The Initial Causes What Chemotherapy Is Used For Prostate Cancer
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
Side Effects Of Chemotherapy
All chemotherapy drugs work in slightly different ways, making it challenging to predict side effects for individual patients. Dosages, drug combinations and drug responses will vary from patient to patient.
The American Cancer Society lists the following as the most common side effects of chemotherapy:
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Increased risk of infections
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Easy bruising or bleeding
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
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What Can Be Done To Treat Or Reduce Side Effects
Once chemotherapy treatment is complete, its side effects will typically cease. However, steps can be taken to combat any side effects as they occur. For instance, medications can help prevent nausea and vomiting, laxatives or stool-binding medications can manage constipation or diarrhea, respectively, and numbing gel can soothe mouth sores. Additionally, chemotherapy dosages can be changed or alternative chemo drugs can be considered, if appropriate.
Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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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.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
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If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Secondary Cancer In The Bones
After the lymph nodes, the most common place for prostate cancer to spread to is the bones. Prostate cancer may spread to bones, such as the:
It may affect different areas of the bones rather than only one area.
- Pain
The first sign of a secondary cancer in the bones is usually an ache in the bone. This is often in the hips or in the back. A secondary cancer in the bone may gradually make the bone weaker. Bones that are very weak may break more easily. There are treatments you can have to help strengthen the bones and reduce pain.
- Spinal cord compression
If the bones in the spine have cancer in them, the cancer may press on the spinal cord. This is called Malignant spinal cord compression . It usually affects your legs and may cause:
- numbness or tingling in your legs.
Spinal cord compression is not common. But if you notice these symptoms, you should contact your doctors straight away even at the weekend or during a holiday period. If you cannot contact your GP or cancer doctor, you should go to the nearest emergency department .
Prostate cancer can sometimes spread from the bone to the bone marrow. Bone marrow is the spongy material in the middle of our bones where our blood cells are made. This includes red blood cells, which carry oxygen around the body.
If the bone marrow cannot produce enough red blood cells, you may become anaemic. This can make you feel very tired and breathless, and you may look very pale.
Emerging Therapies For Prostate Cancer
Researchers are pursuing several new ways to treat advanced prostate cancer. Vaccines that alter the body’s immune system and use genetically modified viruses show the most promise. One vaccine technique works by manipulating blood cells from the patient’s immune system and causing them to attack the prostate cancer.
Blood is drawn from the patient. From the blood sample, cells that are part of the immune system are exposed to cells that make up prostate cancer. Then the blood cells are placed back in the body, with the hope that they will cause other immune system cells to attack the prostate cancer. In a more traditional type of vaccine, the patient is injected with a virus that contains PSA. When the body is exposed to the virus, it becomes sensitized to cells in the body that contain PSA and their immune system attacks them.
Immune or genetic therapy have the potential to deliver more targeted, less invasive treatments for advanced prostate cancer. This would result in fewer side effects and better control of the prostate cancer.
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The Role Of Adjuvant Chemotherapy
The role of adjuvant chemotherapy after radiation therapy in PCa was recently evaluated in a large Phase III trial, the RTOG 0521 that randomized a total of 563 high-risk PCa patients to either ADT and radiotherapy or ADT and radiotherapy followed by sequential docetaxel and prednisone.86 Androgen suppression was given for 24 months external-beam radiation therapy was given for 8 weeks and docetaxel was given at 75 mg m2 on day 1 for 6 cycles, starting 4 weeks after the completion of radiotherapy along with prednisone 10 mg. The enrolled patients had Gleason scores between 8 and 10, PSA 20 ng ml1 , or T2 stage. At a median follow-up of 5.5 years, 4-year OS was 89% in ADT/radiation arm and 93% with the addition of docetaxel, for an absolute benefit of 4% resulting in a 30% reduction in risk of death favoring adjuvant docetaxel. In addition, there was an absolute 10% reduction in the rate of disease-free survival at 6 years and the risk of biochemical failure was reduced by 20% in the docetaxel-containing arm. As expected, there was more Grade 3 or 4 hematologic toxicity in the chemotherapy arm. This was one of the promising trials that evaluated adjuvant chemotherapy after radiation which was included in a provisionary statement in the National Comprehensive Cancer Network Guidelines for PCa treatment in men with high-risk disease as a consideration for selected patients who are fit to receive chemotherapy.87
Endocrine Drugs For Prostate Cancer
Drugs work as well as prostate cancer surgery to reduce the level of hormones in the body. Most men opt for drug therapy rather than surgery. The three types of hormone-related drugs approved to treat advanced prostate cancer include luteinizing hormone-releasing hormone analogs, luteinizing hormone-releasing hormone antagonists, and antiandrogens.
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How Is Chemotherapy Given
Chemo drugs for prostate cancer are typically given into a vein , either as an infusion over a certain period of time. This can be done in a doctors office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
Many different kinds of CVCs are available. The most common types are the port and the PICC line.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
The length of treatment for advanced prostate cancer is based on how well it is working and what side effects you have.
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 .
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What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
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.
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Before You Start Chemotherapy
You need to have blood tests to make sure its safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.
Pca Working Group Criteria For Response
Given the challenges and lack of standardization in defining PSA responses as well as progression, the PSA working group initially convened a consensus conference and published the guidelines in 1999 in order to guide selection of candidate agents for further testing and choosing which agents that can proceed to Phase III trials especially if they are based on different gauge of PSA changes.46 They also proposed that response duration and time to PSA progression may be important clinical endpoints. The working group criteria were further revised in 2009 with an emphasis on using different parameters, not just PSA progression alone, and patients with early changes in PSA and/or pain are not encouraged to be acted upon without other evidence of objective disease progression such as radiographic technetium scan or computed tomography scans using the Response Evaluation Criteria in Solid Tumors criterion and pain scales.47 In addition, given drugs that were felt to be more cytostatic than cytotoxic, treatment was encouraged to be continued for at least 3 months so that drug exposure was ensured to be adequate. The Prostate Cancer Clinical Trials Working Group 3 reconvened and published updated guidelines in 2016. The emphasis was to be able to distinguish between first progression and the clinical need to switch treatment, with the provision for using blood-based diagnostics, novel imaging and biologic profiling wherever applicable.48
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