Expert Review And References
- American Cancer Society. Prostate Cancer. Atlanta, GA: American Cancer Society 2015: .
- American Society of Clinical Oncology. Prostate Cancer. 2014: .
- Garnick MB . Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
- National Cancer Institute. Prostate Cancer Treatment . 2015: .
- National Cancer Institute. Prostate Cancer Treatment for Health Professionals . 2015: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . .
- Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Prostate Cancer. 2015: .
- Saad F, Chi KN, Finelli A, Hotte SJ, Izawa J, Kapoor A, et al. The 2015 CUA-CUOG Guidelines for the management of castration-resistant prostate cancer . Canadian Urological Association Journal. 2015: .
Available Treatment Options To Reduce Toxicity
Simmons Cancer Centers world-class team of cancer specialists has adopted cutting-edge therapies that might reduce the acute and chronic side effects associated with radiation and surgery. One product in active development, used in conjunction with RT, is the SpaceOAR hydrogel. The purpose of SpaceOAR is to temporarily position the anterior rectal wall away from the prostate during RT to reduce the radiation dose delivered to the anterior rectum.
SpaceOAR was evaluated in a single-blind phase three trial of image-guided intensity-modulated RT. Prostate cancer patients were randomized in a 2:1 manner to the spacer or control group. The dose administered was 79.2 Gy in 1.8-Gy fractions to the prostate with or without the seminal vesicles. After analysis, the results showed the three-year incidence of grade 1 and grade 2 rectal toxicity favored the spacer arm.
At three years, more men in the control arm had suffered an MID decline in bowel quality of life and urinary QOL compared with the spacer arm. After a median follow-up of three years, the men in the spacer arm had lower bowel toxicity and less deterioration in both urinary and bowel QOL than the control group.
At Simmons, we were one of the first in the nation to embrace new technology using a gel-like substance that is injected into the space between the rectum and the prostate and eventually solidifies. During the time of radiation treatment, the gel will prevent the radiation from reaching the rectum.
What Are Male Sex Hormones
Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make semen. Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .
Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .
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What Tests Check For Prostate Cancer
Common tests to check for prostate cancer include:
- Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
- PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
- A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.
If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.
Cancer May Spread From Where It Began To Other Parts Of The Body
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.
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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
Other Items To Consider:
Should I choose surgery or radiation for my prostate cancer?
For men deciding between surgery and radiation for prostate cancer treatment, that may help you weigh the pros and cons of each option.
Genomic testing and prostate cancer
Genomic tests can help determine how aggressive your prostate cancer is, and this may influence your treatment decisions. Genomic testing can also help you and your doctor learn more about how your cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively, therefore influencing treatment decisions.
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If I Choose Radiation Therapy Will Surgical Treatment Still Be An Option
If radiation therapy is used as the primary treatment, and the treatment is not successful, surgery or repeat radiation therapy are not considered to be desirable treatments due to the high risk of serious complications. It is important to note that the cure rates for surgery and radiation are similar. Therefore, you may have the same risk of cancer recurring if surgery is performed. If surgery is performed after radiation, or additional radiation is recommended, the physician performing the re-treatment should have a high level of experience. There are experimental clinical studies being evaluated for use of very localized re-irradiation for this group of patients. Some patients for which radiation is not effective are treated by systemic therapy or by close surveillance.
There Are Three Ways That Cancer Spreads In The Body
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
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A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.
What Is Focal Therapy
This novel approach to treating prostate cancer destroys the tumor within the prostate. Not all prostate cancers can be treated safely with focal therapy, and this is an ongoing area of research. We do know that high-quality imaging is critical. By visualizing the tumor with precision on MRI scans or other imaging tests, surgeons can use various sources of energy to get rid of the tumor. These include cryoablation , laser ablation, or high frequency ultrasound. High-intensity frequency ultrasound can also destroy the tumor without harming the prostate.
Focal therapy can successfully remove the prostate cancer without damaging the rest of the prostate gland, thus minimizing the risk of urinary or sexual side effects.
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What Have Researchers Found About How These Treatments Compare With Each Other
Researchers found that for some men:
- The risk of the cancer spreading to other parts of the body is much lower with surgery to remove the prostate gland than with watchful waiting.
- Surgery to remove the prostate gland appears to increase the chance of surviving the cancer more than external-beam radiation therapy.
- A combination of 3D-CRT and hormone therapy appears to increase the chance of surviving the cancer more than 3D-CRT alone.
Research is only one source that helps guide doctors when they treat localized prostate cancer. Doctors also rely on their experience and on guidelines for treatment based on evidence and recommendations by experts.
When thinking about what treatment may be best for you, your doctor will consider several things, including:
- Your age
- Other health problems you may have
- How long you are expected to live
- Your preferences
Your doctor will also discuss possible side effects to help you decide about treatment. Talk with your doctor about your options and the trade-offs between possible benefits and side effects. Usually, you have time to think about your options before making a decision.
Treatment Of Prostate Cancer Through Surgery
The main method of treating prostate cancer is surgical removal of the tumor, namely prostatectomy. Prostatectomy can be of two kinds: radical and partial. Partial removal of the gland is carried out in case of benign tumor. In prostate cancer, complete removal of the neoplasm and the surrounding tissues is performed.
There are three ways of surgical intervention: the perineal, the retropubic and the transvesical prostatectomy. The retropubic prostatectomy is performed through the incision in the peritoneum. Pros of this type of operation is the ability to remove a large tumor, as well as lymph nodes.
With perineal prostatectomy, the tumor is removed through the perineal incision. Drawback of this surgery is the lack of the ability to remove lymph nodes, as well as the risk of damage to the neural bundle and erectile dysfunction. Transtrusive prostatectomy, in turn, is the most traumatic and is used exclusively in cases when the tumor is so large that it can not be removed in any other way.
The success rates of surgical treatment of prostate cancer, for example in Israel is up to 92%.
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Example 7phase I Dose Escalation Studies With Compound
Compound was administered orally to human subjects at doses of 35 mg/day, 70 mg/day, 140 mg/day, and 280 mg/day.
In the 35 mg/day cohort , no dose limiting toxicity was observed and no adverse events at grades 2, 3, or 4 were observed.
In the 70 mg/day cohort , no dose limiting toxicity was observed. One patient experienced grade 2 adverse events . One patient experienced a grade 3 adverse event that was unrelated to the administration of compound .
In the 140 mg/day cohort , no dose limiting toxicity was observed. 50% of the patients experienced grade 2 adverse events and 1 patient experienced a grade 3 adverse event . These results do not include one patient in this cohort group who was determined to be non-evaluable and treatment was discontinued on day 1.
In the 280 mg/day cohort , one patient experienced dose-limiting toxicity and renal failure, and 5 of the patients experienced grade 2 or less adverse events.
Chemotherapy For Prostate Cancer
https://www.youtube.com/embed/O24t-bbE1k4 The decision on when to start chemotherapy is difficult and highly individualized based on several factors: What other treatment options or clinical trials are available. How well chemotherapy is likely to be tolerated. What prior therapies you have received. If radiation is needed prior to…
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Features Of Angiodynamics Nanoknife Ire System:
- Not sensitive to Heat Loss . IRE is a non-thermal electric field dependent event. Therefore, it is not sensitive to heat losses or heat sources due to anatomical structures located in the target ablation area.
- Has Tissue Protection Feature. Since it does not have a thermal effect, some connective tissues such as thermally sensitive capsular membranes, vessels, bile ducts and neurovascular bundles located in the electric field regions created during the IRE procedure can protect neurological tissues. IRE is located close to the airways and large vessels in pancreatic cancers that cannot be surgically intervened and treated with known local ablative treatment methods, with vascular invasion, HCC and metastatic liver tumors adjacent to the vascular and biliary tract, centrally located kidney tumors, prostate cancers affecting the neurovascular bundle of the prostate. It becomes an important treatment option in central lung tumors.
Example 1in Vitro Studies With Compound
Compound was shown to degrade 95% to 98% of androgen receptors in multiple cells lines typically used in prostate cancer research, including, for example, VCaP cells. is 1 nM.) Near-maximal degradation was observed within 4 hours of administration of Compound . Compound inhibits VCaP proliferation about 60 times more potently than enzalutamide.
FIG. 2 shows the reduction of AR in VCaP tumor cells in response to treatment with Compound at concentrations of 0.03 nM, 0.1 nM, 0.3 nM, 1 nM, 3 nM, 10 nM, 30 nM, 100 nM, and 300 nM.
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Sex And Fertility After Prostate Cancer
- Can you have sex when you have prostate cancer? Sex during and after prostate cancer surgery or treatments can be difficult. Impotence, or not being able to maintain an erection, may be a problem after prostate cancer treatment and can be temporary or permanent.
- Can you father a child after prostate cancer? Not surprisingly, some men can be concerned about their fertility when facing surgery for prostate cancer. Treatments typically involve removal of the seminal vesicles and or cutting the tube that transports semen. If you want to have children in the future, talk to your doctor about banking sperm before your treatment.
Prostate Cancer Clinical Trials
As one of the worlds leading cancer centers, MD Anderson is home to many clinical trials for prostate cancer patients. Your care team may discuss clinical trials with you if they believe they offer you a better outcome than standard treatments.
Trials are designed to improve prostate cancer survival rates, minimize treatment side effects and support a higher quality of life for patients. They may include new drugs or drug combinations, new approaches to prostate cancer surgery, different forms of radiation therapy, or some combination of all three. Learn more about clinical trials.
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How Can I Choose From Among The Options
In addition to talking with family and friends, you will need a team of physicians to help advise you. It is advisable that you meet with all of the specialists involved in your cancer treatment planning prior to making a decision regarding treatment, including:
- your primary care physician as well as a urologist to discuss surgery
- a radiation oncologist to discuss radiation therapy.
Once you have met with these doctors, you will be able to make a more informed decision regarding your treatment options. If you have an early-stage cancer or moderately advanced cancer and there is no evidence of spread to other organs , the two major options for treatment are surgery or radiation therapy .
If your cancer is advanced and you require hormonal suppression therapy or chemotherapy, then you will also need a medical oncologist, who administers these drugs. Hormone-ablation therapy, which is often used to treat more advanced prostate cancer by suppressing your androgen hormones since most prostate cancer growth is stimulated by androgen or testosterone. The androgen suppression treatment can be administered by your internist, urologist, radiation oncologist or medical oncologist. Depending on the stage of the cancer, hormone suppression therapy may be used in addition to radiation therapy to help control the cancer. Hormone suppression therapy may be administered for as little as four to six months, or for as long as two to three years.