HomeCancerStage 4 Metastatic Prostate Cancer

Stage 4 Metastatic Prostate Cancer

Impact Of Age On Treatment

Metastatic prostate Cancer Stage 4 Gleason 8. Help, I am dying.

The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests. Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.,

Chodak and associates evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.

What Is The Survival Rate Of Stage 4 Prostate Cancer

Doctors use the term stage to characterize the characteristics of the original tumor itself, such as its size and how far prostate cancer has spread when it is discovered, as they do with all malignancies.

Staging systems are difficult to understand. Most malignancies, including prostate cancer, are staged using three different elements of tumor growth and dissemination. The TNM system stands for tumor, nodes, and metastasis:

  • T, for tumor describes the size of the main area of prostate cancer.
  • N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
  • M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.

The TNM approach allows each mans prostate cancer to be characterized in depth and compared to the prostate cancers of other men. Doctors utilize this information to conduct research and make treatment decisions.

However, in terms of prostate cancer survival statistics, the staging method is straightforward. As previously stated, males with prostate cancer can be split into two groups in terms of survival rates:

  • Men with prostate cancer that is localized to the prostate or just nearby.
  • Prostate cancer has a high long-term survival percentage in these men. Almost all men will live for more than five years after being diagnosed with prostate cancer, and many will live for much longer.
  • Men whose prostate cancer has spread to distant areas, like their bones.

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.

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What Is Stage 4 Prostate Cancer

The fourth stage of prostate cancerdefines a tumor that has progressed to other regions of the body, such as the lymph nodes, lungs, liver, bones, or bladder. The 5-year survival rate for these tumors is 29 percent.

Keep in mind that each case is unique, and figures like these are merely suggestions. As advances in prostate cancer treatment become more common, your odds of surviving this disease improve.

In general, prostate cancer has a very good survival rate one of the greatest of any cancer type. Because prostate cancer is frequently a slow-moving disease, the majority of men diagnosed with it will die from an unrelated reason.

Stage 4 prostate cancer means the cancer has spread to lymph nodes or to other parts of the body. It is further divided into two substages:

  • Prostate Cancer Stage 4A Stage 4A: The cancer has spread to nearby lymph nodes but may or may not have spread to nearby tissues.
  • Prostate Cancer Stage 4B Stage 4B: The cancer has spread to another area of the body, such as the bones or distant lymph nodes.

Dealing With The Downsides

New Subtype of Treatment

Billy has had to cope with side effects from the hormone therapy thats controlling his cancer, including fatigue, weakness, night sweats, and loss of libido and muscle mass. He takes walks to keep fit. Unfortunately, I acquired asthma from the lung surgery that took half of my left lung, and now I have to carry an oxygen tank to enable me to walk, he says. If I dont use it, Im not going to get very far, but I dont want to reduce my activity level. I refuse to accept that.

These side effects can be scary, he says, but its nice to know that MSK offers resources like the Sexual Health Program that can address some of them. MSK also provides services such as social work, physical rehabilitation, and complementary therapies. Billy didnt end up using those particular options, but he says, Theres a certain level of comfort and security about MSK that I dont believe I would get anywhere else. I feel safe. They have my back.

This was especially evident when Billy became depressed after learning he had metastatic prostate cancer and also losing his younger brother to suicide. He reached out to MSKs Counseling Center for someone to talk to. Depression is slow and insidious I was just sinking into an abyss, and losing my brother was the tipping point for me, he recalls.

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Diagnosing Stage 4 Prostate Cancer

There are two systems which physicians often use to determine the stage of prostate cancer: the TNM & the Jewett System. Both systems use a four grade scale.

With the TNM system, final stage prostate cancer is stage 4 the final stage of the Jewett System is stage D. Therefore, using both systems, if prostate cancer has spread to areas outside the prostate gland, other than the seminal vesicles, then it is classed as stage 4 or stage D.

If the tumor has extended through the prostate gland cover, and the seminal vesicles are the only affected area outside the prostate, then the cancer is Stage 3 .

What Does It Mean To Have A Gleason Score Of 6 Or 7 Or 8

The lowest Gleason Score of a cancer found on a prostate biopsy is 6. These cancers may be called well-differentiated or low-grade and are likely to be less aggressive they tend to grow and spread slowly.

Cancers with Gleason Scores of 8 to 10 may be called poorly differentiated or high grade. These cancers tend to be aggressive, meaning they are likely to grow and spread more quickly.

Cancers with a Gleason Score of 7 may be called moderately differentiated or intermediate grade. The rate at which they grow and spread tends to be in between the other 2.

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What Is Prostate Cancer

Prostate cancer is cancer that affects the prostate gland in men. Prostate cancer is the second-leading cause of cancer deaths for men in the US.

The prostate lies below the bladder and in front of the rectum. In men, the size of the prostate increases with increasing age. In younger men, it is about the size of a walnut. Its primary function is to make fluid to nourish the semen.

Growth in the prostate can be of two types

  • Benign growths: These are noncancerous growths and are rarely a threat to life. For example, benign prostatic hyperplasia.
  • Malignant growths: These are cancerous growths that can sometimes be life-threatening.
  • Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.

    Chances Of Developing Metastatic Prostate Cancer

    Living with advanced prostate cancer

    About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.

    A small percentage of men aren’t diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it’s metastatic cancer when they take a small sample of the tissue and study the cells.

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    Distant Metastatic Prostate Cancer

    Distant metastatic prostate cancer is more advanced, having spread to areas outside the pelvic region. The most common distant places where prostate cancer spreads include the:

    • Bones
    • Lungs
    • Liver

    Less commonly, prostate cancer may spread to the adrenal glands, kidneys, brain, pancreas or another organ. It is important to note that it is still considered prostate cancer when it spreads to other regions, as the cancer cells in distant areas are the same as the original cancer cells in the prostate gland, even if the prostate gland was previously removed. A biopsy may be recommended to confirm this.

    Symptoms Of Stage 4 Prostate Cancer

    The symptoms of Stage 4 prostate cancer include the urinary and sexual symptoms associated with previous stages 2 and 3.

    However, a diagnosis of stage 4 prostate cancer means that other areas of the body are affected, giving rise to a wider range of symptoms.

    Bone metastases, in which cancer spreads to the bones, is a common occurrence with stage 4 prostate cancer. Associated symptoms of bone metastasis include pain, a higher risk of bone fracture and a condition known as hypercalcemia. Hypercalcemia is a potentially fatal condition in which the blood has very high levels of calcium.

    Where organs of the body are affected, there will symptoms specific to that organs dysfunction.

    See also, ‘Advanced Prostate Cancer Symptoms‘.

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    Active Surveillance And Watchful Waiting

    If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

    Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

    ASCO encourages the following testing schedule for active surveillance:

    • A PSA test every 3 to 6 months

    • A DRE at least once every year

    • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

    Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

    Prognosis For Prostate Cancer

    Prostate Cancer Stages &  Options

    It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

    Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.

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    Ethics Approval And Consent To Participate

    As the data used was extracted from SEER dataset , Ethics approval and Consent to participate could be checked in SEER. We were permitted to have Internet access after our signed data-use agreement was approved by the SEER administration . The date collected from the Second Affiliated Hospital of Zhejiang University School of Medicine was approved by the Ethics Committee of Zhejiang University .

    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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    Strategies To Improve Treatment

    The progress that has been made in the treatment of prostate cancer has resulted from development of better treatments that were evaluated in clinical studies. Future progress in the treatment of prostate cancer will result from patients continued participation in appropriate clinical trials. Developing novel precision cancer medicines and immunotherapies is the main area of active current investigation.

    Cabazitaxel : Cabazitaxel is administered intravenously and has been demonstrated to improve time to cancer progression and overall survival in men with HRPC previously treated with docetaxel. Cabazitaxels primary side effect is neutropenia, and it is recommended that patients receive a white blood cell growth factor if they are at high risk of this complication.

    Sipuleucel-T: Sipuleucel-T is an immunotherapy that prompts the bodys immune system to respond against the cancer. A Phase III clinical trial that contributed to the FDA approval of sipuleucel-T was a study known as IMPACT which demonstrated an improvement in overall survival for men treated with sipuleucel-T. The main side effects reported were chills, fever, and headache.

    References:

    Good Prostate Cancer Care

    How is stage 4 prostate cancer treated? – Dr. Anil Kamath

    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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    Treatment Of Bone Complications

    Patients with advanced prostate cancer can have cancer cells that have spread to their bones, called bone metastases. Bone metastases commonly cause pain, increase the risk of fractures, and can lead to a life-threatening condition characterized by an increased amount of calcium in the blood called hypercalcemia. Treatments for bone complications may include drug therapy or radiation therapy.

    Zometa® is a bisphosphonate drug that can effectively prevent loss of bone that occurs from cancer that has spread to the bones thereby reducing the risk of fractures, and decreasing pain. Bisphosphonate drugs work by inhibiting bone resorption, or breakdown. Zoledronic acid may be used to reduce the risk of complications from bone metastases or to treat cancer-related hypercalcemia,

    Xgeva targets a protein known as the RANK ligand. This protein regulates the activity of osteoclasts . Studies have suggested that Denosumab may be more effective than Zoledronic acid at delaying bone complications in prostate cancer patients with bone metastases. Denosumab is associated with side effects including hypocalcemia and osteonecrosis of the jaw .

    Radiation therapy: Pain from bone metastases may also be relieved with radiation therapy directed to the affected bones.

    The Truth About Stage 4 Metastatic Cancer

    The most advanced stage of any types of cancers is stage 4 metastatic cancer. Stage 4 cancer of any kind is hard to treat. This still means that there is a chance for curing. There are many clinical trials that are improving that contribute in the increase of survival rates of patients.

    Stage 4 Metastatic Cancer

    However, the improvement of prognosis depends on the treatment. How a patient responds to the treatment matters a lot. Having the right treatment is very important for survival.

    Stage 4 metastatic cancer life expectancy is not good at all. It has the lowest percentage when it comes to the five-year survival rate. This is because the cancerous cells have already spread to other parts of the body. Therefore, the stage 4 metastatic cancer prognosis of patient is poor and not progressive. Lets take an example such as in stage 4 metastatic cancer liver. This is the condition wherein the cancer has spread from the liver to others parts of the body. This cancer of the liver which is already in its most advanced stage has originated from the lungs that spread to breast, pancreas, large intestines and stomach. This is a condition that may be difficult to cure. Another example is the stage 4 metastatic cancer spine is the cancer in the spine that has widely spread the cancer cells to the whole spine and to other parts of the body too.Treating this stage cancer very extensively is needed for patients to survive.

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    I Really Want To Live

    So its a positive world out there. I can tell you this, Larry. When people come to me and say Dennis, I hear you had some good success with people whove had stage 4 cancer and Ive got this, what do you think? And I simply say to them, You know, one of my requirements is that Ive got to have you answer one question for me first. And they say Yes, what is your question? And I wait purposely quite awhile. I want them to kinda get thinking in their mind What the heck is he gonna ask me? Because I want them really thinking about it.

    Then I said Okay heres the question: Do you really want to live?And I dont say another word. And when I get that positive exciting response like Yes, Yes Denny. I really want to live! I really want to live! And I get that kinda response from a lot of them. And I said I want to tell you something. Youre already half healed. Your body is gonna work with you if you give it the right stuff. And I said I got just the stuff that you need to take.

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