate cancer cause side effects that can affect your sex life, some more than others. This can have a huge effect on your mood, self-esteem and body image. It is important to discuss your concerns with your specialist before treatment starts, so that you are aware of any potential problems and how you can manage and limit their impact.
If you are having problems with your sex life after your treatment is over, ask your doctor or nurse for help. If you have a partner, it also helps to be as open as possible with them about how you are feeling. Prostate Cancer Foundation of Australias booklet called Understanding Sexual Issues following prostate cancer treatment may be helpful to read.
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Which Treatment To Choosewith Whom
Treatment To Lower Testicular Androgen Levels
Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.
Orchiectomy
Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens are made. This causes most prostate cancers to stop growing or shrink for a time.
This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Because of this, they may choose treatment with drugs that lower hormone levels instead.
Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.
LHRH agonists
Luteinizing hormone-releasing hormone agonists are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy.
With these drugs, the testicles stay in place, but they will shrink over time, and they may even become too small to feel.
- Leuprolide mesylate
LHRH antagonists
Possible side effects
Many side effects of hormone therapy can be prevented or treated. For example:
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If I Have No Symptoms Should I Get Checked For Prostate Cancer
The following people who have no symptoms are recommended to get checked for prostate cancer:
- you are a man aged 5070 years old but dont have any family history of prostate cancer
- you are a man aged 4070 years old and your father or brother has had prostate cancer
- you are a man aged more than 70 years old and you have family history of prostate cancer or you have had an abnormal PSA test previously, and you have a life expectancy of more than 10 years.
Having a prostate check is your decision. The check wont tell you if you have prostate cancer, but it will tell you how likely you are to have it. Checks usually involve a blood test called a prostate-specific antigen test and a digital rectal examination .
Read more about prostate testing.
Results Of Treating Prostate Cancer With Radiation Therapy
American Cancer Society. Radiation therapy for prostate cancer. January 2013.
Radiation therapy is best used as an early treatment for a lower-grade cancer that is confined within the prostate gland. The survival rates are similar to the results of radical prostatectomy. Radiation therapy treatments can also be used along with hormone therapy as a first step in treating prostate cancer that has spread outside of the prostate gland to nearby tissues. External beam radiation therapy can be focused on the prostate gland therefore, reducing the radiation exposure to the surrounding healthy tissues. This may increase survival rates over other forms of prostate cancer treatments.
National Cancer Institute at the National Institutes of Health. September 2012
Clinical trials show that external-beam radiation therapy does not seem to improve the survival rate of prostate cancer, but it does help to stop the progression of the disease. One such trial showed an increased progression-free survival at 4 years for patients with a 15% estimated risk of lymph node involvement who received whole-pelvic radiation therapy as compared with prostate-only radiation therapy With this in mind, radiation therapy treatments should be delayed 4 to 6 weeks after a TURP procedure in order to reduce incidence of stricture.
Stevens, G Firth, I. Audit in radiation therapy: long-term survival and cost of treatment. National Institute of Health. Feb. 1997
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Drug Triggers Immune Cells To Attack Prostate Cancer
by Julia Evangelou Strait, Washington University School of Medicine
A single drug compound simultaneously attacks hard-to-treat prostate cancer on several fronts, according to a new study in mice and human cells. It triggers immune cells to attack, helps the immune cells penetrate the tumor, and cuts off the tumors ability to burn testosterone as fuel, according to new research from Washington University School of Medicine in St. Louis. The drug may offer a promising new strategy for treating patients whose tumors dont respond to standard therapy.
The study appears online in the journal Nature Communications.
Prostate cancer is notorious for eventually developing resistance to standard treatments that block or reduce testosterone, which fuels growth of these tumors. And like many solid tumors, prostate cancer also has proven stubbornly resistant to newer immunotherapies, which are intended to take the brakes off the immune systems T cells to get them fighting cancerous invaders. Immunotherapiesmost commonly, immune checkpoint inhibitorscan be extremely effective but only in certain cancers, such as melanoma.
We need to develop better therapies for prostate cancer patients, because most of these tumors develop resistance to hormone-based therapies doctors rely on to treat these cancers, said senior author Nupam P. Mahajan, Ph.D., a professor of surgery.
More information:Nature CommunicationsJournal information:
Ongoing Side Effects Of Prostate Cancer Treatment
Depending on the treatment you undergo, you may experience some of the following:
- Erectile dysfunction
- Weight gain due to hormone therapy
These side effects have different durations for different people.
Because a side effect of treatment may include erectile dysfunction, prostate cancer can have a serious impact on intimate relationships. As many people who have been through the journey will tell you, prostate cancer isnt just a mans disease, its a couples disease. Make sure you involve your partner as you think through the various treatment options.
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Last Week Of Treatment
An appointment will be scheduled for you to meet with a member of our patient care team to answer any questions and to ensure appropriate care is organised after your last treatment visit. This may include regular monitoring of blood results, appointments for dressings and management of side effects.
The Future Of Hormone Therapy For Prostate Cancer
Some experts arent sure how much further we can improve hormone therapy for prostate cancer.
Im not saying that weve reached the end of what we can do with hormonal therapy, Thrasher tells WebMD, but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.
Brooks argues that, overall, prostate cancer is only moderately affected by hormones. You can only do so much manipulating the levels of hormones, says Brooks. We have to find better ways to fight the basis of the cancer cells.
Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.
But Holden remains optimistic about the future of hormone therapy for prostate cancer.
Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy, he says. But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.
Its like an endless chess game, he says. You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
Ng Tohu Matua: Te Maimoatanga Matepukupuku Repe Ure
- M te mhio ki te whanga o t matepukupuku repe ure, e whina i t rp maimoa ki te whakamahere i maimoatanga.
- Ka whakaritea he whakamtau toto prostate specific antigen ki te ine i te taumata PSA kei roto i t toto. Mehemea
- kua piki t PSA, he tohu tnei kua piki ake te mrea o t whai i te matepukupuku repe ure, e ai ki te tangata whai taumata PSA pai.
- Ara an tahi atu take, atu i te matepukupuku, piki ai te PSA, n reira, kore e taea te whakamahi i te whakamtautau PSA anake ki te whakatau i te matepukupuku repe ure.
- Ko te whakamtautau -mati tou, ko te porooro, ko te unuhanga tahi atu whakamtautau.Mehemea kei roto te matepukupuku i to tauira unuhanga, ka tauinetia m te whakamahi i te tauine ISUP .
- He huarahi te mahi tauine ki te krero i te momo hua u ptau matepukupuku, te tere o t rtou tipu, me te hua o tna kaha ki te hrapa ki whi k o te tinana.Tr pea ka whakahaerehia tahi atu titiro whakatau pr ki te CT, ki te MRI rnei, , i tahi w, he titiro whakatau -kiwi.Ka whakamahia ng putanga o ng whakamtautau me ng titiro whakatau ki te krawarawa i te whanga taumata o t matepukupuku tna rahi, me tna kaha rauroha.
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Other Factors To Consider:
It is easier to monitor the control of the cancer after surgery, as the PSA should fall to undetectable levels.
In addition, the prostate once removed is examined by a pathologist, and the size of the tumour and margin status are reported , this all provides valuable information about outcome / prognosis.
The PSA should fall to undetectable levels after surgery. The PSA normally drops below 2ug/L with brachytherapy, but in about 20% of men it can fluctuate. This bounce effect can be disconcerting.