Other Ways To Measure Risk Of Prostate Cancer Growing And Spreading
In addition to the risk groups above, doctors are still learning about the best use of other types of tests and prognostic models to help decide the most effective treatment options for someone. If your doctor suggests using one of these ways to help determine your treatment options, have them explain what it can tell you, as well as how accurate its likely to be.
The Gleason Grading System
Screening for prostate cancer involves the prostate-specific antigen test and a digital rectal exam. If results are suspect, your doctor may recommend a prostate biopsythe only way to confirm the diagnosis.
During a prostate biopsy, a urologist uses a small needle to remove tissue samples from different parts of the prostate. These samplesalso called coresare then sent to a pathologist so they can review each one under a microscope.
The pathologist uses a pattern scale, developed by Donald Gleason, MD, PhD in 1966, to give each sample a grade from 1 to 5. Grade 1 cells are well-differentiated and look like normal tissue. Grade 5 cells, on the other hand, are poorly differentiated or even unrecognizable from normal tissue.
Your Gleason score is the sum of the two numbers that represent the most common types of tissue found in your biopsy. The first number in the equation is the most common grade present, the second number is the second most common grade. For example, if seven of your cores are grade 5 and five are grade 4, your Gleason score would be 5+4, or a Gleason 9.
Today, pathologists typically only flag tissue samples that are grade 3 or higher, making 6 the lowest Gleason score.
In 2014, a revised grading system for prostate cancercalled Grade Groupswas established. This system builds on the Gleason scoring system and breaks prostate cancer into five groups based on risk. This can help make it easier to understand the Gleason score scale.
How Do The Treatment Options Compare
A study known as the ProtecT trial is the most important study on treatments for low-risk prostate cancer so far. ProtecT stands for prostate testing for cancer and treatment. This trial compared three treatment options: active surveillance, external radiotherapy and surgery to remove the prostate. A total of 1,643 men between the ages of 50 and 69 took part in the trial. They all agreed to be randomly assigned to one of the three treatment groups. About two thirds of them had low-risk prostate cancer. The treatment outcomes were recorded over an average of ten years, and then compared with each other at the end of the trial.
The following was found over a period of ten years:
- no difference in mortality rate between the active surveillance, radiotherapy and surgical removal groups,
- a somewhat higher risk of metastases in the active surveillance group,
- a much higher risk of accidental urine leakage in men who had surgery,
- a much higher risk of erection problems in men who had radiotherapy or surgery .
- a somewhat higher risk of accidental stool leakage in men who had radiotherapy.
Based on the results of this trial and other research, we have developed a decision aid that can help men who have low-risk prostate cancer to weigh the pros and cons of the various treatment options for example, together with their friends, family and doctors.
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Active Surveillance And Focal Therapy For Low
Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
Keywords: Active surveillance focal therapy low risk prostate cancer minimally invasive conservative management biomarkers
Submitted Jun 01, 2015. Accepted for publication Jun 05, 2015.
Treatment For Low Risk Prostate Cancer
Widespread screening with PSA and DRE leads to the detection of prostate cancer at an early stage. However, a significant number of prostate cancers diagnosed are slow to develop and do not pose a threat to a mans longevity. Once diagnosed with prostate cancer, at UCLA we use information such as your PSA, Gleason grade, MRI findings and biomarkers to determine the overall risk of your cancer spreading. If you have low risk prostate cancer , we know that you are not likely to die of prostate cancer. As a result, we will often not recommend treatment for these cancers.
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Prostate Cancer Risk Factors
A risk factor is anything that raises your risk of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a persons age or family history, cant be changed.
But having a risk factor, or even several, does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
Researchers have found several factors that might affect a mans risk of getting prostate cancer.
When Should You Get Immediate Treatment For Prostate Cancer
If your cancer is advanced or higher-risk, you will probably need treatment right away. Signs of higher-risk cancer include:
- PSA value that is high or rapidly rising.
- Test results show that the tumor is outside the prostate gland. Or the tumor is growing rapidly and is likely to spread outside the gland.
- Gleason score is high-risk.
Ask your team if your cancer shows any of these signs. If so, active surveillance may not be a good choice.
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Surveillance A Good Option In Very Low
Men with low-risk prostate cancer monitored by active surveillance are not likely to have their disease spread to other organs or die of their prostate cancer.
Men with low-risk prostate cancer monitored by active surveillance are not likely to have their disease spread to other organs or to die of their prostate cancer, according to results of a study in the Journal of Clinical Oncology.
Men in the study, followed with active surveillance rather than curative treatment, were about 24 times more likely to die from a cause other than prostate cancer over a 15-year period.
The long-term results of the study suggest that men with non-aggressive disease should consider active surveillance-the careful monitoring of their disease by their clinician-over treatments that can cause adverse events.
H. Ballentine Carter, MD, professor of urologic oncology and director of adult urology at Johns Hopkins Medical Center in Baltimore, Maryland, and colleagues followed the outcomes of 1,298 men enrolled in the Johns Hopkins surveillance program over the past 20 years. Two of these men died of prostate cancer-including one who was in the active surveillance program for 16 years. An additional 3 men developed metastatic disease while 47 men died of causes other than prostate cancer, including cardiovascular disease. Nine men received treatment for their prostate cancer.
The median treatment-free survival was 8.5 years and ranged from 0.01 to 18 years.
Applying The Results To Practice
Younger age alone should not preclude men from active surveillance of low-risk prostate cancer. Active surveillance spares many such patients from intervention, provides adequate time for intervention if required and is associated with durable disease-specific survival.
Unfavorable measures of tumor volume are important factors to discuss in shared decision-making with patients. They may be signs of more aggressive disease that would benefit from definitive treatment, even in patients otherwise categorized as low risk.
Clinicians should consider that younger patients generally have good urinary and sexual function, and any treatment-associated decline in function may impact their relative quality of life more significantly than in older men.
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Findings May Help Predict Outcomes Of Active Surveillance
Active surveillance is used to monitor slow-growing, low-risk, or localized prostate cancer rather than treating it straight away. It typically involves regular prostate-specific antigen screenings, prostate exams, imaging studies, and repeat biopsies to carefully monitor prostate cancer misclassification, growth, or progression without compromising long-term outcomes. The aim of active surveillance is to avoid or delay unnecessary treatment and its side effects.
Active surveillance is increasingly viewed as the preferred approach for the management of lower-risk prostate cancer. However, there is limited information on how long patients remain on active surveillance before converting to active or definitive treatment, such as surgery or radiation therapy.
Dr. Catalona and colleagues analyzed data on 6,775 patients with prostate cancer managed with active surveillance at 28 medical centers in a National Cancer Institute-sponsored Prostate SPORE project study. Sixty-eight percent of the men were classified as having low-risk disease, based on factors including the Gleason grade, which assesses the aggressiveness of cancer cell behavior tumor stage, which reflects how far cancer has spread and the number of positive biopsy specimens .
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Is There A Difference Between Low
- Gautam Jayram, MD
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What does that mean?
Often Prostate Cancer Is Low
Many prostate cancers are found with a PSA blood test. Often these cancers are low-risk. This means:
- The tumor is small.
- It is contained within the prostate.
- It is probably growing so slowly that it will not become life-threatening.
Usually a man with low-risk prostate cancer dies of something else, even if he doesnt get treatment.
What Does Active Surveillance Involve
Active surveillance has one big advantage: Men whose prostate cancer doesnt grow can avoid surgery or radiotherapy, including the side effects. One disadvantage is that, if the cancer progresses, it may be discovered too late. It may have already spread to other parts of the body by then . Knowing that you have cancer in your body can be distressing too.
Another disadvantage of active surveillance is that you have to have regular check-ups. The medical societies in Germany recommend the following:
- A PSA test and palpation examination every 3 to 6 months in the first two years.
- InA total of three biopsies in the first three years:
- One biopsy after 6 months,
- a second biopsy about 12 to 18 months after the first one, and
- a third biopsy at the end of the three years.
After that, a biopsy should be done every three years.
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Observation Best For Low
20-year study found little difference in death rates, more complications with surgery
THURSDAY, July 13, 2017 Men with early stage prostate cancer who have surgery to remove their tumor do not live longer than those who receive no treatment at all, a long-running clinical trial has concluded.
At the same time, nearly one in three men who had the surgery wound up with long-term complications, such as urinary incontinence and erectile dysfunction, said lead researcher Dr. Timothy Wilt. He is a clinical investigator with the Minneapolis Veterans Affairs Health Care System.
Based on these findings, cancer experts should revise clinical guidelines so most men with low-risk prostate cancer receive no treatment, Wilt said.
Instead, doctors should simply track the progress of their patients slow-growing cancer by asking about signs and symptoms of disease progression.
Our results demonstrate that for the large majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment, Wilt said.
These patients have an excellent prognosis without surgery, Andriole said. This study confirms that aggressive treatment usually is not necessary.
In fact, this was the first randomized trial comparing surgery against no treatment since PSA testing became common, Wilt said.
More Active Surveillance But Not Enough
To conduct their study, Dr. Cooperberg and his colleagues looked at data from all men newly diagnosed with prostate cancer in the AUA Quality Registry. This registry collects real-time data from more than 240 participating US urology practices and more than 2,100 urologists.
Overall, of the more than 84,000 patients covered by the study, 20.3% were diagnosed with low-risk disease. The number of men diagnosed with low-risk disease actually fell during the study period, from about 24.6% in 2014 to 14.0% in 2019. That finding is consistent with other recent studies showing a decline in low-risk diagnoses, which researchers have attributed to fewer men being screened via PSA testing.
But even as diagnoses of low-risk disease have dropped, more men with low-risk disease are opting for active surveillance, Dr. Cooperberg reported. In 2014, 26.5% of men with low-risk prostate cancer chose active surveillance. By the end of 2021, 59.6% did.
Rates of active surveillance also increased among men diagnosed with intermediate-risk prostate cancer, which is considered to have a modestly greater likelihood than low-risk prostate cancer of progressing to the point where it could be fatal.
The variability in the use of active surveillance is alarming, Dr. Parnes said. It likely reflects, at least to some degree, entrenched patterns of care among some urologists. For some, I suspect their feeling is, I treat cancer, and this is cancer. Im not having this conversation , he said.
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Gene And Protein Tests For Prostate Cancer
For men with prostate cancer that is localized , a major issue is that its often hard to tell how quickly the cancer is likely to grow and spread. This can make it hard to decide if the cancer needs to be treated right away, as well as which types of treatment might be good options.
Some types of lab tests, known as genomic, molecular, or proteomic tests, can be used along with other information to help better predict how quickly a prostate cancer might grow or spread, and as a result, help decide what treatment options might be best and when they should be given. These tests look at which genes or proteins are active inside the prostate cancer cells. Examples of such tests include:
These tests continue to be studied to find more areas where they can be useful in prostate cancer risk and treatment decisions.
Dont Rush To Get Treatment
If you are diagnosed with prostate cancer, you should discuss treatments and quality-of-life issues with your cancer care team.
Your team should include a urologist and a radiation oncologist. You can also get helpful advice from a medical oncologist.
Common treatments are surgery and radiation. However, there is another approach to learn about. Its called active surveillance or watchful waiting. Its for men with low-risk prostate cancer. In active surveillance, your team watches your condition closely. If tests show that its getting worse, you will get treatment. Discuss active surveillance with your team. Heres why:
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Technique Of Focal Therapy
A variety of techniques have been described, all involving the use of directed energy and image guidance. These include high intensity focused ultrasound , MR guided ultrasound, laser ablation, cryosurgical ablation, focal photodynamic therapy, electroporation, various forms of radiation. Ultimately, which of these therapies becomes widely used will be a reflection of precision of treatment, morbidity, cost, and availability and convenience. The principles and methods used with these directed energies have been described previously. The experience with these technologies used for focal therapy is summarized in the table below, in chronological order.
Most of the focal therapy data lacks robust endpoints. In most published studies, follow-up biopsies were usually not systematic, and in most studies the majority of patients were not biopsied. This is a potential source of bias, in that PSA and MRI may misidentify as responders some patients with residual disease. In patients having a biopsy, the rate of positive biopsies ranged from 14% to 50% . Further, most authors only biopsied the treated area. Biopsies of the untreated area were selective based on mpMRI.
Low Risk Of Cancer Spread On Active Surveillance For Early Prostate Cancer
9, 2020 Men undergoing active surveillance for prostate cancer have very low rates one percent or less of cancer spread or death from prostate cancer, according to a recent study published in The Journal of Urology®, an Official Journal of the American Urological Association . The journal is published in the Lippincott portfolio by Wolters Kluwer.
In the long-term, active surveillance is a safe and viable option for men with low-risk and carefully selected intermediate-risk prostate cancer, according to the report by senior author Peter R. Carroll, MD, MPH, of University of California, San Francisco and colleagues.
During active surveillance, prostate cancer is carefully monitored for signs of progression through regular prostate-specific antigen screening, prostate exams, imaging and repeat biopsies. If symptoms develop, or if tests indicate the cancer is more aggressive, active treatment such as surgery or radiation may be warranted.
New data on outcomes of active surveillance
The goal of active surveillance is to avoid or delay the side effects of treatment in men with favorable-risk disease without compromising such long-term outcomes as survival or metastasis. Dr. Carroll and his team set out to assess the long-term outcomes of men on active surveillance for prostate cancer to determine which, if any, prognostic factors could predict the risk of metastases.
Results showed risk of metastases during long-term active surveillance was affected by three factors:
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