Considering Prostate Cancer Treatment Options
For most men diagnosed with prostate cancer, the cancer is found while it’s still at an early stage — it’s small and has not spread beyond the prostate gland. These men often have several treatment options to consider.
Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors such as your age and general health, and the likelihood that the cancer will cause problems for you to consider before deciding what to do. You should also think about the possible side effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side effects such as incontinence or erection problems for as long as possible. Other men are less concerned about these side effects and more concerned about removing or destroying the cancer.
If you’re older or have other serious health problems and your cancer is slow growing , you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may think more about watchful waiting or active surveillance, and less about treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best reason for your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.
Therapies That Interfere With Androgen Function
Taken daily as pills, antiandrogens bind to the androgen receptor proteins in the prostate cells, preventing the androgens from functioning. In addition to preventing a flare reaction, antiandrogens may be added to your treatment plan if an orchiectomy, LHRH agonist or LHRH antagonist is no longer working by itself. Commonly prescribed antiandrogens include flutamide and bicalutamide .
Enzalutamide is a newer type of antiandrogen that blocks the signal that the receptor normally sends to the cells control center to trigger growth and division. This antiandrogen may be used to treat castration-resistant prostate cancer.
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:
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Managing Prostate Cancer Treatment Side Effects
Early management of side effects has been shown to help patients live longer, better lives.
It is very important that you communicate with your doctors about the side effects that you are experiencing as you undergo treatment. Ongoing and proactive communication will enable your doctor to manage your side effects as early as possible to prevent worsening or development of downstream complications.
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How Long Does External Radiation Treatment Take
In most cases the total dose of radiation needed to kill a tumor cant be given all at once. This is because a large dose given one time can cause more damage to nearby normal tissues. This can cause more side effects than giving the same dose over spread out over days or weeks into many treatments.
The total dose of external radiation therapy is usually divided into smaller doses called fractions. Most patients get radiation treatments daily, 5 days a week for 5 to 8 weeks. Weekend rest breaks allow time for normal cells to recover. The total dose of radiation and the number of treatments is based on:
- The size and location of the cancer
- The type of cancer
- The reason for the treatment
- Your general health
- Any other treatments youre getting
Other radiation schedules might be used in certain cases. For instance, radiation therapy might last only a few weeks when its used to relieve symptoms, because the overall dose of radiation needed is lower. In some cases, radiation might be given as 2 or more treatments each day. Or you might have several weeks off in the middle of treatments so your body can recover while the cancer shrinks. Your doctor will talk to you about the best plan in your case.
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Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.
Testing Options For Prostate Cancer
There is no one age for prostate cancer testing, but the American Cancer Society makes recommendations about prostate cancer screenings. According to the ACS, patients in any of these groups should consider asking their doctor about testing:
- Men age 50 or older who have an average risk of prostate cancer and a life expectancy of at least 10 more years
- Men age 45 or older with a high risk, including African-American men and those with a first-degree relative who had prostate cancer before age 65
- Men age 40 or older who have a higher risk, such as more than one first-degree relative diagnosed with prostate cancer at an early age
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How Do Doctors Tell If Hormone Therapy Stops Working
To monitor how hormone therapy is working, a doctor will measure prostate-specific antigen levels in the blood, as well as testosterone levels.
Rising PSA levels and low testosterone levels can indicate CRPC. Doctors may also use imaging tests to determine whether the cancer is growing.
- Complete androgen blockade: Androgen receptor blockers, such as enzalutamide, flutamide, or bicalutamide.
- Abiraterone: A type of anti-androgen medication.
- Immunotherapy: This uses sipuleucel-T, a vaccine that helps the immune system fight prostate cancer.
- Chemotherapy: Doctors usually use the drug docetaxel for CRPC or cabazitaxel.
- Targeted therapy: Rucaparib camsylate and olaparib are two types of targeted therapy drugs that may help treat CRPC that has mutations.
- Radium-223 dichloride: Radium-223 dichloride is a type of radiotherapy drug that works inside the body to kill cancer cells with radiation.
- Radiation therapy: Doctors may combine external radiation therapy with hormone therapy to destroy cancer cells and relieve pain or urinary problems.
- Clinical trials: Clinical trials may offer new treatment options for people with prostate cancer that is resistant to standard treatments.
Doctors will continue to prescribe ADT as part of the treatment. This keeps testosterone levels low, as an increase in testosterone could contribute to tumor growth.
, in recent years, there have been improvements in treatment for CRPC, particularly metastatic CRPC, with many promising new treatments.
Mental And Emotional Health
A cancer diagnosis and cancer treatment may affect how you feel mentally and emotionally. Hormone therapy can cause:
- A drop in mental sharpness
If you have any of these side effects, your doctor may recommend medication, counseling, or both.
Research shows that hormone therapy for prostate cancer may lead to problems with short-term memory, language, thinking, and concentration. But these problems are usually mild. Researchers are still studying the effect of hormone therapy on the brain.
When you stop taking hormone therapy, emotional and mental side effects usually disappear. But if youâve taken the drugs for many years, they may not fully go away.
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How Long Is Hormone Therapy For Prostate Cancer Effective
Doctors are unable to predict how long hormone therapy will be able to effectively prevent prostate cancer from growing.
Doctors will regularly test PSA levels in people taking hormone therapy longer than a few months. If PSA levels rise despite low androgen levels, it may be a sign that the current hormone therapy is no longer an effective treatment.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
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Short Term Side Effects
Patients who receive any type of radiation therapy to treat their prostate cancer can have side effects. Short term side effects are ones that start during or shortly after your radiation treatment. Below is a list of possible short term side effects. Treatments can affect each patient differently, and you may not have these particular side effects. Talk with your care team about what you can expect from your treatment
Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
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Hormone Treatment Side Effects
While hormone therapy is among the most effective forms of systemic therapy for prostate cancer, any man considering hormone therapy should weigh the risks and benefits of the treatment, including possible side effects.
Most hormone therapies cause similar side effects due to changes in the levels of hormones . The side effects of medicine-based hormone therapy and the time it takes to get over some of them depend on the type of medicine, the dose, the length of time itâs given and your overall health.
Similar side effects can occur with surgical removal of the testicles . Though orchiectomy is a simple outpatient procedure, it also has the typical side effects and risks associated with surgery, including risks for bleeding and infection.
What To Expect During Hormone Therapy
As you go through hormone deprivation therapy, youâll have follow-up visits with your cancer doctor. Theyâll ask about side effects and check your PSA levels.
Doctors donât know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itâs a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.
Youâll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.
To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.
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Guide To Managing Side Effects Of Chemotherapy
Follow these simple rules to manage your side effects:
Pay attention. Be aware of all expected and unexpected reactions to the drugs.
Be proactive. Make a list of your medications. Talk with your health care providers about what signs to look for and when to call them.
Relax and get well. Chemotherapy drugs are powerful and can take a toll on the body. Focus on getting well by finding ways to alleviate stress. These may include listening to music, doing yoga or stretching exercises, taking walks or watching TV.
Keep a journal. Write down any physical and emotional changes you experience while taking the medications. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your health care team to manage your side effects.
Consult your doctor. Talk with your health care providers about any side effects you experience. There are several drugs designed to help ward off or treat different side effects.
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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Prostate Cancer Treatment: Radiation Therapy
Radiation, focused as a beam, can be used to kill cancer cells, especially those cells that have migrated from the prostate gland. Beams of radiation can be used to reduce bone pain caused by invasive cancer cells.
Low Dose Rate Brachytherapy
In another type of radiation therapy termed low dose rate brachytherapy, radioactive pellets about the size of a grain of rice are inserted into the prostate.
High Dose Rate Brachytherapy
High dose rate brachytherapy applies more radioactive sources temporarily into the cancerous prostate gland.
Both methods have side effects that can include erectile dysfunction, urinary tract problems, diarrhea, and other side effects.
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Chemotherapy For Prostate Cancer
Chemotherapy refers to any type of therapy that uses chemicals to kill or halt the growth of cancer cells. While chemotherapy is unlikely to cure prostate cancer, it may provide some benefits to patients. For example, it may be used:
To relieve symptoms associated with very advanced or metastatic disease, improving the patients quality of life
To improve the outcome of prostate cancer surgery if administered for a short time after the procedure
To work in conjunction with hormone therapy and improve the patient outcome
To prolong the life of a prostate cancer patient who no longer responds to hormone therapy
To treat men with advanced prostate cancer who carry the AR-V7 gene variant
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What Are Male Sex Hormones
Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.
Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .
Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make . Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .
Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .