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Living With Metastatic Prostate Cancer

Improving How Long Patients Live

Living with Metastatic Prostate Cancer

The ENZAMET trialfunded in part by the drugs manufacturer, Astellas Pharma, as well as government health agencies in Canada and Australiaenrolled more than 1,100 men with hormone-sensitive metastatic prostate cancer. The men were randomly assigned to ADT combined with enzalutamide or with any of three other androgen-blocking drugs.

At a median follow-up of nearly 3 years, men who received ADT plus enzalutamide had a 33% reduced risk of death, with 80% still alive compared with 72% of men treated with ADT plus another antiandrogen drug, reported the trials lead investigator, Christopher Sweeney, M.B.B.S., of the Dana-Farber Cancer Institute.

Men in the enzalutamide group also had better clinical progression-free survival , which the research team defined as the time until the return of disease-related symptoms, the detection of new metastases on imaging scans, or the initiation of another cancer treatment for prostate cancer, whichever came first. At 3 years, 63% of men in the enzalutamide group were alive without clinical progression of their disease, compared with 33% in the standard treatment group.

Although enzalutamide appeared to be effective regardless of whether men had high- or low-volume disease, one apparent differentiating factor was planned early treatment with docetaxel. Nearly half of the men in both treatment groups received early treatment with docetaxel and, for those men, enzalutamide was not associated with longer overall survival.

Worries About Dying From Advanced Prostate Cancer

Not all men with advanced prostate cancer will die from prostate cancer and men often live with advanced prostate cancer for several years. But you might have questions about what will happen if your cancer progresses and youre approaching the end of your life. It can help to know what to expect and how you can get the support you need. This can also make things easier for your family and friends.

Coming to terms with things

If youre approaching the end of your life, this might be hard for you and your family to accept. Even if youve been living with prostate cancer for years, it can still be a shock. Some men feel upset, alone, or angry. Some men worry about their family and friends. It can be difficult to talk to your family about whats happening.

Give yourself time it can take a while to process whats happening. Some men want time by themselves or with a family member or close friend. There are things you can do to help yourself and people who can support you.

What to expect

Some men find that they get more symptoms in their last months and weeks. Others find that existing problems get worse. Read more information about what to expect.

Getting access to care

Towards the end of your life, your doctor or nurse will try to manage any pain and other symptoms. They will try to give you emotional, physical, practical and spiritual support. And provide support for your family and for people looking after you. This is sometimes called palliative or supportive care.

Race And Prostate Cancer

African-American men and Jamaican men of African descent have a greater chance of developing the kind of prostate cancer that grows and spreads. Researchers are not sure why there is a difference in disease and death rates among different races. Some experts think there may be a genetic link.footnote 3

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Are There Any Lifestyle Changes I Should Consider While In Treatment For Metastatic Prostate Cancer

The most important thing you can do is to stay physically active and strong. This includes following a heart-healthy diet and exercising.

Cardiovascular exercise is the most important. The degree, or intensity and duration, of cardio exercise depends on the individual person.

Several studies have pointed to a link between obesity and aggressive prostate cancer, although the mechanism is still being worked out.

Weight loss is generally encouraged if youre overweight, but excessive or unintentional weight loss can be a sign of disease progression and should be discussed with your doctor.

Finally, if youre a smoker, stop! If youre finding it hard to quit, ask your doctor about products and medications that might help you.

Men With Incurable Prostate Cancer Living For Twice As Long As Decade Ago

Where prostate cancer spreads in the body affects survival ...

Patients with advanced prostate cancer treated with the latest therapies are living on average for more than twice as long as a decade ago, a striking new analysis reveals.It showed that patients with incurable prostate cancer treated at leading cancer hospital The Royal Marsden NHS Foundation Trust now live for about two extra years on average than they did just 10 years ago.The research, conducted by The Institute of Cancer Research, London, and The Royal Marsden, found the introduction of a range of new drugs has had such an impact that the system doctors use to predict how long patients will live now needs to be revised.The research is published in European Urology and was conducted by researchers who are funded by Prostate Cancer UK, Cancer Research UK, the Medical Research Council and the Prostate Cancer Foundation, US.The team studied data from 442 UK patients across 32 clinical trials and two extended access drug programmes at The Royal Marsden since 2003.Some 78% of patients received docetaxel-based chemotherapy, which was approved for use on the NHS in 2005.

Half received abiraterone, a targeted prostate cancer drug discovered at The Institute of Cancer Research and approved for use on the NHS last year.

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Many Factors Can Affect Your Prognosis

Some of the factors that affect prognosis include:

  • The type of cancer and where it is in your body
  • The stage of the cancer, which refers to the size of the cancer and if it has spread to other parts of your body
  • The cancers grade, which refers to how abnormal the cancer cells look under a microscope. Grade provides clues about how quickly the cancer is likely to grow and spread.
  • Certain traits of the cancer cells
  • Your age and how healthy you were before cancer
  • How you respond to treatment

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Staging Spread And Survival Rates

As with all cancers, doctors use the term stage to describe the characteristics of the primary tumor itself, such as its size and how far prostate cancer has spread when it is found.

Staging systems are complicated. The staging system for most cancers, including prostate cancer, uses three different aspects of tumor growth and spread. Its called the TNM system, for tumor, nodes, and metastasis:

  • T, for tumor describes the size of the main area of prostate cancer.
  • N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
  • M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.

Using the TNM system, each mans prostate cancer can be described in detail and compared to other mens prostate cancer. Doctors use this information for studies and to decide on treatments.

As far as survival rates for prostate cancer go, however, the staging system is pretty simple. As weve mentioned, in terms of survival rates, men with prostate cancer can be divided into two groups:

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Deaths From Prostate Cancer

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA . SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Last Revised: January 12, 2021

What Are Some Of My Options To Manage Those Side Effects

Living with Metastatic Prostate Cancer

Hot flashes tend to be the most bothersome.

Non-medication strategies like keeping cool drinks with you, dressing comfortably, relaxation techniques, and breathing exercises might be helpful.

Medications, such as megestrol, estrogen therapies, antidepressants, and neuroleptic agents like gabapentin can improve hot flashes but often come with dose-limiting side effects.

Pain, although usually not a side effect of treatment, is managed with non-narcotic or narcotic pain medications. We sometimes have to manage the side effects of pain medication, such as constipation.

Using the mildest medication is always best.

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How Do I Know If Treatment Worked

If treatment is successful, levels of PSA in the blood will decrease. PSA levels can rise substantially when an individual is battling prostate cancer, and these levels are used as an early indicator of potential cancer.

When prostate cancer is successfully treated using radiation therapies, PSA levels will drop to lower levels and stabilize. When prostate cancer is successfully treated by surgically removing the prostate, PSA levels will decrease to the point of being virtually undetectable. When monitoring for recurrence of prostate cancer, one common method is to monitor PSA levels in the blood. If the prostate cancer returns, it is likely that PSA levels will rise again.

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Survival Rates For Prostate Cancer

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.

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Death From Other Causes

The mean age at metastatic prostate cancer diagnosis in the study was roughly 71 years. Most of the cohort was White and had a diagnosis of stage M1b metastatic prostate cancer , which means the cancer had spread to the bones.

Among men in the cohort, the rates of death from septicemia, suicide, accidents, COPD, and cerebrovascular diseases were significantly increased compared with the general US male population, the team observes.

Thus, the study authors were concerned with not only with death from metastatic prostate cancer, but death from other causes.

That concern is rooted in the established fact that there is now improved survival among patients with prostate cancer in the US, including among men with advanced disease. “Patients tend to live long enough after a prostate cancer diagnosis for noncancer-related comorbidities to be associated with their overall survival,” they write.

The editorialists agree: prostate cancer “has a high long-term survival rate compared with almost all other cancer types and signals the need for greater holistic care for patients.”

As noted above, cardiovascular diseases were the most common cause of non-prostate cancer-related deaths in the new study.

As in the management of other cancers, there is concern among clinicians and researchers about the cardiotoxic effects of prostate cancer treatments.

The study had no specific funding. The study authors and editorialists have disclosed no relevant financial relationships.

Men Initially Diagnosed With De Novo Metastatic Prostate Cancer Are Living Longer

SIR

A newly published study entitled Improved cancer-specific free survival and overall free survival in contemporary metastatic prostate cancer patients: a population-based study is important but needs to be interpreted with a significant degree of caution.

Bandini et al. have conducted a careful and sophisticated statistical analysis of the overall and prostate cancer-specific survival times of men diagnosed with metastatic prostate cancer in the US between 2004 and 2014. Starting with > 19,000 men identifiable in the SEER database, the authors used a technique known as propensity score matching to winnow down the initial 19,000+ men to a cohort of 8,596 patients with de novo metastatic prostate cancer who were matched to each other in a consistent manner.

Based on the median year of diagnosis of these men, they divided them into two groups:

  • Group A: Men diagnosed between 2004 and 2008
  • Group B: Men diagnosed between 2009 and 2014

The 4,298 men in each group had an average age of 70 years, and the majority had received no prior treatment for localized disease.

They then looked at the prostate cancer-specific and overall survival data for these two groups of patients.

Here is what they found:

  • Cancer-specific mortality-free survival from time of diagnosis was
  • 32 months for patients in Group A
  • 36 months for patients in Group B
  • This difference was highly statistically significant
  • Overall mortality-free survival from time of diagnosis was
  • 26 months for patients in Group A
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    Igniting A New Field Of Research

    To address these questions, NCI sponsored a virtual meeting that brought together researchers, health care providers, patient advocates, and people like Ross who are living with advanced or metastatic cancer.

    The meeting featured presentations by survivorship researchers and people living with advanced or metastatic disease, as well as panel discussions. Each panel included at least one person living with cancer.

    We came together to exchange ideas about how we are caring for these patients and what we can do better, said Temel. Our goal is to ignite a new field of research to better support and address the care needs of patients with advanced cancers.

    People living with advanced or metastatic cancer have needs that may differ from those of people who have been treated for early-stage cancers, noted Lisa Gallicchio, Ph.D., of NCIs Division of Cancer Control and Population Sciences , who co-led the meeting.

    Examples of these needs include the management of chronic conditions, psychosocial support, caregiver support, financial support, and communication around the goals of care.

    People with advanced or metastatic cancer might require treatment for the disease indefinitely, or they might be on and off treatment for the rest of their lives, Dr. Gallicchio said. They will also likely undergo regular testing to identify signs of a recurrence.

    What Are The Symptoms

    Sometimes there are no symptoms of either locally advanced or metastatic prostate cancer.

    When they do appear, symptoms of locally advanced prostate cancer include:

    • Waking up many times during the night to urinate.
    • Having trouble starting your urine stream, having a weaker-than-normal stream, or not being able to urinate at all.
    • Having pain or a burning feeling when you urinate.
    • Having blood in your urine.
    • Having a deep pain or stiffness in your lower back, upper thighs, or hips.

    Symptoms of metastatic prostate cancer may include:

    • Bone pain.
    • Swelling in your legs and feet.

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    At What Point Should I Consider A Clinical Trial

    Clinical trials are designed to answer a wide array of clinical questions. A quick search of clinicaltrials.gov shows over 150 mCaP trials currently enrolling patients in the United States.

    Its important to remember that clinical trials are often not intended to treat or cure participants, but rather to further the knowledge of the scientific community.

    If youre diagnosed with mCaP and are inclined to get involved with research, discuss it with your physician or check the site above for trials in your area.

    I would add that for patients very close to the end of life, time might be better spent with family and friends.

    What Does Cancer Remission Mean

    How Living with Metastatic Prostate Cancer Changed Our Outlook

    Cancer remission is when the signs and symptoms of cancer have lessened or are undetectable.

    In blood-related cancers like leukemia, this means youll have a decrease in the number of cancer cells. For solid tumors, that means that the tumor size has decreased. The decrease must last for at least one month to be considered remission.

    types of cancer remission

    There different types of remission:

    • Partial. A reduction of at least 50 percent in measurable tumor size or cancer cells
    • Complete. All detectable evidence of cancer is gone.
    • Spontaneous. When cancer goes into remission without therapy considered adequate to otherwise lead to remission. This usually happens after a fever or infection, and is rare.

    Remission is not a cure, and it doesnt mean that youre totally cancer-free. Even in complete remission, there can still be some cancer cells in your body, and these can start growing again.

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    How Is Prostate Cancer Diagnosed

    A blood test called a prostate-specific antigen test is the most common way to check for prostate cancer. A higher level of PSA may mean that you have prostate cancer or that your prostate cancer has come back.

    Your doctor also may do a biopsy. In this test, your doctor takes samples of tissue from your prostate gland or from the area where the cancer may have spread and sends the samples to a lab for testing. A biopsy is the only way to know for sure that you have prostate cancer.

    If you have had prostate cancer before, your doctor may also order a bone scan, CT scan, or MRI to see if it has come back or spread.

    Learning that you have cancer that has spread or come back can be very hard. Some people find that it helps to talk about their feelings with their family and friends. You may also want to talk with your doctor or with other people who have had this kind of cancer. Your local American Cancer Society chapter can help you find a support group.

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