How Prostate Cancer Staging And Risk Group Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:
- Localized: Theres no indication that the cancer has spread beyond the prostate.
- Regional: Theres evidence of cancer cells in nearby lymph nodes or tissue.
- Distant: Theres evidence the cancer has spread to other organs or body parts farther from the prostate.
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
Treatment guidelines for prostate cancer
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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After A Radical Prostatectomy
For a few hours after the operation, a person usually has a drip in their arm. The drip can come out once the person can eat and drink again.
Healthcare teams usually encourage people to start moving around again as soon as possible. This reduces the risk of blood clots and other complications. Some people may also need injections to prevent blood clots once they get home.
Before discharge, a nurse will teach the person how to care for their surgical wounds and instruct them on painkiller use.
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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.
Robotic Assisted Laparoscopic Radical Prostatectomy
Minimally invasive surgical technique to remove the prostate and seminal vesicles. The surgeon performs the procedure through five 1-cm incisions spread in the shape of a fan across the lower abdomen. The surgeon performs the procedure using a robotic surgical assist device called the daVinci® Surgical System. Takes 2.5-3.5 hours to perform with a hospital stay of 24-48 hours.
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What Is Localized Prostate Cancer
Prostate cancer is the abnormal growth of cells in the prostate gland. Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesn’t cause symptoms.
Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.
Men of African descent have the highest rates of both prostate cancer and deaths from it.
About 21,000 men are diagnosed with prostate cancer in Canada every year.footnote 1 In the United States, about 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime in their lifetime.footnote 2 But most men who are diagnosed with prostate cancer don’t die from prostate cancer.
Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery.
Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.
When Is Brachytherapy Alone The Right Choice
For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.
This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.
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Stereotactic Body Radiation Therapy
This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.
SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife, X-Knife, CyberKnife, and Clinac.
The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.
Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
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How To Decide If You Want Radiation Or Surgery For Prostate Cancer
There is still a debate on selecting the best options to go by. Research that has been conducted on the outcomes of both procedures shows that both of them are effective in the treatment of prostate cancer and the choice of either of these depends on your underlying health conditions and is different from person to person.
To better decide on the treatment option to follow, it is important to first understand the disease itself. You can also gather as much information about the recovery experiences on either of these methods. Having a deep understanding of what it takes during and after the surgery or radiation therapy will help you to make a solid decision on which path to follow.
Making the right decision comes down to understanding the options that you have and how each of them can affect the outcomes you get. That is the main reason why it is always important first to undergo intensive diagnosis and pre-screening. This helps you to make the right decisions based on the results from the tests.
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Proton Therapy For Pediatric Cancers
Proton therapy is particularly beneficial for treating children and adolescents with cancerous and noncancerous tumors. Children are at a significantly higher risk of late effects from cancer treatments compared to adults. Two-thirds of children who survive a cancer diagnosis face at least one chronic health condition. One-fourth of pediatric cancer survivors face a severe or life-threatening side effect from treatment that occurs later in life. These include heart damage, lung damage, infertility, cognitive impairment, growth deficits, hearing loss, vision loss, secondary cancers and more.
Thanks to treatment advances, including radiation, pediatric cancer survival rates have dramatically increased to nearly 85% today from 10% only decades ago. One of these advancements, proton therapy, reduces a childs risk of experiencing harmful long-term side effects. Proton therapy limits and reduces radiation doses to healthy tissues and organs while delivering curative doses to the cancer.
We treat a number of childhood cancers with proton therapy. In certain situations, the cancer center will coordinate with Childrens Mercy specialists to develop a care plan suited to the childs individual treatment requirements. Childhood cancers we treat with proton therapy include:
- Atypical teratoid rhabdoid tumor
- Rhabdomyosarcoma
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.
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Prostate Surgery Leads To Better Survival Vs Radiation
A recent clinical update on prostate cancer in the Urology Times journal discusses new data on the survival benefits of surgical treatment of prostate cancer vs. radiation therapy.
Radical prostatectomy, which is nowadays almost always performed using a robotic surgical platform, may result in a reduced risk of developing an aggressive type of metastatic prostate cancer known as Castration-Resistant Prostate Cancer .
After any treatment for localized prostate cancer, the cancer may recur. One of the initial treatments for recurrent cancer with signs of spread, is hormonal ablation, also known as Androgen Deprivation Therapy .
A recent research study found that 32% of patients who chose radiation as their initial treatment, ended up developing the more aggressive type of advanced prostate cancer. The study also showed that men who received radiation alone had 77% higher overall mortality after developing metastatic disease.
As prostate cancer rates continue to increase, it is important for patients to be well informed regarding their options. Many physicians who do not have access to a highly trained robotic surgeon may only offer radiation therapy as a primary treatment modality.
What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
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Treating With Radiation Alone
The meaning was clear. Oakleys cancer was still in an early stage, and Yeh believed he could treat it successfully with radiation alone. That belief was backed up by data. In early stages, radiation can be an alternative to surgery, with a similar cure rate, he said. The overall survival rate is very similar.
Part of that success is due to the evolution of the older, more traditional external beam machines, such as the linear accelerator, which are noninvasive and deliver radiation aimed at a specific part of the body. Although the basic technology has existed since the 1950s, the last two decades have witnessed major improvements.
Oakley received several weeks of daily intensity modulated radiation therapy . In use since the 1990s, IMRT adapts the strength of the radiation beam to match the precise contours of a tumor and minimize the damage to surrounding tissue. The IMRT is guided by computed tomography imaging, which maps those contours and pinpoints the cancer.
Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
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How Is Radiation Therapy Used To Treat Cancer In Dogs
To protect normal cells, veterinarians carefully limit the doses of radiation and spread the treatment out over time. They also shield as much normal. tissue as possible while they aim the radiation at the site of the cancer. There are two approaches for using radiation therapy in dogs curative and palliative.
The Cambridge Prognostic Groups
In the UK, doctors divide prostate cancer into 5 prognostic groups. This is the Cambridge Prognostic Group . The 5 groups are from CPG 1 to CPG 5. Your CPG depends on:
- the tumour stage. This is from the T stage from the TNM staging
- what the cancer cells look under a microscope. This is the Grade Group or Gleason score
- your PSA blood test level
The CPG helps your doctor recommend if you need treatment and the type of treatment you need. Doctors also consider other factors when recommending the best treatment for you:
- your age and general health
- how you feel about the treatment and side effects
If you cant have treatment because of your age or other health issues, your doctor might monitor the cancer with watchful waiting. They will only recommend treatment if the cancer starts to cause you symptoms.
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