Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The patients age.
- Whether the cancer has just been diagnosed or has recurred .
Treatment options also may depend on the following:
- Whether the patient has other health problems.
- The expected side effects of treatment.
- Past treatment for prostate cancer.
- The wishes of the patient.
Most men diagnosed with prostate cancer do not die of it.
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.
What About Trans People
People assigned male at birth can develop prostate cancer whether they remain male or not.
Trans women who use hormone therapy such as estrogenmay have a lower risk, but the risk is still present.
Anyone assigned male at birth should speak to their doctor about screening for prostate cancer.
Knowing the stage of prostate cancer can help a person understand what to expect, and it will inform decisions about treatment. We list the stages below:
Stage 0: Precancerous cells are present, but they only affect a small area and are slow growing.
Localized : Cancer is only present in the prostate gland. Effective treatment is possible at this stage.
Regional : Cancer has spread to nearby tissues.
Distant : Cancer has spread to other parts of the body, such as the lungs or bones.
If a male has symptoms that may indicate prostate cancer, the doctor will likely:
- ask about symptoms
- ask about personal and medical history
- conduct a blood test to assess PSA levels
- carry out a urine test to look for other biomarkers
- carry out a physical examination, which may include a digital rectal exam
During a DRE, the doctor will check manually for any abnormalities of the prostate with their finger.
Learn more about prostate exams here.
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What Are The Risks Of Radiation Treatment
Radiation treatment for prostate cancer may increase a manâs risk for having another cancer later in life, such as bladder or rectal cancer.
Some radiation side effects, like urinary problems, are usually short-term problems that go away with time. But a radiation side effect can become a long-term problem. Common side effects from radiation treatment include:
- Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
- In one study, 67 out of 100 men had erections firm enough for intercourse before they had radiation. Six years later, 27 out of 100 men who had radiation had erections firm enough for intercourse.footnote 4
For men with intermediate-risk or high-risk prostate cancer, radiation treatment may be given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.
Your doctor might advise you to have surgery if:
- You are healthy enough to have major surgery.
- Radiation therapy isnât a good option for you because you have had previous radiation therapy to your pelvic area or you have a serious bowel disease such as ulcerative colitis.
Your doctor might advise you to have radiation if:
- You want to avoid the side effects of surgery, such as leaking urine and erection problems.
- You have other health problems that make surgery too risky.
What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
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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.
Management Of Advanced And Metastatic Disease
AUA/ASTRO/SUO guidelines on advanced prostate cancer separate management considerations into the following four disease states, which encompass the entire continuum of advanced prostate cancer :
These disease states are defined by the following:
- Primary tumor status
- Presence or absence of distant disease on imaging
- Testosterone levels
- Prior chemotherapy exposure
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Followup By Primary Care Physicians
The American Cancer Society has released evidence- and expert-based guidelines for the management of prostate cancer survivors by primary care physicians , a response to the fact that as the number of men surviving prostate cancer has increased, reliance on PCPs for their care has grown as well. The guidelines address promotion of healthy lifestyles, surveillance for disease recurrence, screening for second primary cancers, and evaluation and management of adverse physical and psychosocial effects caused by the disease and its treatment. Recommendations include the following :
What Happens When Prostate Cancer Is Left Untreated
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their doctors monitor their cancer.
Known as active surveillance, it is common when the cancer is expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. In active surveillance, doctors will initiate cancer treatment only if cancer starts growing.
Others men may choose to not undergo cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits.
This option is certainly OK and reasonable in the right circumstancesrequiring a careful and thoughtful discussion with your doctor and family.
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Active Surveillance Or Watchful Waiting
Because prostate cancer usually grows slowly, doctors may recommend some patients not be treated. These patients are typically older and/or have a very low-risk form of prostate cancer.
Instead, these patients can be put on active surveillance, or watchful waiting.
This approach involves closely monitoring the cancer without treatment. Prostate biopsy procedures and PSA tests are repeated at set intervals. Treatment may be recommended if the tests show the disease is progressing.
What Is The Source Of The Information
Researchers funded by the Agency for Healthcare Research and Quality, a Federal Government research agency, reviewed studies on treatments for localized prostate cancer published between January 1, 2007, and March 7, 2014. The report included 52 studies and was reviewed by health care professionals, researchers, experts, and the public.
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Radiation As Adjuvant Or Salvage Therapy After Surgery
Several randomized trials have evaluated the use of adjuvant radiation therapy to the prostatic bed following surgery for patients at high risk of recurrence . Those include EORTC 22911, SWOG 8794, ARO 96-02/AUO AP 09/95, and FinnProstataX, as well as the ongoing RAVES, GETUG-AFU 17, and RADICALS-RT studies. Recent research has further highlighted the role of early salvage radiation therapy with concomitant ADT for those with biochemical recurrence after prostatectomy, to avoid overtreatment associated with adjuvant radiotherapy. This is reflected in the current AUA/ASTRO guidelines.
Outlook Once Cancer Has Spread To The Bones
The research on cancer metastasis is rapidly growing. As researchers better understand the mechanisms of bone metastasis, new drugs and other treatments are being developed. These target particular processes in cells involved in how the cancer cells invade and grow in bones.
The use of nanoparticles to deliver drugs is very encouraging. These tiny particles are able to deliver drugs to the bone with minimal toxicity to the person with cancer.
Rapidly treating bone metastasis can lead to a
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What Are The Treatment Options For Aggressive Prostate Cancer
The majority of people with prostate cancer nearly 80% are diagnosed early and cured by their treatment, most often radiation or surgery.
But one in five of those diagnosed with prostate cancer has a more aggressive form of the disease. Even before the individual has received any treatment or experienced a recurrence, doctors can identify whether the cancer is likely to be more dangerous and aggressive.
Prostate cancer is determined to be high risk if it is distinguished by any of the following characteristics:
Physicians perform biopsies or take X-rays to determine a cancers grade and stage. The stage is based on the size of the primary tumor or the extent it has spread in the body. The grade describes the appearance of the cancer cells and tissue under a microscope: the more abnormal they are, the higher the grade.
What are the main treatment options for people with aggressive or high-risk prostate cancer and can the sequencing, or order in which different treatments are given, make a difference in overall effectiveness of these therapies?
Why Roswell Park for Prostate Cancer?
Find out what makes Roswell Park unique in treating prostate cancer.
What Is The Purpose Of The Gleason Score
Named after its creator, Dr. Donald Gleason, The Gleason score is a measurement that is given to indicate the aggressiveness of prostate cancer.
Aggressiveness is a medical term used to describe the likelihood of cancer spreading outside the prostate.
The Gleason scoring system was developed at a VA hospital in the 1960s and was quickly adopted all over the world as an effective predictor of the pace of prostate cancer growth.
When he created this measurement, Dr. Gleason assigned a number between 1 and 5 to the different patterns of prostate cancer cell growth. Prostate cancer cells display different patterns of growth, which reveal their aggressiveness.
When your pathologist checks your biopsy samples, they examine your prostate cells under the microscope and will look at the different patterns.
They will then choose the two most commonly appearing patterns and give you a score. The first number indicates the most common pattern in all the samples. The second is the second most common pattern. When these two scores are added together, the total is called the Gleason score.
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Possible Inaccurate Or Unclear Test Results
As an example, neither the PSA test nor the DRE is 100% accurate. These tests can sometimes have abnormal results even when a man does not have cancer , or normal results even when a man does have cancer . Unclear test results can cause confusion and anxiety. False-positive results can lead some men to get prostate biopsies when they dont have cancer. And false-negative results can give some men a false sense of security even though they might actually have cancer.
Active Surveillance May Help Your Quality Of Life
With this approach, you have regular checkups, including a PSA test and rectal exam. Youll get a prostate biopsy if needed. You can start treatment at any time if the cancer starts to grow.
Active surveillance is a good choice for many men with low-risk prostate cancer, because they can avoid the side effects of treatment. This is an especially important choice if you are older or in poor health.
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How Prostate Cancer Develops
However, sometimes something goes wrong within prostate cells, and cancer develops.
In general, cancer is a condition in which a normal cell becomes abnormal and starts to grow and/or reproduce uncontrollably without having the signals or brakes that stop typical cell growth. Prostate cancer occurs when a normal prostate cell begins to grow out of control. In many cases, prostate cancer is a slow-growing cancer that does not spread beyond the prostate gland before the time of diagnosis.
Once prostate cancer forms, it feeds on androgens and uses them as fuel for growth. This is why one of the backbones of treatment for men, especially with advanced prostate cancer, is to lower a mans androgen levels with drugs collectively termed hormone therapy.
Not all prostate cancer cells are alike. Prostate cancers that are composed of very abnormal cells are much more likely to both divide quickly and spread, or metastasize, from the prostate to other regions of the body. Often, prostate cancer spreads first to tissues that are near the prostate, including the seminal vesicles and nearby lymph nodes.
Researchers have identified various biological and genetic subtypes of prostate cancer. Although these subtypes are typically not yet used to guide treatment recommendations, they are the subject of active research funded by the Prostate Cancer Foundation.
Help support PCFs research into causes and treatments of prostate cancer: Donate Today!
Surgery In Metastatic Disease
Physicians have suggested that the benefits seen from radiation to the prostate point to the benefits of local therapy, raising the question of whether radical prostatectomy might have the same results. Trials are ongoing, and at present the use of surgery should be considered investigational and conducted only within the context of a trial. However, transurethral resection is sometimes needed in men who develop obstruction secondary to local tumor growth. Bilateral orchiectomy can be used to produce androgen deprivation in patients with widely advanced and metastatic prostate cancer.
Since the introduction of LHRH agonist and antagonist therapies, surgical intervention has been practiced less often. An indication for immediate bilateral orchiectomy is spinal cord compression, because it avoids the potential flare response that can occur during the first 3 weeks of treatment with an LHRH agonist.
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Prostate Cancer: A Guide For Aging Men
Prostate cancer is one of the most frequently diagnosed cancers in the world, despite it only being diagnosed in males . In fact, more than 70 percent of men over the age of 80 have some quantity of cancer cells in their prostate.
Its so common that it sometimes doesnt go diagnosed until autopsies are performed, though that doesnt mean the cancer is the cause of death. On the contrary, the overall prognosis for men diagnosed with prostate cancer is as positive as you can get when talking about the dreaded c word. The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.
The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.
Nevertheless, prostate cancer is serious business, and the best way to handle a diagnosis is to be informed. Lets take a look at the frequency at which its diagnosed, how youre tested for it, how it can affect your daily life, and what we can do to try and prevent the disease.
Average Age of Prostate Cancer Diagnosis