Stage 4 Prostate Cancer Treatment

Expert Review And References

• American Cancer Society. Treating Prostate Cancer. 2019: .
• American Society of Clinical Oncology. Prostate Cancer. 2020: .
• Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
• PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
• PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
• National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020: .
• Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
• Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatmentand follow-up. Annals of Oncology. 2020: 31: 1119-1134. .

Why Is It Important To Consult A Prostate Cancer Specialist In Delhi India

Delhi is one of the best cities in India for the treatment of prostate cancer, with great availability of surgical specialists and infrastructure for the treatment of this complex disease. Thetreatment for prostate cancerrequires significant expertise and a strong team. Some patients may require treatment for multiple years with many drugs. Improper frontline treatment can lead to disease relapse which is difficult to cure. Recently, there has also been a massive influx of new drugs, genetic tests and personalized therapy. An expert is needed to navigate this complexity.

Dr Vineet Govinda Gupta is a medical oncologist based in Delhi NCR with expertise in the treatment of ovarian cancer. He is gold medalist from AIIMS New Delhi where he has previously worked for more than 12 years. He has received numerous awards and published research in cutting-edge journals. More information here

Survival Of Prostate Cancer

Survival depends on many factors. No one can tell you exactly how long you will live.

Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.

Survival for prostate cancer is generally good, particularly if you are diagnosed early.

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Questions To Ask Your Doctor Or Nurse

• What type of hormone therapy are you offering me and why?
• Are there other treatments I can have?
• What are the advantages and disadvantages of my treatment?
• What treatments and support are available to help manage side effects?
• Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
• How often will I have check-ups and what will this involve?
• How will we know if my cancer starts to grow again?
• What other treatments are available if that happens?
• Can I join any clinical trials?
• If I have any questions or get any new symptoms, who should I contact?

Stage I Bladder Cancer

Stage I describes superficial non-muscle-invasive bladder cancer. It is present in the bladders inner lining but hasnt invaded the muscle wall. We usually perform an initial TUR to determine the extent of the cancer as well as the grade. We typically do a second TUR to remove the rest of the tumor followed by intravesical therapy with either BCG or chemotherapy.

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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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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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How Long Can You Live With Prostate Cancer With No Treatment

Studies have shown that between 86% and 98% of men with LPC do not die from their cancer in all age groups, the researchers wrote. In fact, more than 95% of patients with LPC live at least 10 years after their diagnosis, whereas only 25% of patients in this study expected to live more than 10 years.

What Is Psma Therapy

PSMA is a marker expressed only on prostate cells and absent in normal cells. It is possible to design special radioactive chemicals that specially go and kill only prostate cancer cells. This is called PSMA therapy. It is often used in patients who exhaust other options.

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Subtleties And Future Questions

Several factors have to be carefully considered in interpreting the trial results, explained Dr. Apolo.

A major one is that the study did not directly compare survival between people who got avelumab immediately versus when their cancer progressed. Only about half of the participants who initially received supportive care alone went on to receive immunotherapy after their cancer got worse. There could be many reasons for this, including lack of access to these drugs in different countries, Dr. Apolo said.

But it also might be that, for some people, the cancer was progressing too rapidly, she added. When these tumors start growing, they start growing very quickly. So if you wait to start at the time of progression, maybe its too late, added Dr. Apolo.

Not all patients will be caught by the second-line safety net, agreed Dr. Plimack.

So, for now, said Dr. Balar, the takeaway message from the JAVELIN study is after chemotherapy, dont wait to give immunotherapy.

But more and more, studies are looking at whether some patients should receive immunotherapy as first-line treatment, he continued. Immunotherapy is one of the most important advances weve made in the last 30 years, Dr. Balar said.

The JAVELIN results cant provide any insight into which patients benefit from first-line treatment with a platinum-based chemotherapy, he added. This trial wasnt designed to ask: Is chemotherapy necessarily the best choice for every patient? he explained.

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
• chemotherapy

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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Side Effects Of Chemotherapy

Side effects of chemotherapy are common and may include:

• Hair loss
• Digestive issues such as nausea, vomiting and diarrhea

While on chemotherapy, patients are also susceptible to infections because their white blood cell counts are lower. Other common side effects include bruising or bleeding due to fewer blood platelets and fatigue due to the lowered red blood cell count.

Its also possible to experience a severe allergic reaction to some of the drugs used to treat prostate cancer, especially Taxotere® and Jevtana® . The patients care team may recommend medicines before each session to help prevent a reaction.

The prostate chemotherapy drug mitoxantrone may cause leukemia later in life, but this is rare. The prostate chemotherapy drug Emcyt® may increase the risk for blood clots.

During chemotherapy, doctors may also offer supportive care services to help ease side effects. For example, naturopathic providers may suggest supplements to reduce nausea. Also, a mind-body therapist may recommend techniques to help the patient relax and feel less anxious during prostate cancer chemotherapy treatments.

Types Of Cancers That Are More Likely To Go Undetected

Some cancers are more easily detected than others. For example, certain types of skin cancer can be diagnosed initially just by visual inspection though a biopsy is necessary to confirm the diagnosis.

But other cancers can form and grow undetected for 10 years or more, as one study found, making diagnosis and treatment that much more difficult.

This table provides an overview of common cancers that often display little or no symptoms early on, and how theyre typically detected and diagnosed:

Type of cancer

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Stage 4 Prostate Cancer Clinical Trials

Clinical trials provide cancer patients with life-extending and curative new medicines. Clinical drug trials are critical in getting new medicines to patients who need them the most, as well as securing data so that regulatory clearances may be secured, and new drugs can enter broad clinical practice. Patients who take part in clinical trials benefit both treatment science and their fellow patients.

There are currently 100 Phase III drug trials and more than 500 Phase I/II trials related to prostate cancer treatment in progress in the United States alone. Those that are approved will join the 12 new drugs that have been approved for men with advanced/metastatic disease since 2010 and further improve outcomes for patients:

Using our AI-powered approach, Massive Bio leads patients through the most extensive clinical trial matching process available.

We can assist you if you have been diagnosed with any of the following prostate cancer subtypes:

• Adenocarcinoma
• Transitional Cell Carcinoma
• Small Cell Carcinoma

If you do not know which type of prostate cancer you have, that is okay. Additional testing can help you determine your exact diagnosis.

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Where Do These Numbers Come From

The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.

• Localized: There is no sign that the cancer has spread outside the prostate.
• Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
• Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.

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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 you’ve 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.

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What Is Prostate Cancer Immunotherapy Is Prostate Cancer Immunotherapy Available In Delhi India

Immunotherapy works by stimulating the bodys own immune system to kill cancer

Immunotherapy is a new revolution in cancer treatment. Immunotherapy works by stimulating the bodys own immune system to kill cancer cells. This allows it to exert powerful action with minimum side-effects. Thus one can produce dramatic results even in hopeless cases. This is an area of furious research in prostate cancer. At present immunotherapy is generally used in patients with limited options. This is expected to change rapidly in future.

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Gleason Prostate Cancer Score

1960s as a way to measure how aggressive your prostate cancer may be.

A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.

The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.

For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.

A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.

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Staging And Grading For Stage 4 Cancer

Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:

• T , or the size of the original tumor
• N , or whether the cancer is present in the lymph nodes
• M , or whether the cancer has spread to other parts of the body

Not all cancers are staged using the TNM system, though. Some cancers, especially liquid cancers, are staged through different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. Female reproductive system cancers, such as cervical cancer, are staged with a separate staging system created by the International Federation of Gynecology and Obstetrics .

As your care team gathers information about your cancer for the purposes of staging, they may need to order several tests, including:

• Computed tomography scans

Your care team may likely also need to perform a biopsy, a procedure that involves removing a sample of cells and analyzing it for signs of cancer. Imaging scans may be able to tell your care team where your cancer is, but looking at the cancer cells specifically tell them how fast they are likely to growor what grade they are.

Grading is different from staging and is done for most, but not all, cancers.

The grade of your cancer is part of how your cancer care team stages your cancer and determines your prognosis, or outlook.

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Radiation Therapy In Metastatic Crpc

Approximately 90% of advanced PCa patients will develop bone metastases. Radiation therapy is an important therapeutic option for of bone disease. Patients with isolated, painful bone lesions may be treated with palliative external beam radiation. Additionally, oligometastatic disease may be treated to slow progression. Systemically administered, bone targeted radiopharmaceuticals can be used for control of bone predominant disease. Radium-223 is an alpha particle emitting agent approved for the treatment of mCRPC patients with symptomatic bone lesions, without visceral disease. Patients in the ALSYMPCA trial receiving radium-223 had an improvement in OS as well as significant improvements in skeletal- and pain-related outcomes.20 Treatment with radium-223 alone has been shown effective in comparison to placebo however, there are several ongoing studies investigating combinations with other approved agents in mCRPC.

How Prostate Cancer Staging Is Done

Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging.

PSA refers to a protein made by the prostate measured by a lab test.

• A higher level of PSA can indicate a more advanced cancer.
• The doctors will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor.

A prostate biopsy is done in your doctor’s office. The results can indicate:

• How much of the prostate is involved.
• The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores 6 or less suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread.

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Treatments To Control And Prevent Further Cancer Spread In Patients With Castrate Refractory Advanced Prostate Cancer:

At BPC we offer:

• Radium-223

Other treatment options ongoing clinical studies:

• Autologous cellular immunotherapy, which is in late trial stage and although not currently available outside a trial setting in the UK, is likely to be licensed soon.
• Cabozantinib

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How Would I Treat Stage 4 Prostate Cancer

• I would stop all the foods that cause cancer, and stop using all the household and bodycare products that leach toxins into the body.
• I would change to those foods that resonate with my body through personal testing as I describe in my book.
• I would only eat fresh organic foods, grains, nuts and seeds properly prepared and soaked to reduce the phytic acid cooked nourishing broths and meats from grass-fed and pastured animals and eat raw, unpasteurized dairy and eggs which have a completely different profile than conventional cancer-causing, factory-farmed and produced foods which are loaded with toxins.
• I would stop all harmful foods listed on this site and in my book. For end stage prostate cancer, I would stop all sugar and its substitutes. Why? They feed the cancer.
• I would undergo cleansing short fasts with freshly made vegetable juices if personally tested Yes. I would do a liver flush, or many, to rid the body of major toxins quickly and easily.
• I would ensure that if couldnt get adequate sun on my skin, I would at least take an adequate dosage of Vitamin D3 levels.
• I would take aloe vera juice each day and test for which supplements my body needed like zinc and magnesium.

And more

End stage prostate cancer could then no longer find a host in my body for I would have changed the conditions that I either knowingly or unknowingly created that led to it.

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