Characteristics Of Bone Metastasis
The propensity of PCa cells to metastasize to the skeleton, and further progression to other organs, is a principal cause of morbidity and mortality among the male population. Although bone metastases can be initially asymptomatic, their consequences are often detrimental due to the occurrence of skeletal-related events such as fractures, bone pain, and spinal cord compression that markedly reduce the quality of life. While most of the solid tumors, such as breast cancer and melanoma, tend to cause osteolytic lesions with excessive bone resorption, bone lesions resulting from PCa are primarily osteoblastic and associated with uncontrolled low-quality bone formation .
In summary, despite significant progress into mechanisms of PCa, further analyses need to be addressed in order to unravel the molecular basis of bone metastasis at both early and late stages. This will help to reduce the rate of metastasis formation and eventually develop new molecular targeting strategies for PCa management.
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.
The Stages Of Prostate Cancer: What You Need To Know
After a prostate cancer diagnosis, your oncologist will refer to the stage of your cancer. All cancers are categorized into four distinct stages, each of which identifies the progress of the growth of cancerous cells within clinically defined standards. These stages help doctors determine the most appropriate care for each patient based on his or her condition, and can also provide easy-to-understand context for your diagnosis. Learn more about the stages of prostate cancer, how each stage will affect your treatment plan and the survival rates for each stage, then contact Regional Cancer Care Associates to schedule a consultation.
Prostate Cancer That Spreads To The Brain
ByDavid Smidev | Submitted On March 05, 2010
Cancer of prostate develops in the prostate gland and typically develops slowly. Advanced prostate cancer could extend to the brain or other body parts. The brain is one of the most common sites of metastasis from solid tumors.
When symptoms of metastatic cancer take place, the type and frequency of the symptoms will rely on the size and location of the metastasis. For instance, cancer that extends to the bones is probable to lead to pain and can cause bone fractures. Cancer that extends to the brain can lead to various symptoms including headaches, seizures and unsteadiness. Shortness of breath might be a sign of lung involvement.
Prostate cancer typically causes no symptoms until it achieves an advanced stage. Sometimes, symptoms close to those of benign prostatic hyperplasia develop, including difficulty urinating and a necessity to urinate recurrently or urgently. However, these symptoms do not enlarge until after the cancer develops large enough to compress the urethra and partly block the flow of urine. Afterward, the cancer might lead to bloody urine or a sudden incapability to urinate.
Metastatic brain tumors are classified relying on the precise site of the tumor in the brain, kind of tissue involved, original site of the tumor, and other factors. Rarely, a tumor could extend to the brain, yet the original location or site of the tumor is unknown. This is named cancer of unknown primary origin.
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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Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. That’s because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes — not their prostate cancer.
Prognosis And Survival For Prostate Cancer
If you have prostate cancer, you may have questions about yourprognosis. A prognosis is thedoctor’s best estimate of how cancer will affect someone and how it willrespond to treatment. Prognosis and survival depend on many factors. Only adoctor familiar with your medical history, the type and stage and otherfeatures of the cancer, the treatments chosen and the response to treatment canput all of this information together with survival statistics to arrive at aprognosis.
A prognostic factoris an aspect of the cancer or a characteristic of the person that the doctorwill consider when making a prognosis. A predictive factor influences how acancer will respond to a certain treatment. Prognostic and predictive factorsare often discussed together. They both play a part in deciding on a treatmentplan and a prognosis.
The following are prognostic and predictive factors for prostatecancer.
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Imaging Of Metastasis Status In Prostate Cancer Patients
The screening for PSA level in the serum of patients was introduced in the late 1980s and enabled a dramatic increase in early PCa detection . On the other hand, PSA is not solely a PCa-specific biomarker and, as such, leads to overdiagnosis and overtreatment of clinically insignificant cases, representing a significant burden for patients . Moreover, absolute PSA level does not always correlate with prognosis . Therefore, more specific and sensitive PSA-based values like PSA density , PSA velocity , free-to-total PSA , and PSA doubling time are seen as options with stronger predictive value. For example, PSADT is defined as the length of time for two-fold PSA level increase. A PSADT < 6 months is strongly associated with metastatic disease, increased PCa mortality , and relapse . Nonetheless, the reported benefit of PSADT in PCa management did not enter clinical routine and some studies even reported discrepant results indicating that further studies are required to determine the reliability of PSADT and other available biomarkers .
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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Where Does Prostate Cancer Spread
The most common place for prostate cancer to spread to is the bones. It can also spread to the lymph nodes, liver and lungs and other organs.
A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.
Survival Rate For Patients With Prostate Cancer Metastasis Higher When The Liver Is Not Involved
Given a diagnosis of cancer, most patients immediately ask, “Can it be cured? How much time do I have?” And in a new analysis, Duke Cancer Institute researchers say where prostate cancer metastasizes, or spreads, will directly impact a mans survival time. Patients with metastasis to the lymph alone survive the longest overall, their report indicates. When the liver becomes involved men fare the worst, while those patients who develop a lung or bone metastasis fall in the middle.
“This study is important because of the large number of men that we have analyzed, and confirms that site of metastases is an important factor for survival,” Dr. Susan Halabi, a professor of biostatistics, told Medical Daily in an email.
The prostate is a gland found only in men. It sits beneath the bladder and surrounds the urethra, which is the tube that carries urine and semen through the penis. Usually the size and shape of a walnut, the prostate gland makes semen, the fluid that carries sperm. When a man develops prostate cancer, the website of Prostate Cancer UK explains, some men will show no signs of disease, while others may experience one or some of these symptoms:
- a need to pee more often, especially at night
- difficulty starting to urinate
- straining, or taking a long time to finish
- a weak flow
- a feeling that the bladder hasnt emptied properly
- a need to rush to the toilet, and the occasional leak
- dribbling urine
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What Are My Treatment Options With Advanced Prostate Cancer
The treatments your doctor recommends will depend on factors specific to you, from your overall health to how advanced your cancer was when it was first diagnosed.
Many men receive ADT, a type of hormone therapy, which deprives the body of the male hormones that the cancer needs to keep growing.
For most men, however, hormone therapy stops working at some point. Alternatives to hormone therapy were approved by the Food and Drug Administration in 2018, and Tagawa often starts men on these therapies as soon as theyre diagnosed with bone metastases. Other treatment options may be available through clinical trials.
In addition, chemotherapy, surgery, and immunotherapy as well as radiation treatments, like external beam radiation, which directly target bone problems may be considered. Major cancer centers, such as Memorial Sloan Kettering Cancer Center in New York City and MD Anderson Cancer Center in Houston, have teams of prostate cancer specialists, as well as sophisticated radiation and other treatment equipment consolidated in one place, which can help with the coordination of care.
Should I Make Any Lifestyle Changes Including In My Diet Or Physical Activity
Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. Both diet and exercise, he says, are things that are under a mans direct control.
A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.
While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.
If youre not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancers growth and keeping you as healthy as possible.
As an oncologist, Tagawa says he concentrates on treating the cancer itself, but hes aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.
And if youre on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.
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Biology Of Circulating Tumor Cells
Figure 3 Circulating tumor cells in prostate cancer patients. Early metastatic features within PCa cells can be induced under stress conditions e.g. hypoxia, immune attack, or therapeutic pressure. In response to TGF-, Wnt or IL-6 PCa cells undergo EMT to gain motility and invasiveness. PCa cells intravasate into blood vessels either passively throughout leaky vessel walls or actively via trans-endothelial migration. Prostate CTCs circulate either as single cells, CTC cluster, or coated with platelets, neutrophils or macrophages shielding immune attack and reducing shear stress. CD45-EpCAM+ CTCs are a heterogeneous population differing in, e.g. the expression of androgen receptor splice variants, TMPRSS2-ERG status or loss of tumor suppressors PTEN, RB1, and TP53 recapitulating local tumor heterogeneity, influencing metastatic capacity and indicating therapy response.
Prostate Cancer Survival Rates Are Favorable Overall
Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.
To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides what’s called the relative survival rate for prostate cancer.
Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, we’re not counting men with prostate cancer who die of other causes:
- 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
- Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.
Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:
- the relative 10-year survival rate is 98%
- the relative 15-year survival rate is 96%
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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
Neurologic Complications Of Prostate Cancer
RAMSIS BENJAMIN, M.D., M.P.H., Keck School of Medicine of the University of Southern California, Los Angeles, California
Am Fam Physician. 2002 May 1 65:1834-1841.
This article exemplifies the AAFP 2002 Annual Clinical Focus on cancer: prevention, detection, management, support, and survival.
Neurologic complications continue to pose problems in patients with metastatic prostate cancer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batson’s plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 percent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neurologic complications of metastatic prostate cancer require prompt treatment, early recognition is important. Physicians should consider metastasis in the differential diagnosis of new-onset low back pain or headache in men more than 50 years of age. Spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment.
More Common Neurologic Complications in Patients with Metastatic Prostate Cancer*
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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.