Causes Of Advanced Prostate Cancer
Prostate cancer is the most common cancer in men in the UK. It is more common over the age 65. Although it can happen at a younger age it is uncommon under 50. People who have a prostate include men, transwomen and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you still have a prostate. Trans men do not have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer or have symptoms.
We have more information about the risk factors of prostate cancer.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
The Role Of Biochemical Markers
Urokinase, a member of serine proteases that also function as a growth factor to osteoblastic cells, is believed to play a catalytic role in the metastasis of prostate cancer to the skeleton and extraskeletal sites. In a model of urokinase overexpression, Copenhagen rats inoculated with MatLyLu rat prostate carcinoma cells transfected with plasmids encoding overexpression of urokinase were investigated for the pattern of metastasis . The study outcomes revealed significantly earlier and more widespread development of bone metastasis in the ribs, scapula, and femora of rats inoculated with pYN-ruPA as compared to the control that manifested metastasis only in the lumbar vertebrae at 2021 days post inoculation. Biochemical assay and histological evaluation revealed an accompanying progressive increase in serum ALP level and osteoblastic activity compared to the control animals .
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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Stage 1 Prostate Cancer
In stage 1, the cancer is confined to the prostate. Stage 1 prostate cancer cant be detected during a digital rectal exam and is usually expected to be slow-growing. The tumor is one half of one lobe of the prostate or even less . There is no regional lymph node metastasis and no distant metastasis. . The PSA level is below 10ng/ml. The Grade Group is 1.
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Managing Symptoms Of Advanced Prostate Cancer
Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.
You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.
Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.
Pharmacologic Agents In Prostate Cancer
Gonadotropin-releasing hormone analogues suppress ovarian and testicular steroidogenesis by decreasing luteinizing hormone and follicle stimulating hormone levels, whereas GnRH antagonists lower serum testosterone levels by suppressing LH and FSH.
Bisphosphonates are analogues of pyrophosphate that act by binding to hydroxyapatite in bone matrix, thereby inhibiting the dissolution of crystals. These agents prevent osteoclast attachment to the bone matrix and osteoclast recruitment and viability.
Antiandrogens are used as combination agents to treat prostate cancer. Antifungal agents produce a response similar to that of antiandrogens. These drugs inhibit various cytochrome P-450 enzymes, including 11-beta-hydroxylase and 17-alpha-hydroxylase, which in turn inhibit steroid synthesis. The antiandrogen abiraterone is a 17 alpha-hydroxylase/C17, 20-lyase inhibitor that was approved by the US Food and Drug Administration in 2011 for use in combination with prednisone for treatment of metastatic castration-resistant prostate cancer in patients who received prior chemotherapy containing docetaxel.
An ultramicronized abiraterone tablet was approved in May 2018 for CRPC in combination with methylprednisolone. The ultramicronized formulation may be administered with or without food, whereas, the original tablet formulation must be administered 1 hour before or 2 hours after meals.
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
Characteristics Of Lymph Node Metastasis
Taken together, the concept of the pre-metastatic niche also holds true in prostate cancer lymph node metastasis. Identifying key pathways of niche communication may have significant implications for prognostic and therapeutic purposes in prostate cancer, such as targeting the VEGR3-VEGF-C axis to halt the progression of lymph node metastasis and improve the patient´s prognosis.
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Bone Metastases And Mortality In Prostate Cancer Can We Be Doing More
Variable Migratory Pathways of Bone Metastases.Bone metastases are associated with higher mortality.Impact of Bone Metastases on Quality of Life
- Fatigue: 85%
- Difficulty sleeping as a result of pain: 42%
- Difficulty performing normal activities: 40%
- Anxiety or distress as a result of pain: 40%
- Vomiting: 25%18
- Loss of appetite18
Economic Burden of Bone MetastasesIs Earlier Detection of Bone Metastatic Disease of Value?Use of ALP and PSA to Predict Risk of Bone Metastatic Disease
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What Are Bone Metastases With Prostate Cancer
The ACS describes bone metastases as areas of bone containing cancer cells that have spread from another place in the body. In the case of prostate cancer, the cells have spread beyond the prostate gland. Since the cancer cells originated in the prostate gland, the cancer is referred to as metastatic prostate cancer.
The cancer cells spread to the bones by breaking away from the prostate gland and escaping attack from your immune system as they travel to your bones.
These cancer cells then grow new tumors in your bones. Cancer can spread to any bone in the body, but the spine is most often affected. Other areas cancer cells commonly travel to, according to the ACS, include the pelvis, upper legs and arms, and the ribs.
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Survival Of Prostate Cancer
Survival depends on many factors. No one can tell you exactly how long you will live.
Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.
Survival for prostate cancer is generally good, particularly if you are diagnosed early.
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:
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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Survival By Tumor Grade
One way cancer is staged is by looking at the grade of cancer. Grade refers to how cancer cells look like under a microscope.
Traditionally for prostate cancer, this has been done using the Gleason Score, which was developed in the 1960s. Under this system, cancerous cells are categorized on a scale from 1 to 5. Grade 1 cells are considered normal prostate tissues, while cells in the grade 5 range have mutated to such an extent they no longer resemble normal cells.
In determining a Gleason score, a pathologist will examine a biopsy sample under a microscope and give a Gleason grade using the above scale to the most predominant pattern displayed, then a second grade to the pattern that is the second most predominant. Those two grades are then added to form the overall Gleason score .
In theory, Gleason scores could range from 2 to 10, but pathologists today rarely give a score between 2 and 5 and are more likely to be in the range of 6 to 10 with 6 being the lowest grade of prostate cancer.
Under the Gleason Score system, a 6 is considered low grade, 7 is intermediate and scores of 8, 9, or 10 are considered high-grade cancers.
The higher the Gleason score, the more likely it is the prostate cancer will grow and spread quickly.
However, there have been some issues with the Gleason system, and a new grading system, to act as an extension of the Gleason system, has been developed.
Under this system Gleason scores are now categorized into grade groups:
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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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
Treatments To Control And Prevent Further Cancer Spread In Patients With Castrate Refractory Advanced Prostate Cancer:
At BPC we offer:
- Hormones , Enzalutamide , Diethylstilboestrol)
- Chemotherapy .
Other treatment options ongoing clinical studies:
- Autologous cellular immunotherapy, which is in late trial stage and although not currently available outside a trial setting in the UK, is likely to be licensed soon.
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General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
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What Affects Survival
Your outlook depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread.
The type of prostate cancer and grade of the cancer also affects your survival. Grade means how abnormal the cells look under the microscope. The most common system used to grade prostate cancer is the Gleason score. Men with a higher Gleason score have a poorer outlook.
Your outlook also depends on your PSA level. A high PSA level may mean your cancer grows more quickly.
Your general health and fitness also affect survival. The fitter you are, the better you are able to cope with your cancer and treatment.
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What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.
What Are Prostate Cancer Survival Rates By Stage
Staging evaluation is essential for the planning of treatment for prostate cancer.
- A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
- Further testing and calculations may be performed to best estimate a patients prognosis and help the doctor and patient decide upon treatment options.
Prognosis refers to the likelihood that cancer can be cured by treatment, and what the patients life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.
If cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival-based again on group statistics for people who have been in the same situation.
Nomograms are charts or computer-based tools that use complex math from the analysis of many patients treatment results.
The prognosis for prostate cancer varies widely and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and cancers responsiveness to treatment, among other factors.
The 5 and 10-year survival rate of prostate cancer chart
|Stage and 5-Year Survival|
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Survival By Disease Progression
The extent prostate cancer has progressed can influence survival rates.
Prostate-specific antigen is a protein produced by cells of the prostate gland by normal and malignant cells. In men with prostate cancer, blood levels of PSA are often elevated.
Doctors can use PSA as a marker to better understand the progression of prostate cancer and the resulting prognosis.
One way doctors assess the progression of the disease is through PSA doubling time. This refers to the number of months it takes for PSA to double.
One study suggests a short doubling time means a poorer prognosis for patients with stage IV prostate cancer. Median survival was 16.5 months for those with a PSA doubling time lower than 45 days compared with 26 months for patients with a longer PSA doubling time.
Whether or not the cancer has metastasized and spread to other areas of the body outside the prostate can also influence survival. In distant or stage IV prostate cancer, when cancer has spread from the prostate to other organs like the liver or lungs, the five-year survival rate is 31% compared with localized cancer, which has a five-year survival rate of nearly 100%.
What Are Bone Metastases
Bone metastases are not the same as cancer that starts in the bone. Cancer that starts in the bone is called primary bone cancer. There are different types of primary bone cancers, like osteosarcoma and Ewing sarcoma.
A tumor that has metastasized to bone is not made of bone cells. Bone metastases are made up of abnormal cancer cells that started from the original tumor site. For instance, lung cancer that spreads to the bone is made of lung cancer cells. In this case, the bone metastasis would be called metastatic lung cancer. In adults, metastatic bone cancer is much more common than primary bone cancer.
Cancer cells that spread to the bone often affect these places:
Cancer cells that spread from tumors in other parts of the body can form two main types of bone tumors:
The tumor may eat away areas of bone. This creates holes called osteolytic lesions. They can make bones fragile and weak. So the bones can break or fracture easily. These areas may be painful.
The tumor may cause the bone to form and build up abnormally. These areas of new bone are called osteosclerotic or osteoblastic lesions. Theyre hard, but theyre weak and unstable. They may break or collapse. They can also be painful.
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