For Many Men Diagnosed With Prostate Cancer The Treatment May Be Worse Than The Disease
To screen or not to screen? For prostate cancerthe second leading cause of cancer deaths in men, after lung cancerthat is the bedeviling question.
The dilemma springs the wide variation in the potential of prostate cancers to spread to the rest of the body. The vast majority of these malignancies, especially those discovered with the extensively used prostate-specific antigen, or PSA, test, are slow-growing tumors that are unlikely to cause a man any harm during his lifetime. Yet in 10 to 15 percent of cases, the cancer is aggressive and advances beyond the prostate, sometimes turning lethal.
Myth: If You Have A Low Psa You Don’t Have Prostate Cancer
Fact: PSA levels can be useful in diagnosing prostate cancer, but theyre really only one piece of the larger puzzle. The PSA test is far from perfect, Sartor says. He draws a parallel between low PSA readings and negative mammograms in women. If you have a negative mammogram, it’s not 100 in terms of excluding cancer. The probability is less, but likewise just because your PSA is relatively low, you cant interpret that to mean that there is no cancer present.
However, the opposite can also occur: Sartor described a different scenario in which one of his patients a very bright and accomplished attorney has a biopsy after getting an elevated PSA, and the biopsy came back negative. After this negative result he figured he didnt have cancer, and waited three to four years before having his PSA tested again, Sartor says. Now he has prostate cancer that has spread to other parts of his body. In other words: metastatic disease. He took the negative biopsy as literally meaning he doesn’t have cancer, and it turned out badly for him.
To get the most complete picture of your prostate health, you need to get other diagnostic tests as well. This may mean getting a biopsy. But that standard is changing, says Sartor, citing a major study published in The New England Journal of Medicine in March 2018 and The Lancet in February 2017 that point to the value of a special type of MRI imaging called multiparametric magnetic resonance imaging.
Can Prostate Cancer Be Completely Cured
Prostate cancer is the second most common cancer in men. The average age of diagnosis is 66 year olds, although it may affect younger men as well. By age 80, more than half of all men have some cancerous growth in their prostate.
Due to routine screening of prostate-specific antigen levels in the United States, nearly 90% of prostate cancers get detected in early stages. In most cases, the cancer is confined only to the prostate and does not spread to other organs. With the widespread use of screening tests in the United States, early diagnosis of prostate cancer has become much easier.
When found early, there are several treatment options available and prostate cancer has a high chance of getting cured. Moreover, prostate cancer is a slow-growing cancer that takes many years to become big enough to cause symptoms. It also takes quite long to spread to other organs. This gives sufficient time for the doctors to treat it.
Oncologists recommend patients to not rush and take some time to understand the various treatment options available after consulting with more than one doctor. Patients can discuss various modes of treatment with the doctor and select the most appropriate option for their prostate cancer.
The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. There are more than three million survivors of prostate cancer in the United States today.
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What Are Prostate Cancer Survival Rates By Stage
Staging evaluation is essential for the planning of treatment for prostate cancer.
- A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
- Further testing and calculations may be performed to best estimate a patient’s prognosis and help the doctor and patient decide upon treatment options.
Prognosis refers to the likelihood that the cancer can be cured by treatment, and what the patient’s life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.
If a cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If the cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival based again on group statistics for people who have been in the same situation.
Nomograms are charts or computer-based tools that use complex math from analysis of many patients’ treatment results.
The prognosis for prostate cancer varies widely, and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and the cancer’s responsiveness to treatment, among other factors.
Is Prostate Cancer Serious
The seriousness of prostate cancer depends on the stage at which it is diagnosed. Five-year survival rates can range from 100 percent for early stages that have yet to spread beyond the prostate to 30 percent for later stages in which the cancer has spread to surrounding organs. If the cancer has become metastatic, or spread to distant organs or the bones, then no cure is possible and death cannot be prevented, usually coming within three years of diagnosis.
After skin cancer, cancer of the prostate is the most common cancer in American men. This disease is extremely common and often produces no symptoms, because it usually spreads quite slowly.
Prostate cancers occur most frequently in older men. About 35,000 to 40,000 men die annually from prostate cancer, but this amounts to only about 3 to 4 percent of all deaths in men. Even so, prostate cancer is the second leading cause of cancer deaths in American men. Unfortunately, the rate has been increasing about 6 percent a yearoddly enough, because of greater efforts at early detection of the disease.
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Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate
The prostate is agland in the malereproductive system. It lies just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland makes fluid that is part of the semen.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.
What Is Prostate Cancer
The prostate is a walnut-shaped gland that lies below the bladder and in front of the rectum. In men, the size of the prostate increases with increasing age. Its primary function is to make fluid to nourish and lubricate the semen.
Growth in the prostate can be of two types:
- Benign growths: These are noncancerous growths and are rarely a threat to life .
- Malignant growths: These are cancerous growths that are potentially life-threatening.
Quality Of Life With Advanced Stage Prostate Cancer
Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.
Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.
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Please Help Docs Is Prostate Cancer Usually Fatal
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Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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Myth: Prostate Cancer Isn’t Deadly
Fact: While the five-year survival rate with prostate cancer is very high 90 percent, according to the ACS its still the second leading cause of cancer death in men. The only cancer that kills more men is lung cancer.
Most prostate cancers are what doctors call indolent, which means that they grow slowly and can often be actively monitored over the course of many years without other treatment. But sometimes prostate cancer is aggressive, and grows quickly.
While most men dont have a prostate cancer thats fast and deadly, acknowledges Sartor, it does exist. And you wont know which type you have until its thoroughly checked out.
In other words, assuming prostate cancer isnt serious and not having further testing because of this misconception could be a downright deadly way of approaching the illness.
The dangers and risks of prostate cancer arent distributed evenly among American men, either. The U.S. Department of Health and Human Services Office of Minority Health reports that African-American men are 2.3 times as likely to die from prostate cancer as compared to non-Hispanic white men.
Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
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Prostate Cancer Kills While Other Patients Live Decades After Diagnosis
What can be done to identify the lethal forms of prostate cancer?
Aggressive disease upon diagnosis often has a grim outlook. A diagnostic biopsy involves placing a needle into the walnut-sized prostate gland at standard locations or cores. MRI and ultrasound are sometimes used for visualization.
New Technology with Biopsy Cores
Usually theres a dozen cores or locations where tissue is extracted for biopsy to check for the presence of cancer cells.
If cancer is present, a score, called Gleason, is assigned, based on the changes in glandular architecture.
A Gleason of 6 or less means a slow growing or indolent malignancy. A patient with a borderline Gleason score may still undergo surgery which reveals a more aggressive cancer.
On the other hand, there are men with high Gleason scores whose surgery reveals indolent cancer.
Michael Wigler and Alexander Krasnitz, of Cold Spring Harbor Laboratory, have developed a method that sequences the genomes of hundreds of single cells taken from each biopsy core.
They search for patterns called CNVs: copy-number variations. CNVs are DNA disturbances.
CNV patterns are compared. DO any cells have CNV profiles that have the same irregularities? If so, this means clonality. Malignant tumors are made of clonal cells.
Each set of biopsy cores gets a number thats based on how many of the cores have clonality how many clonal cells that each core contains and how far these clonal cells have dispersed within the prostate.
The Role Of Parathyroid Hormone
Parathyroid hormone is a hormone secreted by the parathyroid gland which plays an important role in bone remodeling. It stimulates bone resorption by osteoclasts indirectly through PTH binding receptors located on osteoblasts. Upon binding of PTH on osteoblasts, the expression of OPG is downregulated whereas the expression of RANKL is upregulated . Signaling to the bone marrow-derived osteoclast precursors, high levels of RANKL consequently stimulate their fusion, differentiation, and activation. PTH causes a net bone loss through an increased resorption process when administered in a continuous fashion, but a net bone gain through an enhanced formation process when administered intermittently. To our knowledge, only a handful of evidence documented the ectopic expression of PTH by the thyroid and other non-parathyroid tumors . Specifically, studies on the ectopic expression of PTH by prostate tumors are limited .
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To Treat Or Not To Treat
Up until now, with a few notable exceptions, doctors have myopically focused on treating prostate cancer, says Adami. They are willing to spend tens of thousands of dollars on chemotherapy that has minimal effects on cancer mortality, often with substantial side effects. But we ignore entirely the fact that large groups of prostate cancer patients die from other causes that actually are preventable.
Among older patients especially, that activity can take the form of vigorous walking. Recently, Mucci has spearheaded an intervention with Adami and other colleagues in Sweden, Iceland, and Ireland in which men walk in groups with a nurse three times a week. In a pilot study, researchers found improvements in just 12 weeks in body weight, blood pressure, sleep, urinary function, and mental health.
Scientists at HSPH are also searching for genetic and lifestyle markers that help predict how aggressive a patients prostate cancer will be. For example, an ongoing project led by Mucci and Adami draws on detailed cancer registries in Nordic countries, including an analysis of 300,000 twins, to tease out the relative contribution of different genes to prostate cancer incidence and survival.
is a Boston-based journalist and author of The Coke Machine: The Dirty Truth Behind the Worlds Favorite Soft Drink.
If Your Prostate Cancer Comes Back
If your cancer goes into remission but later returns, follow-up treatments will depend on where the cancer is located and which treatments youâve already tried.
- If the cancer is contained in your prostate, surgery or a second attempt at radiation is suggested. If youve had a radical prostatectomy, radiation therapy is a good option. If you had radiation, radical prostatectomy might be the best approach. Cryosurgery might also be an option.
- If the cancer has spread to other parts of your body, hormone therapy might be the most effective treatment. External or IV radiation therapy or bisphosphonate drugs can relieve your bone pain.
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Early Prostate Cancer Doesnt Have Symptoms
It can be tricky to identify prostate cancer in its early stages without a screening. Thats because most early prostate cancers are not symptomatic, according to Andrew Hung, MD, a urologist at Keck Medicine of USC and assistant professor of clinical urology at the Keck School of Medicine of USC..Early prostate cancer is usually caught by an abnormal blood test an elevated prostate-specific antigen test, or PSA test, says Hung.
Men often confuse symptoms of an enlarged prostate with warning signs of prostate cancer, although they are typically independent of each other, Hung explains. Symptoms of an enlarged prostate include problems urinating, like the need to go more frequently, difficulty emptying the bladder or a slow or weak stream.
Symptoms of advanced prostate cancer might include difficulty with urination, fatigue or persistent pain in the back, hips or pelvis.
Prostate Cancer Survival Rates Are Favorable Overall
Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.
To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides whats called the relative survival rate for prostate cancer.
Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, were not counting men with prostate cancer who die of other causes:
- 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
- Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.
Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:
- the relative 10-year survival rate is 98%
- the relative 15-year survival rate is 96%
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