How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
What About Trans People
People born with a prostate can develop prostate cancer. Individuals born without a prostate cannot develop prostate cancer.
Anyone born with a prostate should speak to their doctor about screening for prostate cancer.
Are Older Men Undertreated
Schwartz and colleagues44 reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.
Thompson and colleagues46 investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.
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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.
I Have Prostate Cancer Now What
What men need to consider when making decisions about prostate cancer treatment.
7 min read
Like any cancer diagnosis, the news can leave men and their loved ones feeling anxious and unsure about the future. And with so many different options available for treating prostate cancerincluding surgery, radiation, hormonal therapy, and even the option to initially do no treatment at allthe decision-making process can often be complicated.
To find out more about prostate cancer treatment options and the various factors that both doctors and patients must consider when making a decision, I spoke to three Northwell Health physicians who care for patients with prostate cancer: Dr. Louis Potters and Dr. Richard Byrnes, who are radiation oncologists, and Dr. Lee Richstone, a urologist.
Heres what they had to say:
Diagnosed With Prostate Cancer: Now What
If you have recently been diagnosed with prostate cancer, you may be thinking, Now what do I do? The first thing you need to do is take a big breath and relax. You have a very good chance that your prostate cancer is very treatable and is not likely to kill you.
The statistics are in your favor. In the United States, a male has a 16 percent chance of receiving a diagnosis of prostate cancer but only a 2.8 percent risk of dying from prostate cancer. Survival rates for prostate cancer, as reported by the American Cancer Society, show that the five-year survival rate is almost 100 percent and the 10-year rate is 91 percent. Most men who find out they have prostate cancer do not die from the cancer itself but from other, concurrent causes.
Now that you are calmer, there are several important steps you can take to help prevent cancer from spreading, minimize the impact of the prostate cancer on your life and help ease your mind, while giving peace of mind to your family.
You do have some work ahead of you in becoming an informed patient and an advocate for your own health. For your best outcome you should follow some guidelines to continue to have a good quality of life and give yourself the best shot at defeating prostate cancer.
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Make Lifestyle Changes To Promote Prostate Health
Here are 19 steps to better prostate health:
Consider Your Treatment Options
Maintain Medical Records
Establish A Social Network
Understand Treatment Options And Risks
Regardless of your Gleason score or prostate cancer stage, every patients situation is unique. Its important that you fully understand yours by discussing it with your physician.
If you accurately diagnose and treat your prostate cancer, you can have a better chance of preventing it from getting worse .
The three main types of prostate cancer treatment are active surveillance, radiation therapy, and surgical removal . There are benefits and drawbacks to each treatment type.
For example, if prostate cancer is already spreading but was misdiagnosed or missed altogether, active surveillance may not be the best course of action. Similarly, a prostatectomy could be unnecessary if your prostate cancer is confined to a single, small T-stage tumor that can be closely monitored.
This is why working closely with your medical team to accurately diagnose your prostate cancer is so important. Accurate and early diagnosis followed by active, consistent treatment is the best path to fighting prostate cancer and preventing a recurrence.
Learn more: What Are the Treatment Options for Prostate Cancer
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Make Smart Lifestyle Moves
A healthy diet, regular exercise, and weight management are important for keeping you healthy through prostate cancer treatment and preventing other diseases that can come along with getting older.
Another way to look at it, says Canfield, is that diet and exercise help the immune system and prostate cancer does seem to be somewhat affected by the immune system. A healthy lifestyle certainly can’t hurt your prognosis, and it may be helpful.
Here are some specific diet recommendations from the UCSF:
- Eat a variety of vegetables, including cooked tomatoes and cruciferous vegetables like broccoli and cabbage, which some studies suggest may reduce the risk of developing aggressive prostate cancer.
- Avoid processed meat and poultry. Instead, choose healthier protein sources, including salmon and other fish that contain omega-3 fatty acids.
- Focus on good fats. Instead of fried foods and saturated fat, go for olive oil, nuts, and other vegetable fat sources.
- Get plenty of calcium from low-fat sources, such as skim milk, vegetables like kale and spinach, and fortified foods like whole-grain cereals and soy or nut milks.
In addition to what you eat, aim for vigorous physical activity for at least 30 minutes on days when youre feeling able, maintain a healthy weight, and dont smoke.
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
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Impact Of Age On Treatment
The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests.10 Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.11,12
Chodak and associates12 evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.
Ask These Key Questions About Your Cancer
The first tip is to get educated. Dr. Carroll recommends seeking multidisciplinary opinions from experienced providers.
When talking to your doctor, its a good idea to have other people in the room with you. Friends and family can create a support team thats often helpful, Carroll explains, since people hear different things and tend to ask different questions.
Dr. Canfield adds that taking notes when reviewing information on the web is also important because you are going to see so many things that may or may not apply to your specific cancer it’s so common to forget what you were going to ask the doctor.
To get started, Carroll suggests the following questions, which can help you get to the heart of your situation.
Other tools are also available to assess your disease and help predict likely outcomes of different treatments. For example, prostate cancer prediction tools, called nomograms, are available online through institutions such as Memorial Sloan Kettering Cancer Center in New York City.
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How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
Questions To Ask Your Doctor
Asking questions of your doctor may help you make more informed decisions about your care. Open communication between a patient and his doctor is extremely important. Here are answers to some common questions prostate cancer patients should ask their doctors:
What is a prostate-specific antigen level?
PSA is a substance produced by both the healthy prostate and prostate cancer. A PSA test is used primarily to screen for prostate cancer. The levels of PSA in the blood may be higher in men who have prostate cancer or other conditions. A PSA test measures the amount of prostate-specific antigen in your blood. The PSA test may detect high levels of PSA that could indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, may also increase PSA levels.
What is a Gleason score?
A Gleason Sum of seven may mean the cancer is likely to grow and spread at a modest pace. Some of these patients are candidates for active surveillance, while others should be treated immediately.
A Gleason Sum between eight and 10 may mean the cancer is likely to grow and spread aggressively. These patients are high risk and require immediate treatment.
How much experience do you have treating my type and stage of prostate cancer?
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Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
How Serious Is My Cancer
If you have prostate cancer, the doctor will want to find out how far it has spread. This is called the stage of the cancer. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of the cancer through the prostate, and if it has spread to other parts of your body. It also includes your blood PSA level and the grade of the cancer. The prostate cancer cells are given a grade, based on how they look under a microscope. Those that look very different from normal cells are given a higher grade and are likely to grow faster. The grade of your cancer might be given as a Gleason score or a Grade Group . Ask your doctor to explain the grade of your cancer. The grade also can helpdecide which treatments might be best for you.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate.
If your cancer hasn’t spread to other parts of the body, it might also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help tell if other tests should be done, and what the best treatment options might be.
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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.
Will My Treatment Be Paid For By Insurance
Cancer treatment is expensive. After a prostate cancer diagnosis, request a full description of your medical benefits from your insurance provider. Bring that with you to your first appointment. During your first visit youll spend some time with the Virginia Oncology Associatespatient benefits specialist. They will know how to help you with gaps in coverage for prescriptions or other concerns that many patients have related to paying for cancer treatment.
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How Is Prostate Cancer Treated
The best treatment for your prostate cancer depends on your age, general health and the grade and stage of your cancer. Although nearly all treatments have side effects, most can be effectively managed. Ask your doctor what side-effects to expect and how best to manage these.
Active surveillance is sometimes a valid option and is a way of monitoring prostate cancer when it isnt causing symptoms or problems. This form of treatment may be suggested by your doctor if the cancer is small and slow growing and its unlikely to spread. The possible side effects of treatment such as surgery may have more impact on your life than the cancer. You will still need regular prostate tests, which may include repeated biopsies, to make sure things haven’t changed.
Watchful waiting is another way of monitoring prostate cancer in case symptoms develop or change. It involves regular prostate specific antigen tests and check ups. Watchful waiting is not as strict as active surveillance and additional biopsies are not usually needed.
Surgery involves the removal of the prostate , and sometimes the surrounding tissue. Surgery requires on average three to six days in hospital, followed by a four to six week recovery period.
Surgery is an option if you have localised prostate cancer and you are fit for surgery. Once the cancer has spread outside the prostate gland, surgery is not normally an option, however other treatments are available.