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Prostate Cancer Liver Metastases Treatment

How Liver Metastasis Is Treated

Treatment for Few Metastases | Oligo-Metastases Disease | Mark Scholz, MD | PCRI

Liver metastasis, also known as secondary liver cancer, refers to cancer that has spread to the liver from the site of the original tumormost often the colon or rectum, although it’s possible for cancer that originates anywhere in the body to spread to the liver. This disease is considered advanced, or stage IV cancer, so in most cases, the goal of treatment is to shrink tumors, extend life expectancy, and boost quality of life rather than try to cure the cancer. Treatments for liver metastasis include surgery to remove the tumor, chemotherapy, biologic drugs, radiation, or a procedure called ablation which destroys cancerous lesions. If none of these treatments is an option, palliative care may be necessary.

Liver metastasis is different from metastatic liver cancer, which is the term used to refer to primary liver cancer that has spread to another site or sites in the body.

Overview Of The Staging System

After a thorough assessment by your oncologist, your cancer will be assigned a stage between I and IV. Prostate cancer stages are based on the American Joint Committee on Cancer TNM system. Using the TNM system, your oncologist:

  • Examines the tumor
  • Determines if the cancer has spread to any lymph nodes
  • Assesses whether the cancer has metastasized
  • Considers the prostate-specific antigen level from blood testing
  • Assigns a grade group based on how abnormal the cancer appears under a microscope

With this information in mind, you can better understand how stages are assigned and what they mean for patients in general.

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Selective Internal Radiation Therapy

Also known as radioembolization, SIRT combines radiation therapy with embolization. This treatment involves the injection of tiny radioactive particles into the hepatic artery in order to restrict the blood supply to tumors.

SIRT sometimes results in significant shrinkage of secondary liver tumors. Research shows that combining chemotherapy and SIRT may control the growth of tumors for a longer time.

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Metastatic Liver Cancer Life Expectancy

When liver cancer metastasizes, it most commonly spreads to the lungs and bones. The five-year survival rate for a patient whose liver cancer has spread to surrounding tissue, organs and/or lymph nodes is estimated at 11 percent. The five-year survival rate for a patient whose liver cancer has spread to distant tissue, organs and/or lymph nodes is estimated at 3 percent.

Symptoms Of Prostate Cancer Spread To The Bones

When prostate cancer spreads, where it goes matters

The most common place for prostate cancer to spread to is the bones. This can include the:

  • spine

The most common symptom if cancer has spread to the bone is bone pain. It is usually there most of the time and can wake you up at night. The pain can be a dull ache or stabbing pain.

Your bones might also become weaker and more likely to break .

When prostate cancer spreads to the spine, it can put pressure on the spinal cord and cause spinal cord compression. This stops the nerves from being able to work properly. Back pain is usually the first symptom of spinal cord compression.

Spinal cord compression is an emergency. You should contact your treatment team immediately if you are worried you might have spinal cord compression.

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Natural Treatments For Prostate Cancer

At Immunity Therapy Center, we utilize a variety of alternative cancer treatments to strengthen your immune system while directly targeting your cancer cells. We take a holistic approach to prostate cancerand focus on the overall health of our patients.

We offer a variety of options for holistic treatment for prostate cancer such as Cryoablation Therapy and intravenous solutions . As part of our alternative therapy, were big advocates in the idea that your attitude truly affects the results of your cancer treatment program. We find patients with positive attitudes, and hope for their cancer therapy, see more successful results.

If you are interested in alternative prostate cancer treatment in Mexico, reach out to us today. Tijuana has become a hub for alternative cancer treatment centers, paving the way for holistic care to become part of the cancer treatment dialogue everywhere. Were proud to be one of the leaders who offer prostate cancer natural treatment options.

Were passionate about providing a customized alternative therapy treatment plan for each of our patients. If you or your loved one have tried mainstream medicine only to have relapsed or been economically drained, were here for you. Alternative medicine can be the answer to the perfect holistic treatment for prostate cancer.

What Is Advanced Prostate Cancer

When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.

Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.

  • Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
  • Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
  • Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.

When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.

There are several types of advanced prostate cancer, including:

Biochemical Recurrence

With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.

Castration-Resistant Prostate Cancer

Non-Metastatic Castration-Resistant Prostate Cancer

Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.

Metastatic Prostate Cancer

  • Lymph nodes outside the pelvis
  • Bones
  • Other organs, such as liver or lungs

Metastatic Hormone-Sensitive Prostate Cancer

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Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.

Early-stage prostate cancer

Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer

Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.

More About Dr Scholz:

Bone Metastasis: Treatments, Scans & Side Effects | Ask a Prostate Expert, Mark Scholz, MD

A board-certified medical oncologist, Mark C. Scholz, MD, serves as medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA, a medical practice exclusively focused on prostate cancer. He is also the Executive Director of the Prostate Cancer Research Institute. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is the co-author of the book Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Potency. He is a strong advocate for patient empowerment.

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What Tests Will My Healthcare Provider Use To Diagnose Metastatic Cancer

There is no standard test to check for metastasis. Your healthcare provider will order tests based on the type of cancer you have and the symptoms youve developed.

Blood tests

Routine blood tests can tell your provider if your liver enzymes are elevated. This could indicate liver metastasis. In many cases, however, these blood test results are normal, even in the presence of advanced cancer.

Tumor markers

Some cancers have tumor markers that can be helpful in monitoring cancer after diagnosis. If tumor marker levels increase, it could mean that your cancer is advancing. Some examples are:

  • Colon cancer: CEA .
  • Prostate cancer: PSA .
  • Testes cancer: AFP and HCG .

There are several tumor markers that are less specific, and therefore, not used as a tool for diagnosing metastasis.

Imaging

There are many tests that take pictures of the inside of your body. Appropriate tests depend on the symptoms and the type of cancer. Imaging tests may include:

The results of these tests may not provide definitive answers. In some cases, your healthcare provider may also take a biopsy of the suspected metastatic tumor.

Highlighting The Place Of Metastasis

  • 1Department of Medical Oncology, Jolimont Hospital, La Louvière, Belgium
  • 2Department of Radiotherapy, Jolimont Hospital, La Louvière, Belgium
  • 3Department of Surgery, Jolimont Hospital, La Louvière, Belgium
  • 4Department of Pathology, Jolimont Hospital, La Louvière, Belgium

Metastatic prostate cancer remains a challenge for clinicians. Metastases involve mainly the bone compartment and can manifest as oligometastatic disease. In this setting, the role of metastasis-directed therapies including surgery and/or stereotactic body radiotherapy is currently evaluated. Visceral metastases are less common and have very poor prognosis in mPC. Whether treating isolated visceral metastases such as liver metastases with MDT could increase the prognosis remains unknown. We report the management of a prostate cancer patient who progressed on androgen deprivation therapy with apparition of two liver metastases. We describe the feasibility of combining MDT with abiraterone acetate and prednisone in a patient with metastatic castration-resistant prostate cancer. MDT allowed the interruption of abiraterone acetate, preventing cumulative toxicity of this agent.

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Testing The Concept In Clinical Trials

The gold standard for research that typically moves the needle of cancer care is a clinical trial, particularly a large trial that randomly assigns participants to one of two groups, each of which receive different treatments.

Only a handful of randomized clinical trials have specifically enrolled patients with oligometastatic cancer and tested direct treatment of their metastatic tumors, and most of these have been relatively small.

One such trial, called SABR-COMET, enrolled approximately 100 patients with any type of solid cancer as long as they had five or fewer metastases. Participants were randomly assigned to the standard treatment for their particular cancer or the standard treatment and a targeted form of radiation called stereotactic body radiation therapy also known as SABRto treat their metastases.

When initial results were published 2 years ago, trial researchers reported that patients in the SBRT group lived more than a year longer than those in the control group.

The trial has received some criticism, however. Among the critiques is that there were many more patients with prostate cancer in the SBRT group than the control group. Prostate cancer patients with metastases live longer than patients with other metastatic cancers , Dr. Vikram said, and this imbalance could likely have accounted for the better outcomes in that group.

There are many questions about the concept of oligometastatic cancer that still need to be answered, Dr. Salama added.

Managing Bone Pain And Weakness

Partial response of liver metastases treated with abiraterone in ...

Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.

Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.

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What Are The Symptoms Of Metastatic Cancer

Some people will have minimal or no symptoms of metastatic cancer. If symptoms are present, theyre based on the location of the metastasis.

Bone metastasis

Bone metastasis may or may not cause pain. The first sign of bone metastasis is bone breakage after a minor injury or no injury. Severe back pain accompanied by leg numbness or difficulty with bowel or bladder control must be evaluated immediately.

Brain metastasis

If a tumor has metastasized to the brain, symptoms may include headache, dizziness, visual problems, speech problems, nausea, difficulty walking or confusion.

Lung metastasis

Cancer symptoms of lung metastasis are usually very vague. This is because they can be similar to symptoms of other health conditions. Warning signs may include a cough , coughing up blood, chest pain or shortness of breath.

Liver metastasis

Liver metastasis can cause pain, weight loss, nausea, loss of appetite, abdominal fluid or jaundice .

What Is The Treatment For Advanced Prostate Cancer

No matter where prostate cancer spreads, its still treated as prostate cancer. Its harder to treat when it reaches an advanced stage.

Treatment for advanced prostate cancer involves targeted and systemic therapies. Most men need a combination of treatments and they may have to be adjusted from time to time.

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What Tests Will I Have If My Doctor Suspects Bladder Cancer Or Another Urinary Problem

Your doctor will want to analyze your urine to determine if an infection could be a cause of your symptoms. A microscopic examination of the urine, called cytology, will look for cancer cells.

A cystoscopy is the main procedure to identify and diagnose bladder cancer. In this procedure, a lighted telescope is inserted into your bladder from the urethra to view the inside of the bladder and, when done under anesthesia, take tissue samples , which are later examined under a microscope for signs of cancer. When this procedure is done in the doctors office, local anesthesia gel is placed into the urethra prior to the procedure to minimize the discomfort.

If the diagnosis of bladder cancer is made, then the next step is to remove the tumor for detailed staging and diagnosis.

Transurethral resection is a procedure done under general or spinal anesthesia in the operating room. A telescope is inserted into the bladder and the tumor is removed by scraping it from the bladder wall , using a special cystoscope . This procedure is diagnostic as well as therapeutic.

This often can be done as an outpatient procedure, with patients discharged from hospital the same day. After removal, the tumor is analyzed by a pathologist, who will determine the type of tumor, the tumor grade and the depth of invasion. The purpose of the procedure is to remove the tumor and obtain important staging information .

Watchful Waiting And Active Surveillance

Local Therapy – Managing Locoregional Complications in Metastatic Prostate Cancer

Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.

Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.

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What Is Metastatic Cancer

Metastatic cancer refers to cancer that has spread beyond the point of origin to other, distant areas of the body. To fully understand metastatic cancer, well first define metastasis:

Metastasis is a word used to describe the spread of cancer. Unlike normal cells, cancer cells have the ability to grow outside of the place in your body where they originated. When this happens, its called metastatic cancer, advanced cancer or Stage IV cancer. Nearly all types of cancer have the potential to metastasize, but whether they do depends on a number of factors. Metastatic tumors can occur in three ways:

  • They can grow directly into the tissue surrounding the tumor.
  • Cancer cells can travel through your bloodstream to distant locations in your body.
  • Cancer cells can travel through your lymph system to nearby or distant lymph nodes.
  • Survival Rates For Prostate Cancer

    Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

    Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.

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