What Is Prostate Cancer
Growth in the prostate can be of two types
Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.
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What Are Bone Metastases With Prostate Cancer
The ACS describes bone metastases as areas of bone containing cancer cells that have spread from another place in the body. In the case of prostate cancer, the cells have spread beyond the prostate gland. Since the cancer cells originated in the prostate gland, the cancer is referred to as metastatic prostate cancer.
The cancer cells spread to the bones by breaking away from the prostate gland and escaping attack from your immune system as they travel to your bones.
These cancer cells then grow new tumors in your bones. Cancer can spread to any bone in the body, but the spine is most often affected. Other areas cancer cells commonly travel to, according to the ACS, include the pelvis, upper legs and arms, and the ribs.
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Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment
If your prostate-specific antigen blood level shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment youve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.
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What If You Have Metastatic Castration
This means you have a type of metastatic prostate cancer thatÃ¢â¬â¢s able to grow and spread after you had hormone therapy to lower your testosterone levels.
Still, most people with mCRPC stay on androgen deprivation therapy because it might still be effective against some prostate cancer cells.
Your doctor may recommend adding other treatments like:
- Treatments to ease symptoms like pain
You could also find out if a clinical trial might be right for you.
Some people with mCRPC simply choose to try active surveillance or watchful waiting.
Metastatic Prostate Cancer Treatment
If a patient has been diagnosed with prostate cancer and he or she is concerned about prostate cancer metastasis, they should talk with a doctor about the risk of prostate cancer metastasis and corresponding treatment options.
Treatments for stage 4 prostate cancer may depend on where in the body the disease has spread. Options include:
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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. .
- neuroendocrine tumors
Experts believe some males can also have a mixed type, which combines a common and a rare type of prostate cancer. Rare forms of prostate cancer are more likely to metastasize.
Prostate cancer overall is the second most common cancer in males after skin cancer. Doctors discover most prostate cancers in the prostate or nearby tissues. However, about 16% of new cases spread into distant locations.
Between 2012 and 2018, about more cases of prostate cancer occurred in the United States.
Research has shown the incidence of prostate cancer for African American males is that of people who are white. Among African Americans, the cancer types tend to be more aggressive, and deaths are double compared with white Americans.
The differences in outcomes for African American males may originate from:
- Physical: Higher prostate-specific antigen levels in the blood.
- Genetic: Some African American males carry certain gene mutations or chromosomal abnormalities that can increase prostate cancer risk.
- Environmental: Social disparities may cause people from historically marginalized groups to live on a lower income and have limited access to healthy food.
- Social: Disparities in healthcare can limit genetic screening or disease treatment access, leading to underdiagnosis.
Other people should begin screening at the age of 50.
The Most Common Symptoms Of Stage 3 Mesothelioma Include:
- Shortness of breath
As the tumors continue to grow and spread throughout the chest, symptoms will become more problematic. Stage 3 symptoms vary from patient to patient depending on where the cancer is spreading and if the tumor mass damages vital organs. Some patients may experience referred pain felt in the neck, back or shoulders.
A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties. Pleural mesothelioma tumors also cause increased pleural fluid, which puts pressure on the lungs. Symptoms and characteristics of stage 3 mesothelioma vary based primarily on cancer type.
Connect with a Top Mesothelioma Specialist
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Find A Prostate Cancer Clinical Trial
There are many clinical studies offered for patients with metastatic prostate cancer. Many of these studies try to find out if study medications are safe and if they can help prevent, find, or treat prostate cancer. Learning about clinical trials and whether or not they are an option for you is an important part of the treatment decision making process.
Click HERE to learn more about clinical trial phases, eligibility, informed consent, and patient protection.
How Prostate Cancer Staging Is Done
Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging.
PSA refers to a protein made by the prostate measured by a lab test.
- A higher level of PSA can indicate a more advanced cancer.
- The doctors will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor.
A prostate biopsy is done in your doctors office. The results can indicate:
- How much of the prostate is involved.
- The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores 6 or less suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread.
General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
About Rare Prostate Cancers
Although prostate cancer is a common cancer in men, there are different types of prostate cancer, and some of these are rare. Because they are rare, we dont know as much about them. If you are diagnosed with one of the cancers mentioned here, speak to your doctor or nurse about what that means and what treatments are suitable for you.
Like most things in our body, the prostate is made up of different types of cells . The type of cancer that develops depends on the cell it starts in.
The most common type of prostate cancer starts in some of the cells that line the prostate, called glandular epithelial cells. There are two types of gland cells basal cells and luminal cells . Prostate cancer can develop in either of these cells.
When we talk about common prostate cancer here, we mean this type of prostate cancer. You may hear it called adenocarcinoma or acinar adenocarcinoma or see this written in your biopsy results .
Rarer types of cancer can also develop from gland cells, or from other types of cells in the prostate.
Some men have more than one type of prostate cancer. For example, they may have some common prostate cancer as well as a rare cancer.
Some of the rare cancers may be more aggressive than common prostate cancer. This means they may grow faster and are more likely to spread outside the prostate.
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Some Colorectal Tumors Are Born To Be Bad
To get a better handle on the timing of metastasis, the team developed a computer model to simulate the evolution of millions of virtual tumors under different conditions.
We could then compare the simulated data with the observed patient data using various statistical techniques, Dr. Curtis explained.
The modeling data indicated that metastasis begins very early during tumor developmentwhen the primary tumor is smaller than the tip of a sharpened pencil.
In other words, Dr. Curtis said, some tumors may be born to be bad.
The team next investigated whether the results from their small set of paired samples of primary and metastatic tumors from patients could be extended to a larger number of patients.
They analyzed publicly available data from 938 people with metastatic colorectal cancer and 1,813 people with early-stage, nonmetastatic colorectal cancer whose medical histories were known. The primary tumors of these patients had been profiled to identify genetic changes in known cancer-associated genes.
This analysis showed that certain genetic changes tend to occur together, and that specific combinations of three to five mutations were more common in patients with metastatic cancer than in those with nonmetastatic disease, suggesting that specific combinations of early genetic changes confer the potential for tumor cells to spread.
If confirmed in future studies, this information could potentially be used to guide treatment decisions, she said.
An Evolving Standard Of Care
Hormone-sensitive prostate cancer means a patients tumors are still largely being fueled by male sex hormones called androgens. For many years, metastatic hormone-sensitive prostate cancer was treated with ADT alone, which blocks the production of androgens by the testicles.
In 2014, a large clinical trial showed that adding the chemotherapy drug docetaxel to ADT improved survival in men with metastatic hormone-sensitive prostate cancer. Since then, this combination has become the standard of care for this group of patients.
More recently, studies have shown that adding other drugs that block the production or binding of androgensincluding abiraterone , enzalutamide , and apalutamide to ADT also helps people with metastatic hormone-sensitive prostate cancer live longer. In a trial combining apalutamide with ADT, for example, approximately 82% of men were still alive after 2 years compared with 74% of men treated with ADT alone.
Several clinical trials were then launched to see if combining any of these drugs with ADT and docetaxel could build on those survival gains. Results of those studies, however, have been mixed, with one showing an improvement in survival without the disease progressing and another finding no increase in overall survival.
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Stage 4 Prostate Cancer: Survival Rates Treatment And Support
Prostate cancer is in stage 4 when the cancer spreads beyond the lymph nodes and into other areas of the body. While the vast majority of prostate cancer cases are caught before this happens, when the cancer is treatable, stage 4 is far more difficult to treat. Therefore, the survival rate among men with stage 4 prostate cancer is much lower.
There are two types of stage 4 prostate cancer: 4A and 4B, according to the American Cancer Society. The type assigned to a persons diagnosis is based on whether the cancer has spread and to what degree, and the value assigned to two additional factors called the Grade Group and the prostate-specific antigen . The Grade Group is a measure of how likely the cancer is to spread quickly, and the PSA is a measure of a protein in the blood produced by cells in the prostate.
With stage 4A, the tumor has already spread into the lymph nodes and may be spreading into tissues adjacent to the prostate, but has not spread to other areas of the body. The Grade Group can be of any value, as can the PSA.
With stage 4B, the tumor may have spread into the lymph nodes, may be spreading into nearby tissues and has spread to other areas of the body like the bones, certain organs and distant lymph nodes. The Grade Group and PSA can be of any value.
What Is Metastatic Prostate Cancer
Sometimes cancer cells will escape the prostate and grow quickly, spreading to nearby tissue, or metastasizing. Nearby lymph nodes are often the first destination for a spreading cancer. If prostate cancer has spread to your lymph nodes when it is diagnosed, it means that there is higher chance that it has spread to other areas of the body as well.
If and when prostate cancer cells gain access to the bloodstream, they can be deposited in various sites throughout the body, most commonly in bones, and more rarely to other organs such as the liver, lung, or brain. Bone metastases are seen in 85% to 90% of metastatic cases.
No matter where a cancer turns up in the body, it is always identified by the tissue type in which it started. Prostate cancer can metastasize to other organs, but it is always prostate cancer, because it consists of mutated prostate cells.
Men diagnosed with metastatic prostate cancer , will often not undergo local treatments of the primary prostate tumor, such as surgery or radiation. Instead, their therapeutic journey might start with hormone therapy, and from there follow a similar path as men who were diagnosed at an earlier stage and had subsequent disease progression.
Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.
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Questions To Ask Your Doctor Or Nurse
- What type of hormone therapy are you offering me and why?
- Are there other treatments I can have?
- What are the advantages and disadvantages of my treatment?
- What treatments and support are available to help manage side effects?
- Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
- How often will I have check-ups and what will this involve?
- How will we know if my cancer starts to grow again?
- What other treatments are available if that happens?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
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Stage 4 Prostate Cancer Prognosis
Doctors need to know how far the cancer has advanced, or its stage, in order to choose the best treatment. A pathologist, a specialist who specializes in studying cells obtained from a prostate biopsy, will provide two starting points: the cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy reveals prostate cancer, the patient may be subjected to additional testing to determine whether the disease has spread to other regions of the body via the blood or lymph nodes. These are typically imaging examinations, such as a bone scan, positron emission tomography scan, or computed tomography scan.
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Financial Assistance For Advanced Prostate Cancer Patients
There are resources available to help men pay for their medications for treatment and other related expenses. Treatments may include oral drugs, injections, supportive care drugs, or other medications and procedures. To help offset the cost of prescription drugs, patient assistance programs have been established. Other resources exist to help people navigate the ever-changing costs associated with cancer care today. Visit our Financial Resources section to learn about resources for support.
You can also contact ZERO360 for help finding financial assistance and other resources.
Prostatic Metastasis Of Pulmonary Large Cell Neuroendocrine Carcinoma
Kumi Shimizu1, Taichiro Goto2 , Arafumi Maeshima3, Yoshitaka Oyamada1, Ryoichi Kato2
1. Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan 2. Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan 3. Department of Pathology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Corresponding author: Taichiro Goto, MD., Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo 152-8902, Japan. Phone: +81-3-3411-0111 Fax: +81-3-3412-9811 Email: taichirojukuin.keio.ac.jp.More
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Treatments To Control And Prevent Symptoms Caused By The Spread Of Prostate Cancer To The Bones
Palliative External beam radiotherapy
Radiopharmaceuticals: Strontium-89 , samarium-153
Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment.
Zolidronic acid is a bisphosphonate given by a 15-minute intravenous infusion every 34 weeks. It reduces the risk of bone complications, including pain and fractures.
Xgeva : this is a newly licensed drug available at BPC.
Surgery may be undertaken to treat bone fractures or to relieve the pressure on the spinal cord by bone metastases.