Low Risk Localised Prostate Cancer
The treatments your doctor will offer you are:
- active surveillance or watchful waiting
- surgery to remove your prostate
- radiotherapy either internal or external beam
Your doctor will discuss the possible risks and benefits of each treatment with you.
Radiotherapy and surgery work equally well at curing prostate cancer but have different side effects. Your doctor can explain these to you.
The table below shows that there is very little difference in survival between the treatments. Understanding these and the possible side effects of each treatment can help you and your doctor to make a decision.
|Treatment for low risk localised cancer||Percentage of men who survive after 10 years|
|Active surveillance||98 out of 100|
|Surgery to remove your prostate||99 out of 100|
|Radiotherapy aiming to cure cancer||99 out of 100|
|Active surveillance||Surgery to remove the prostate||External beam radiotherapy|
|39 out of 100||71 out of 100||38 out of 100|
|Difficulty getting an erection||29 out of 100||66 out of 100||48 out of 100|
|Problems controlling your bowels||2 out of 100||1 out of 100||5 out of 100|
The risk of the same side effects after 6 years of treatment is similar between the different treatment groups.
Psa And Gleason Score
Two other important factors that doctors and specialists use to assess cancer cells are the prostate specific antigen and the Gleason score.
PSA levels: PSA is a protein that appears in higher levels in the bloodstream when there is a problem with the prostate. Normally, PSA levels in the blood are very low, and a test cannot detect them. However, in some circumstance, such as prostate cancer, PSA levels start to rise.
Screening for prostate cancer uses a blood test for PSA. If PSA levels are high, the doctor may recommend further tests to see if prostate cancer is present.
There are various other reasons why PSA levels may rise, including sexual stimulation or an infection.
The grade and Gleason score: Different types of cancer cell act differently. Some types, or grades, are more aggressive and can spread more easily. The Gleason score and grade are different measures, but they both reflect how likely it is that a tumor will spread, and how quickly it will do so. Either a biopsy or surgery can determine the types of cancer cells present in the prostate tissues.
Nearly 50% of males have a condition known as prostatic intraepithelial neoplasia by the time they are 50 years old. PIN is when there are changes in the cells that line the prostate gland.
High grade PIN is not cancer, but the cells can become cancerous in the future. For this reason, a doctor may recommend treatment to remove the cells.
Undergoing Treatment Of Prostate Cancer With Metastases In Europe
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Prostate Cancer Stages And Other Ways To Assess Risk
After a man is diagnosed with prostate cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a prostate cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer’s stage when talking about survival statistics.
The stage is based on tests described in Tests to Diagnose and Stage Prostate Cancer, including the blood PSA level and prostate biopsy results.
Comparison Of Curative Treatments
Active surveillance, radiation therapy, and surgery all have advantages and disadvantages .13,2427 A randomized controlled trial of 1,643 men in Great Britain compared active surveillance, radical prostatectomy, and external beam radiation therapy for treatment of clinically localized prostate cancer over a median of 10 years.24 There were 17 prostate cancerspecific deaths overall: eight in the active-surveillance group , five in the radical prostatectomy group , and four in the EBRT group . There were no significant differences among groups in prostate cancerspecific mortality or all-cause mortality. Surgery and radiation therapy were associated with lower incidences of disease progression than active surveillance. No trials have compared treatment outcomes by race or ethnicity.
Summary of Curative Treatment Options for Localized Prostate Cancer
EBRT = external beam radiation therapy.
Summary of Curative Treatment Options for Localized Prostate Cancer
EBRT = external beam radiation therapy.
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Consider Choosing Proton Therapy Radiation
Proton therapy is gaining popularity for its ability to more precisely target tumors and reduce radiation damage to healthy tissues and surrounding organs. This treatment has also been shown to result in strong cure rates, reduced side effects and improved long-term outcomes, such as a lower risk of impotence and incontinence.
Treatment Options Under Clinical Evaluation For Stage I Prostate Cancer
Treatment options under clinical evaluation for patients with stage I prostate cancer include the following:
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer. In the CLIN1001 PCM301 randomized trial, 413 men with low-risk cancer were randomly assigned in an open-label trial to receive either the photosensitizing agent, padeliporfin , or active surveillance. Median time to local disease progression was 28.3 months for patients receiving padeliporfin and 14.1 months for patients who were assigned to active surveillance . However, the appropriate population for photodynamic therapy may be quite narrow, as it may overtreat men with very low-risk disease and undertreat men with higher-risk disease.
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When Cancerous Tumors Form On Connective Tissues It Is A Sarcoma
When cancerous tumors form on connective tissues, it is a sarcoma. Webmd explains what metastatic prostate cancer is and how it is found. Breast cancer is the second most common cancer found in women after skin cancer but that doesn’t mean men aren’t at risk as well. The pancreas is a bodily organ that few people think about. Although screenings for prostate cancer are one tool for early detecti. Adenocarcinoma cancers being usually in one of the following organs: One in seven men in the united states will receive a prostate cancer diagnosis during his lifetime. If breast cancer is diagnosed at an early enough stage, it’s treatable. Although the percentage of cases in men is much lower than in women, male breast cancer accounts for a por. However, as with other types of cancer,. There are a number of different treatments doctors recommend. Prostate cancer is a common type of cancer in men, according to the mayo clinic. Of course, your specialist is the main person whose advice you should follow but it doesn’t do anyone harm.
Table 1 Why A Low Psa Does Not Mean You Are Cancer
The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer in some cases, high-grade prostate cancer.
PSA level 13 *Note: A PSA level over 4.0 ng/ml traditionally triggers a biopsy. Adapted with permission from I.M. Thompson, et al. Prevalence of Prostate Cancer Among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004, Table 2.
This study inadvertently provided evidence not only that prostate cancer occurs more often than once believed, but also that PSA levels may not be a reliable indicator of which cancers are most aggressive. Both findings add weight to the growing consensus that many prostate tumors currently being detected may not need to have been diagnosed or treated in the first place.
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After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
If Your Prostate Cancer Comes Back
If your cancer goes into remission but later returns, follow-up treatments will depend on where the cancer is located and which treatments youâve already tried.
- If the cancer is contained in your prostate, surgery or a second attempt at radiation is suggested. If youve had a radical prostatectomy, radiation therapy is a good option. If you had radiation, radical prostatectomy might be the best approach. Cryosurgery might also be an option.
- If the cancer has spread to other parts of your body, hormone therapy might be the most effective treatment. External or IV radiation therapy or bisphosphonate drugs can relieve your bone pain.
Stage 3 Pericardial And Testicular Mesothelioma
Doctors and researchers do not clearly define stage 3 pericardial or testicular mesothelioma due to their rare nature.
Only 1% to 2% of mesothelioma cases are pericardial, which means cancer forms within the sac that protects the heart. Therefore, a diagnosis for this disease is unlikely until the late stages, after metastasis to the lungs or chest cavity.
Doctors evaluate testicular mesothelioma tumor characteristics by using staging guidelines for general testicular cancer. For example, doctors more commonly refer to stage 3 testicular mesothelioma as late-stage cancer. This description indicates that cancer has spread beyond the lining of the testicles to other tissues such as lymph nodes or bone.
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.
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Standard Treatment Options For Stage Iv Prostate Cancer
Standard treatment options for patients with stage IV prostate cancer include the following:
Hormonal treatment is the mainstay of therapy for metastatic prostate cancer. Cure is rarely, if ever, possible, but striking subjective or objective responses to treatment occur in most patients. The cornerstone of hormonal therapy for prostate cancer is medical or surgical castration to stop the production of testosterone by the testes. This is commonly referred to as androgen deprivation therapy and can be achieved with bilateral orchiectomy or with administration of gonadotropin-releasing hormone agonists or antagonists. The most effective purely hormonal approach employs a combination of ADT and one of the following agents:
- Abiraterone acetate, an inhibitor of cytochrome P450c17, a critical enzyme in androgen biosynthesis.
- Apalutamide, an androgen receptor antagonist.
- Enzalutamide, an androgen receptor antagonist.
Randomized controlled trials have reported that combination therapy with any one of these drugs plus ADT results in longer overall survival than does ADT alone.
Immediate versus deferred hormonal therapy
Tools To Help You Decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasn’t spread.
It can’t tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.
To be able to use the tool you need to know the following about your cancer:
- PSA level
- stage of cancer
- grade of cancer
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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.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
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.
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.
Can The Gleason Score On My Biopsy Really Tell What The Cancer Grade Is In The Entire Prostate
Prostate biopsies are tissue samples from different areas of the prostate. The Gleason Score on a biopsy usually reflects the cancer’s true grade. However, it is possible that the Gleason Score from your biopsy is lower or higher than the true grade. To reduce the risk of over-or-under scoring, multiple biopsies are usually taken from different areas within the prostate.
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Your Age And General Health
Your doctor takes your age into account because some prostate cancers grow very slowly. If you are older and your prostate cancer is not causing you any symptoms, you may live just as long without having any active treatment. So you might be offered regular checkups instead of treatment.
You may find it hard to wait and see if you are offered regular checkups. But it could be the right choice for you if the side effects from the treatment might be worse than the effects of the cancer. This is particularly so if you have other health problems. If your cancer starts to cause symptoms you and your doctor can then consider which treatment is best for you.
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How Prostate Cancer Metastases Are Treated
Surgery for prostate cancer treatment is performed primarily in prostate cancer patients without lymph node metastases.
Laparoscopic radical prostatectomy is the complete removal of the prostate gland through several small punctures in the anterior abdominal wall. And again, removal of the prostate is performed when the tumor is limited to the capsule of the organ, without invasion into adjacent organs and without distant metastases. The presence of tumor cells is usually detected with the help of the regional lymph node biopsy, as well as histological examination of the tissues that are removed during a surgery.
There are several alternatives to this intervention, depending on the degree of malignancy and a large number of prognostic indicators:
- Active surveillance implies control of the tumor process and shifting to surgical treatment in case of the disease progression. Active surveillance is performed for low-risk cancer cases.
- Distant radiation therapy or brachytherapy. These methods are not radical but are an indisputable alternative to surgery.
- High-intensity focused ultrasound the non-invasive procedure that heats and destroys cancer cells.
- Cryoablation, if the general somatic condition of the patient implies a high risk of complications during an invasive operation under general anesthesia.
- Chemotherapy or hormone therapy is performed in men with advanced prostate cancer.