The Tnm System For Prostate Cancer Stages
As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:
- Tumor. Whatâs the size of the main area of prostate cancer?
- Nodes. Has it spread to any lymph nodes? If so, how far and how many?
- Metastasis. How far has the prostate cancer spread?
Comparative Outcomes Of Surgery And Observation For Prostate Cancer
The Scandinavian Prostate Cancer Group Study 4 cited previously, compared radical prostatectomy to watchful waiting among men with localized prostate cancer diagnosed in the era prior to PSA screening. After 15 years of follow-up, men that underwent surgical treatment had significantly lower rates of distant metastatic disease and death from prostate cancer. This benefit of surgery was seen only among men below age 65 years, but not in those age 65 years and above in whom surgery did not provide a benefit in terms of freedom from metastatic disease or prostate cancer death. These data highlight an important aspect of prostate cancer management the unlikely probability that treatment will improve health outcomes for older men with low risk disease .
The PSA era Prostate Cancer Intervention versus Observation Trial , compared radical prostatectomy to watchful waiting among 731 men with localized prostate cancer. At 12 years, a subset of men with a PSA above 10 ng/ml and those with intermediate to high risk disease had a reduction in prostate cancer death with surgery as compared to watchful waiting.
The findings from the SPGS-4 and PIVOT should inform practice for the older man with low risk disease, especially those with associated comorbidities unlikely to benefit from curative intervention. For these men, no treatment may be the most rational initial management considering that harm is likely to outweigh any benefit .
Managing Bone Metastases And Pain
When prostate cancer cells spread to the bone, this is known as prostate cancer bone metastases . Bones are the most common site of prostate cancer metastasis, occurring in 85%90% of patients with metastatic prostate cancer. Once the cells settle in the bone, they start to interfere with the bones normal health and strength, often leading to bone pain, fracture, or other complications that can significantly impair a mans health.
Early detection of bone metastases can help determine the best treatment strategy. It can also help ward off complications. Because men with prostate cancer bone metastases often experience painful episodes, pain management and improving quality of life are important goals of treatment.
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Ccl20 Blocking Antibody Treatment
C57BL6/J male mice received an intraperitoneal injection of 45g anti-CCL20 blocking antibody or rat IgG isotype control antibody 1 day prior to intracardiac injection of RM1-BoM3 prostate cancer bone metastasis cells. The administration of blocking antibody and isotype control then continued on a twice-weekly basis until the end of the experiment.
Bone Metastasis Treatment With Medications
Bone metastases can be a part of advanced cancer. They are most common in breast and prostate cancer. Bone metastases can cause:
- Severe pain.
- Life-threatening electrolyte imbalances.
- Pressing down of nerves which can cause pain and/or weakness.
Pain and nerves not working right can be hard to treat and affects quality of life. Often bone metastases means your cancer is advanced and not curable.
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Ethics Approval And Consent To Participate
As the data used was extracted from SEER dataset , Ethics approval and Consent to participate could be checked in SEER. We were permitted to have Internet access after our signed data-use agreement was approved by the SEER administration . The date collected from the Second Affiliated Hospital of Zhejiang University School of Medicine was approved by the Ethics Committee of Zhejiang University .
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Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
How We Treat Prostate Cancer
The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.
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Symptoms Of Advanced Prostate Cancer
If you are worried about prostate cancer, we have more information about the signs and symptoms.
Symptoms of prostate cancer may not develop for many years. The symptoms of advanced prostate cancer may be caused by an enlarged prostate. Or symptoms may be a sign of secondary cancer, where the cancer has spread to another part of the body.
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Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
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Treatments For Prostate Cancer Spread To Bones
If prostate cancer spreads to other parts of the body, it nearly always goes to the bones first. Bone metastasis can be painful and can cause other problems, such as fractures , spinal cord compression , or high blood calcium levels, which can be dangerous or even life threatening.
If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.
Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause.
A Genetic Biomarker Test For Newly Diagnosed Prostate Cancer
Results from a study of a different genetic biomarker test suggest that it could one day help inform treatment decisions for men newly diagnosed with localized prostate cancer.
According to findings published February 24 in JCO Precision Oncology, a biomarker test called the Oncotype DX Genomic Prostate Score accurately predicted the long-term risk of metastasis and death from prostate cancer in men with localized disease. The test needs to be validated in larger forward-looking studies before it can be used to guide treatment, the study researchers noted.
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Bone Loss From Prostate Cancer Treatment
Testosterone, the male sex hormone, fuels the growth of prostate cancer but it also is crucial to bone health. Treatment of prostate cancer with hormone therapy, also called androgen deprivation therapy , blocks the production of testosterone which stops or slows the growth of the cancer. Without testosterone, bones can become weak and break more easily. When a man is on ADT recovery from a bone fracture takes longer than for other men. It is especially important for men taking ADT to speak with their physician about how to plan for and manage the bone loss before a problem arises. Bone strength can also be decreased as a result of radiation and chemotherapy used to treat prostate cancer.
Fortunately there are ways to strengthen and repair your bones including medicines and lifestyle changes.
- Bisphosphonates can prevent the thinning of the bone and help make them stronger
- Oral bisphosphonates include Fosamax and Actonel
- The intravenous bisphosphonate is Zometa
- Strive for a healthy diet and make sure to get enough calcium and vitamin D
- When exercising, include weight bearing and muscle strengthening exercises
- Avoid tobacco and excessive alcohol
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What Are Next Steps
Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But its important to remember that the numbers are only statistics.
The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.
Everyones cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.
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What Is Advanced Prostate Cancer
Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body. It develops when prostate cancer cells move through the blood stream or lymphatic system.
Watch our video about advanced prostate cancer.
You might hear cancer that has spread described as metastatic prostate cancer, secondary prostate cancer, secondaries, metastases or mets. It is still prostate cancer, wherever it is in the body.
Prostate cancer can spread to any part of the body, but most commonly to the bones and lymph nodes. Lymph nodes are part of your lymphatic system, which is part of the bodys immune system. Lymph nodes are found throughout the body including in the pelvic area, near the prostate.
Advanced prostate cancer can cause symptoms, such as fatigue , bone pain, and problems urinating.
The symptoms you have will depend on where the cancer has spread to. Speak to your doctor or nurse if you have any symptoms. There are treatments available to help manage them.
Its not possible to cure advanced prostate cancer. But treatments can help keep it under control and manage any symptoms.
Clinical Manifestations Of Bone Complications In Prostate Cancer
The American Cancer Society estimates for 2009 included over 192,000 new cases of prostate cancer in the United States, accounting for 25% of cancer diagnoses in men, and over 27,000 deaths from metastatic disease. The major site of hematogenous spread of prostate cancer is bone, seen in 80-90% of men with castration-resistant metastatic prostate cancer undergoing therapy, and 90% of patients at autopsy. The most common sites of bone metastasis are the vertebral column, pelvis, ribs, long bones, and skull. These are areas of active hematopoiesis in adults and are hypothesized to provide tumor cells with a rich growth environment. Unlike other cancers that commonly metastasize to bone and cause osteolytic lesions, prostate cancer causes predominantly osteoblastic lesions.
Bone metastases from prostate cancer are a major cause of morbidity. Pain is the most common symptom. Vertebral metastases may cause compression fractures, spinal cord compression, nerve root compression, and cauda equina syndrome. Pathologic fractures of proximal long bones occur at lower rates compared with vertebral fractures. Hypocalcemia, as a result of excessive bone formation, and subsequent secondary hyperparathyroidism is common. Ineffective erythropoiesis due to bone metastases and cancer therapies contributes to a high prevalence of anemia among men with advanced prostate cancer.
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In Five Years A Major Treatment Shift
In men diagnosed with metastatic hormone-sensitive prostate cancer, the cancer is typically driven to grow and spread by androgens that are produced largely in the testes. For many years, treatments that block androgen production have been a mainstay for men initially diagnosed with metastatic prostate cancer.
Starting in 2014, that began to change after a large clinical trial showed that adding the chemotherapy drug docetaxel to ADT improved how long men with hormone-responsive disease lived. Shortly after, another clinical trial showed that adding abiraterone to ADT also improved survival in these men, although primarily in men with many metastatic tumors, known as high-volume disease.
However, docetaxel, which works by directly killing cancer cells, can have substantial side effects, and some patients arent healthy enough to tolerate it. And abirateronewhich blocks androgen production throughout the bodycan also cause side effects, including those that affect the liver. It also has to be given in combination with the steroid prednisone, which carries its own toxicity.
Doing so, Dr. Chi said during a presentation of the TITAN data at the ASCO meeting, might help stave off the typically inevitable development of hormone-resistant cancer, which is more difficult to treat and a key driver of prostate cancer deaths.
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Side Effects Of Chemotherapy
The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are used, and can include:
Mouth sores are also a side effect of chemotherapy. Your doctor may recommend treatments such as:
- Coating agents. These medications coat the entire lining of your mouth, forming a film to protect the sores and minimize pain.
- Topical painkillers. These are medications that can be applied directly to your mouth sores.
- Over-the-counter treatments. These include rinsing with baking soda or salt water, or magic mouthwash, a term given to a solution used to treat mouth sores. Magic mouthwash usually contains at least three of these ingredients: an antibiotic, an antihistamine or local anesthetic, an antifungal, a corticosteroid, and/or an antacid.
Chemotherapy can cause changes in the way food and liquids taste, including causing an unpleasant metallic taste in the mouth. Many people find that switching to plastic utensils helps. It may also help to avoid eating or drinking anything that comes in a can, and to use enamel-coated pots and pans for food preparation.
Early detection of bone metastases can help determine the best treatment strategy. It can also help ward off complications. Because men with prostate cancer bone metastases often experience painful episodes, pain management and improving quality of life are important goals of treatment.
What Happens If My Cancer Starts To Grow Again
Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.
You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:
Which treatments are suitable for me?
Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.
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Cytotoxics And Targeted Therapies
are a relatively new class of cancer drugs that can overcome many of the issues seen with the use of cytotoxics. They are divided into two groups: small molecule and antibodies. The massive toxicity seen with the use of cytotoxics is due to the lack of cell specificity of the drugs. They will kill any rapidly dividing cell, tumor or normal. Targeted therapies are designed to affect cellular proteins or processes that are utilised by the cancer cells. This allows a high dose to cancer tissues with a relatively low dose to other tissues. Although the are often less severe than that seen of cytotoxic chemotherapeutics, life-threatening effects can occur. Initially, the targeted therapeutics were supposed to be solely selective for one protein. Now it is clear that there is often a range of protein targets that the drug can bind. An example target for targeted therapy is the BCR-ABL1 protein produced from the , a genetic lesion found commonly in and in some patients with . This has enzyme activity that can be inhibited by , a drug.
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What Treatments Are Available
If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.
Before you start treatment
Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.
If you have any questions, speak to our Specialist Nurses.
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