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.
What Does The Procedure Look Like
Depending on how far advanced an individuals prostate cancer is, and what treatment effect the procedure is aiming for, different approaches may be used. Most commonly, these approaches include the simple orchiectomy , or the subcapsular orchiectomy . Your provider will help you determine which option is right for you, and you will visit them for a follow-up appointment within several weeks.
It is important to note that orchiectomies are not intended to cure your cancer, but rather is performed to try to shrink existing tumors, prolong survival, and relieve pain. While having an orchiectomy may cut back on money, time, and other treatment hassles, it is important to recognize that the results of an orchiectomy are permanent. When hormone replacement therapy is administered using medications only, the side effects of treatment arent permanent and have the potential to reverse after treatment is stopped. With an orchiectomy, these side effects and life changes are permanent. Your provider will also help you weigh the pros and cons of each option to determine what is appropriate for your specific case and quality of life concerns.3
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
- Bones
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
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Advanced Prostate Cancer Life Expectancy And Prognosis
Typically, each stage of prostate cancer has different prognosis. In general, the advanced stages of the disease are much more difficult to treat than when the disease is still at early stage not yet spread. What are factors that affect the outlook and life expectancy of patient? The following are some statistics for each stage of this disease.
You might also like to know more about how fast prostate cancer spreads and what are the most common sites /organs of the body for the metastasis of this cancer in this section, before continuing
One thing you need to clearly understand that there is no any statistic that can be detail enough to tell you about what will happen. In other words, this statistic is only purposed for general information! In fact, each case of cancer is unique. So, there is always a chance and a hope for anyone who diagnosed with cancer.
Advanced prostate cancer symptoms
The symptoms of the disease are more likely to occur when the disease at advanced stage. This is the most challenging for doctors, because the early warning signs that are more likely to not occur will increase the number of patients diagnosed with the disease at later stages.
Once the cancerous tumor is bigger in size and also spreads to nearby sites or even other distinct organs of the body, there will be more complications that can be generated. These may include:
Understanding n-years survival statistics
The major factors that affect the outlook of patients
What Types Of Hormone Therapy Are Used For Prostate Cancer
Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
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The Future Of Hormone Therapy For Prostate Cancer
Some experts arent sure how much further we can improve hormone therapy for prostate cancer.
Im not saying that weve reached the end of what we can do with hormonal therapy, Thrasher tells WebMD, but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.
Brooks argues that, overall, prostate cancer is only moderately affected by hormones. You can only do so much manipulating the levels of hormones, says Brooks. We have to find better ways to fight the basis of the cancer cells.
Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.
But Holden remains optimistic about the future of hormone therapy for prostate cancer.
Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy, he says. But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.
Its like an endless chess game, he says. You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.
Survival By Disease Recurrence
If a man develops an elevated PSA level after cancer surgery, then the disease is viewed as recurrent.
The number of lymph nodes at the time of prostatectomy can influence the risk of recurrence. One study suggests the removal of a large number of nodes is associated with an improvement in odds of recurrence, but this doesn’t appear to impact overall survival.
But disease recurrence doesn’t always influence survival times. If a recurrence does occur, the 15-year survival rate at the time of diagnosis may be as high as 94% in those with low-risk recurrence.
The main factors influencing survival rates are:
- The Gleason score
- The PSA doubling time
- Whether the recurrence occurred within three years or after three years
A recurrence that occurs within three years reduces survival rates by anywhere from 15 to 20%and even more, if the doubling time is short.
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What Is The Life Expectancy Of Someone With Metastatic Prostate Cancer
In the past, the life expectancy of men with metastatic prostate cancer was 2-3 years. But with advancements in medicine and care, the life expectancy of men with metastatic prostate cancer has increased to about 5-6 years.
The 5-year survival rate of metastatic prostate cancer is 28%, which is much lower than local and regional prostate cancers. This refers to the percentage of people diagnosed with a particular cancer who can expect to live for at least 5 years after diagnosis.
What Is The Prostate
The prostate is a small gland that only men have. Normally, the prostate is about the size of a walnut. The prostate is located underneath the bladder and in front of the rectum. The prostate makes and stores fluid that is part of semen. This fluid is released from a mans penis during ejaculation.
The male hormone, testosterone, helps the prostate gland work as it should. Nerves to the penis, which are important in producing and maintaining an erection, run very close to the prostate. The prostate completely encircles the tube that carries urine from the bladder to the penis, called the urethra. If the prostate grows too big, it can block the flow of urine from the bladder, making it hard for a man to urinate.
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Improvements In Life Expectancy
A decade ago, a man with metastatic prostate cancer would typically have a life expectancy of two to three years. Today, life expectancy for men with the same advanced disease is likely to be five to six years. In the UK the survival rate for men with stage 4 prostate cancer is approximately 50%, meaning that 50 out of every 100 men will survive their cancer for 5 years or more after they are diagnosed with stage 4 prostate cancer*. There is now a much broader range of chemotherapy drugs available for men with advanced disease with greater efficacy . We also have better treatments to control the symptoms of advanced prostate cancer, such as pain from metastases. In this section, we consider in more detail the different treatments that are available and evidence for their effectiveness.
Managing Bone Pain And Weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
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Keeping Health Insurance And Copies Of Your Medical Records
Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and although no one wants to think of their cancer coming back, this could happen.
At some point after your cancer treatment, you might find yourself seeing a new doctor who doesnt know your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Treatment Received For Prostate Cancer
The main stay of treatment in all of the studies was Androgen Deprivation Therapy , including orchidectomy, stilboestrol and LHRH analogues. In most of the studies, about half of the patients had already received hormones prior to PCN insertion.
In Chiou et al. they also used iv diethylstilbestrol disphosphonates and radiotherapy directly to the ureters, but no improvement was seen in any of the patients in which they were used . In two other series, eight patients received chemotherapy in one , and six in the other , in addition to hormonal manipulation, but the outcomes specific to chemotherapy were not documented in either .
The time from diagnosis with prostate cancer to PCN insertion was highly variable. Only 3 studies documented this . Although the time from presenting with malignant urinary obstruction to having PCN 12 years after their initial prostate cancer was variable, the mean time across these three studies was 42 months .
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How Is This Procedure Done
First, your surgeon will lift your penis and tape it to your abdomen. Then, theyll make an incision either on your scrotum or the area right above your pubic bone on your lower abdomen. One or both testicles are then cut out from the surrounding tissues and vessels, and removed through the incision.
Your surgeon will use clamps to prevent your spermatic cords from gushing blood. They may put in a prosthetic testicle to replace the one thats removed. Then, theyll wash the area with a saline solution and sew the incision shut.
You should be able to go home a couple hours after an orchiectomy. Youll need to return the next day for a checkup.
For the first week after an orchiectomy:
- Wear a scrotal support for the first 48 hours after the surgery if instructed to by your doctor or nurse.
- Use ice to reduce swelling in your scrotum or around the incision.
- Wash the area gently with a mild soap when you bathe.
- Keep your incision area dry and covered in gauze for the first few days.
- Use any creams or ointments following your doctors instructions.
- Take nonsteroidal anti-inflammatory drugs like ibuprofen for your pain.
- Avoid straining during bowel movements. Drink lots of water and eat high-fiber foods to keep bowel movements regular. You can also take a stool softener.
See your doctor right away if you notice any of the following side effects:
Talk to your doctor about possible long-term side effects due to having less testosterone in your body, including:
Survival For All Stages Of Prostate Cancer
Generally for men with prostate cancer in England:
- more than 95 out of 100 will survive their cancer for 1 year or more
- more than 85 out of 100 will survive their cancer for 5 years or more
- almost 80 out of 100 will survive their cancer for 10 years or more
Survival of prostate cancer is also reported in Scotland and Northern Ireland. But it is difficult to compare survival between these countries because of differences in the way the information is collected.
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account the background mortality that they would have experienced if they had not had cancer.
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What Are The Advantages Of Orchiectomy
First, it is a single, simple, surgical procedure with a very low risk of problems and 100 percent efficacy.
Second, it can be carried out in ways which are not physically evident. In other words, it is possible to carry out what is known as a subcapsular orchiectomy, in which the cores of the two testes are removed while the capsules remain in the scrotum. This means that the man still appears to be an intact male.
Hormone Therapy In Older Patients
The backbone of prostate cancer treatment is hormonal therapy, which aims to limit the activation of the androgen receptor with testosterone. This limitation of AR activation may occur through agents that decrease circulating testosterone, such as gonadotropin-releasing hormone agonists or antagonists. The use of these agents also decreases testosterone precursors and other off-target effects of testosterone. Agents such as nonsteroidal anti-androgens block AR activation and yet preserve circulating testosterone levels.
Providers must carefully consider the toxicities of androgen deprivation therapy in a physiologically older population. These patients have less reserve to absorb additional imbalances or conditions that will impact their current steady state. In general, agents that result in a hypogonadal state can lead to toxicities within the following domains: metabolic and body composition sexual health and mood and central nervous system symptoms .
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Whos A Good Candidate For This Procedure
Your doctor may do this surgery to treat breast cancer or prostate cancer. Without the testicles, your body cant make as much testosterone. Testosterone is a hormone that can cause prostate or breast cancer to spread more quickly. Without testosterone, the cancer may grow at a slower rate, and some symptoms, such as bone pain, may be more bearable.
Your doctor may recommend orchiectomy if youre in generally good health, and if the cancer cells have not spread beyond your testicles or far beyond your prostate gland.
You may want to do an orchiectomy if youre transitioning from male to female and want to reduce how much testosterone your body makes.
This surgery effectively treats prostate and breast cancer. You can try hormone therapies with antiandrogens before considering an orchiectomy, but these can have side effects, including:
- damage to your thyroid gland, liver, or kidneys
- blood clots
Lutetium Lu 177 Vipivotide Tetraxetan
Lutetium Lu 177 vipivotide tetraxetan is indicated for the treatment of men with prostate-specific membrane antigen -positive, metastatic castration-resistant prostate cancer who have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. It is a radioligand therapeutic agent. The active moiety is the radionuclide lutetium-177, which is linked to a moiety that binds to PSMA, a transmembrane protein expressed in prostate cancer, including mCRPC. Upon binding to PSMA-expressing cells, the lutetium-177 delivers beta-minus radiation to the cells, as well as to surrounding cells, inducing DNA damage that can lead to cell death.
Approval was based on the phase 3 VISION trial. Compared with patients receiving standard care , patients who received lutetium Lu 177 vipivotide tetraxetan plus standard care had significantly prolonged imaging-based progression-free survival and 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.
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