Is Active Surveillance Right For You
There are some risks associated with active surveillance. They include a low risk of infection with every biopsy and a very low risk of cancer progressing in any one interval of surveillance. Sometimes men choose active surveillance for a period of time and then decide to undergo treatment.
Thousands of UCSF patients have chosen active surveillance to initially manage their prostate cancer. This is one of the largest groups of patients on active surveillance in the world. About one-third of these men receive treatment by five years and 50% by 10 years. The window of opportunity to cure prostate cancer is usually measurable in years or even decades. In fact, treatment results for these men appear to be similar to what would have been expected had they chosen treatment right after their original diagnosis. Based on our experience and those reported from other centers, the risk of significant cancer progression in the short to intermediate term, while not zero, appears to be very low.
Some men with risk factors such as family history, genetic mutations and being African American may still be candidates for active surveillance but need a more careful or intense surveillance regimen to make sure any early signs of progression are identified.
The most common reason for seeking treatment is a biopsy that shows the cancer is growing or becoming more aggressive in appearance . Changes in PSA or cancer stage based on imaging results may also lead to treatment.
Side Effects Of Radical Prostatectomy
The most common side effects of the procedure are incontinence and erectile dysfunction . The incontinence, though common early after surgery, usually goes away. Whether erectile function returns depends on whether the nerves surrounding the prostate can be spared at surgery, patient age and baseline function. Men who are older or already have erection problems are most likely to have erectile dysfunction afterward.
For more information on erectile dysfunction and treatment, see Managing Erectile Dysfunction A Patient Guide.
Who Is At Risk For Advanced Prostate Cancer
The exact cause of prostate cancer isnt clear. Your risk of developing this particular cancer increases after you reach age 50.
Certain groups are more likely to develop aggressive forms of prostate cancer, including African-American men and men who carry certain inherited genetic mutations such as BRCA1, BRCA2, and HOXB13.
Most men with prostate cancer dont always have a family history of the disease. But having a father or brother with prostate cancer more than
You probably wont need all of these tests. Your doctor will choose the tests based on your symptoms and physical exam.
If any of the images reveal abnormalities, it doesnt necessarily mean that you have cancer. Additional testing may be necessary. If they find a mass, your doctor will probably order a biopsy.
For a biopsy, your doctor will use a needle to remove samples from the suspicious area. A pathologist will then analyze the removed cells under a microscope to see if theyre cancerous. The pathologist can also determine if you have an aggressive form of prostate cancer.
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Treatments For Stage 4 Prostate Cancer:
Stage-4 prostate cancer is not curable for most patients as the cancer cells spread to other organs and lymph nodes. But it can decrease the signs of ailment and increase the life span of patients. Patients usually live for 4-5 years if prostate cancer has reached the 4th stage before diagnosis.
The following treatments are available which are suggested to different patients depending upon their condition.
Hormone therapy:
Hormone therapy is the most used treatment for stage-4 prostate cancer. In this treatment, the body of the patient is compelled not to produce hormones like testosterone. Prostate cancer cells get help from testosterone to grow and spread in the body. Therefore, it becomes important for the doctors to reduce the production of testosterone by using different medicines.
Hormone therapy for stage-4 prostate cancer may be combined with other treatments like chemotherapy or radiation therapy. It is rarely followed by the surgery. Doctors decide the combination depending on the health of the patient.
The following types of treatments are included in Hormone therapy.
Radiation therapy:
Surgery:
It is not a commonly used treatment for stage-4 prostate cancer. It is rarely suggested by doctors. Surgery is recommended to those patients who are experiencing symptoms like difficulty in the urine. It includes the following treatments.
Radical prostatectomy:
Removal of a lymph node:
Palliative care:
References:
Treatment Of Metastatic Stage Iv Or D2 Prostate Cancer
Prostate cancer that has spread to distant organs and bones is treatable, but not curable with current standard therapies. Hormone therapy has been the standard treatment of metastatic prostate cancer for many years. Metastatic prostate cancer can be controlled with hormone therapy for many years and new treatment options continue to become available.
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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?
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Who Is At Risk Of Stage 4 Prostate Cancer
Each year almost 200,000 American men are diagnosed with prostate cancer. Obesity and smoking are linked to a higher risk of prostate cancer, but most prostate cancers happen to men over 55. The risk increases as you get older about 60% of prostate cancers are diagnosed in men over 65 years old.
Stage 4 prostate cancer happens when cancer becomes aggressive and spreads to other parts of your body. Some genetic mutations have been connected to an increased likelihood of developing aggressive prostate cancer, so men with family histories of the disease are at greater risk. Men with family members who have had pancreatic, breast, or ovarian cancers might also have a higher risk of prostate cancer.
Black or African-American men are also more likely to have aggressive forms of prostate cancer than men from other races.
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Stage 4 Prostate Cancer Clinical Trials
Clinical trials provide cancer patients with life-extending and curative new medicines. Clinical drug trials are critical in getting new medicines to patients who need them the most, as well as securing data so that regulatory clearances may be secured, and new drugs can enter broad clinical practice. Patients who take part in clinical trials benefit both treatment science and their fellow patients.
There are currently 100 Phase III drug trials and more than 500 Phase I/II trials related to prostate cancer treatment in progress in the United States alone. Those that are approved will join the 12 new drugs that have been approved for men with advanced/metastatic disease since 2010 and further improve outcomes for patients:
Using our AI-powered approach, Massive Bio leads patients through the most extensive clinical trial matching process available.
We can assist you if you have been diagnosed with any of the following prostate cancer subtypes:
- Transitional Cell Carcinoma
- Small Cell Carcinoma
If you do not know which type of prostate cancer you have, that is okay. Additional testing can help you determine your exact diagnosis.
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Why Is It Important To Consult A Prostate Cancer Specialist In Delhi India
Delhi is one of the best cities in India for the treatment of prostate cancer, with great availability of surgical specialists and infrastructure for the treatment of this complex disease. Thetreatment for prostate cancerrequires significant expertise and a strong team. Some patients may require treatment for multiple years with many drugs. Improper frontline treatment can lead to disease relapse which is difficult to cure. Recently, there has also been a massive influx of new drugs, genetic tests and personalized therapy. An expert is needed to navigate this complexity.
Dr Vineet Govinda Gupta is a medical oncologist based in Delhi NCR with expertise in the treatment of ovarian cancer. He is gold medalist from AIIMS New Delhi where he has previously worked for more than 12 years. He has received numerous awards and published research in cutting-edge journals. More information here
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Stage I Bladder Cancer
Stage I describes superficial non-muscle-invasive bladder cancer. It is present in the bladders inner lining but hasnt invaded the muscle wall. We usually perform an initial TUR to determine the extent of the cancer as well as the grade. We typically do a second TUR to remove the rest of the tumor followed by intravesical therapy with either BCG or chemotherapy.
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Living With Prostate Cancer
Receiving a prostate cancer diagnosis can be stressful. Even though most people who receive a diagnosis of prostate cancer live for many years after receiving the diagnosis, treatment can be exhausting and cause side effects that impact your quality of life.
Many resources are available to help you get through these difficult times:
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What Does It Mean For Prostate Cancer To Spread
Cancer cells can spread to other parts of the body. Doctors say the cancer has âmetastasizedâ or spread if this occurs.
Prostate cancer can spread to:
- pale skin due to anemia
These symptoms can also occur with aging and an enlarged prostate. As a result, some people may ignore them instead of seeking medical attention.
According to the Prostate Cancer Foundation, age is the biggest contributing factor to prostate cancer risk. Doctors diagnose an estimated 60% of all prostate cancers in males older than 65 years of age.
It states that additional risk factors for prostate cancer include:
- Family history: People with a close relative who has had prostate cancer may be twice as likely to get prostate cancer as those who do not.
- Race: Males of African descent are about 75% more likely to develop prostate cancer than white males and more than twice as likely to die from the condition.
- Smoking: A history of smoking is associated with a higher risk of aggressive prostate cancer.
Researchers are also studying a link between diet and increased prostate cancer risk. Diets high in calcium or low in vegetables may cause an increased risk of aggressive prostate cancer.
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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What Is Metastatic Prostate Cancer
Sometimes cancer cells will escape the prostate and grow quickly, spreading to nearby tissue, or metastasizing. Nearby lymph nodes are often the first destination for a spreading cancer. If prostate cancer has spread to your lymph nodes when it is diagnosed, it means that there is higher chance that it has spread to other areas of the body as well.
If and when prostate cancer cells gain access to the bloodstream, they can be deposited in various sites throughout the body, most commonly in bones, and more rarely to other organs such as the liver, lung, or brain. Bone metastases are seen in 85% to 90% of metastatic cases.
No matter where a cancer turns up in the body, it is always identified by the tissue type in which it started. Prostate cancer can metastasize to other organs, but it is always prostate cancer, because it consists of mutated prostate cells.
Men diagnosed with metastatic prostate cancer , will often not undergo local treatments of the primary prostate tumor, such as surgery or radiation. Instead, their therapeutic journey might start with hormone therapy, and from there follow a similar path as men who were diagnosed at an earlier stage and had subsequent disease progression.
Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.
Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
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What Is The Survival Rate Of Stage 4 Prostate Cancer
Doctors use the term stage to characterize the characteristics of the original tumor itself, such as its size and how far prostate cancer has spread when it is discovered, as they do with all malignancies.
Staging systems are difficult to understand. Most malignancies, including prostate cancer, are staged using three different elements of tumor growth and dissemination. The TNM system stands 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.
The TNM approach allows each mans prostate cancer to be characterized in depth and compared to the prostate cancers of other men. Doctors utilize this information to conduct research and make treatment decisions.
However, in terms of prostate cancer survival statistics, the staging method is straightforward. As previously stated, males with prostate cancer can be split into two groups in terms of survival rates:
- Men with prostate cancer that is localized to the prostate or just nearby.
- Prostate cancer has a high long-term survival percentage in these men. Almost all men will live for more than five years after being diagnosed with prostate cancer, and many will live for much longer.
- Men whose prostate cancer has spread to distant areas, like their bones.
Enzalutamide Improves Survival In Patients With Metastatic Prostate Cancer
Summary
In an international randomizedphase III clinical trial, the hormone therapy enzalutamide extended survival in men with metastatic prostate cancer that had progressed during treatment with androgen deprivation therapy. Participants in the trial had not received chemotherapy.
New England Journal of Medicine, June 1, 2014.
Background
Early in their development, prostate cancers need relatively high levels of male sex hormones to grow. The testes are the main source of androgens, and treatments that stop the testes from producing male sex hormonesknown as hormone therapy or androgen deprivation therapy are therefore a common treatment for androgen-sensitive prostate cancer. However, most prostate cancers eventually become castrate resistantthat is, they can grow even when androgen levels in the blood are very low. ADT does not block production of the small amount of androgen that is made by the adrenal glands and by prostate cancer cells themselves, and this low level is sufficient to fuel the growth of castrate-resistant prostate cancers.
Enzalutamide is among several hormone therapies that have been developed to prevent the androgen-fueled growth of castrate-resistant prostate cancers. This drug works by keeping androgens from binding to the androgen receptors on prostate cancer cells.
The Study
Men in the trial were randomly assigned to receive 160 mg of enzalutamide or a placebo taken orally once daily.
Results
- Posted:June 27, 2014
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Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
Stage Iv Of Prostate Cancer:
Stage IV of prostate cancer is a very advanced stage, with the cancer spreading to the lymph nodes and distant organs like the liver, bones or lungs. It is categorized into the following stages:
Stage IVA:
In this stage, the cancer has spread to the nearby tissues and lymph nodes, but not to any distant organs. It is staged as Any T, N1, M0, Any Grade Group and any PSA levels.
Stage IVB:
These cancers have spread beyond the prostate to the nearby tissues, distant lymph nodes and other organs. It is staged as Any T, any N, M1, Any Grade Group with any levels of PSA.
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Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.