First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
Can Bladder Cancer Be Cured
When detected at an early stage, bladder cancer can usually be treated successfully whereas later-stage cancers may present greater challenges for the patient and their healthcare team. As discussed later, people who have had bladder cancer are at risk for recurrence for the best chance of successfully treating recurrent cancer, early detection is again important.
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Metastatic Prostate Cancer Symptoms
With metastatic prostate cancer, you may notice different symptoms than those generally associated with other stages of the disease. Some of the most frequently occurring symptoms include:
- Bone pain, particularly in the pelvis, ribs, skull and spine
- Unexplained weight loss
- General feeling of being unwell
- Changes in urinary habits, such as needing to go more often
- Cough, breathlessness or other changes involving your lungs and chest
Not everyone with metastatic prostate cancer will experience each of these symptoms, but you should speak with your care team if you notice any such changes.
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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Prostate Cancer In Central America/caribbean
Among the Central American countries, Costa Rica leads with an ASR of 53.8 cases per 100,000 people, followed by Mexico and Cuba with 28.9 and 24.3 cases per 100,000 people respectively . Unfortunately, epidemiological data are scarse for those regions. Trends are available only for Costa Rica which showed an annual increase in incidence of 3.8% per annum over the period 19972008. ASR on mortality put Belize at first place with 28.9 cases per 100,000 people followed by Cuba and Mexico with 24.1 and 17.0 cases per 100,000 people for the period 20032010, respectively. Costa Rica stops at 14.8 cases per 100,000 people . The most recent data on Central America published by GLOBOCAN 2020 shows an ASR incidence of 43.8 and mortality of 11.0 cases per 100,000 people . No active screening program are currently in place in Central America. Between 2004 and 2006, in Monterrey a screening program was run, using PSA and DRE screening of 973 men, 40 years of age, showed that only 44% of the men who had an abnormal result underwent prostate biopsy, and 27% of these were diagnosed with prostate cancer, mostly with high grade lesions .
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Survival By Disease Progression
The extent prostate cancer has progressed can influence survival rates.
Prostate-specific antigen is a protein produced by cells of the prostate gland by normal and malignant cells. In men with prostate cancer, blood levels of PSA are often elevated.
Doctors can use PSA as a marker to better understand the progression of prostate cancer and the resulting prognosis.
One way doctors assess the progression of the disease is through PSA doubling time. This refers to the number of months it takes for PSA to double.
One study suggests a short doubling time means a poorer prognosis for patients with stage IV prostate cancer. Median survival was 16.5 months for those with a PSA doubling time lower than 45 days compared with 26 months for patients with a longer PSA doubling time.
Whether or not the cancer has metastasized and spread to other areas of the body outside the prostate can also influence survival. In distant or stage IV prostate cancer, when cancer has spread from the prostate to other organs like the liver or lungs, the five-year survival rate is 31% compared with localized cancer, which has a five-year survival rate of nearly 100%.
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The Future Of Hormone Therapy For Prostate Cancer
Some experts arent sure how much further we can improve hormone therapy for prostate cancer.
Im not saying that weve reached the end of what we can do with hormonal therapy, Thrasher tells WebMD, but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.
Brooks argues that, overall, prostate cancer is only moderately affected by hormones. You can only do so much manipulating the levels of hormones, says Brooks. We have to find better ways to fight the basis of the cancer cells.
Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.
But Holden remains optimistic about the future of hormone therapy for prostate cancer.
Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy, he says. But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.
Its like an endless chess game, he says. You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.
Stage I Prostate Cancer Treatment
In This Section
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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Prostate Cancer Survival Rates
Outside of skin cancer, prostate cancer is the most common cancer in men in the US. The likelihood of developing prostate cancer increases with age, and some 60% of cases are found in men 65 and above. One in eight men in the US will be diagnosed with prostate cancer at some point in their lives.
Prostate cancer is a serious and dangerous diagnosis. It is the second most common cause of death from cancer in US men.
However, the survival rates for prostate cancer are encouragingly high. While survival rates do not indicate the experience of every man with prostate cancer, they do present an average. Understanding the survival rates of prostate cancer, as with any cancer, can help patients decide their treatment plan.
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What Are The Layers Of The Bladder
The bladder consists of three layers of tissue. The innermost layer of the bladder, which comes in contact with the urine stored inside the bladder, is called the mucosa and consists of several layers of specialized cells called transitional cells, which are almost exclusively found in the urinary system of the body. These same cells also form the inner lining of the ureters, kidneys, and a part of the urethra. These cells form a waterproof lining within these organs to prevent the urine from going into the deeper tissue layers. These cells are also termed urothelial cells, and the mucosa is termed the urothelium.
The middle layer is a thin lining known as the lamina propria and forms the boundary between the inner mucosa and the outer muscular layer. This layer has a network of blood vessels and nerves and is an important landmark in terms of the staging of bladder cancer .
The outer layer of the bladder comprises of the detrusor muscle. This is the thickest layer of the bladder wall. Its main function is to relax slowly as the bladder fills up to provide low-pressure urine storage and then to contract to compress the bladder and expel the urine out during the act of passing urine. Outside these three layers is a variable amount of fat that lines and protects the bladder like a soft cushion and separates it from the surrounding organs such as the rectum and the muscles and bones of the pelvis.
What Is Chemotherapy For Bladder Cancer
Patients who are diagnosed with metastatic bladder cancer are usually treated with chemotherapy. Chemotherapy may also be used in cases of locally advanced bladder cancer in an attempt to decrease the chances of the cancer coming back after radical cystectomy. This is adjuvant chemotherapy. Another strategy entails administering neoadjuvant chemotherapy by giving these medications before radical cystectomy in an attempt to improve the results of surgery and decrease the size of the tumor before the operation.
Chemotherapy has the potential to control metastatic bladder cancer and increase the chances of cure when used in a neoadjuvant or adjuvant setting along with surgery. However, chemotherapy has its own set of side effects that some individuals find intolerable.
The time-honored chemotherapy regimen for bladder cancer is the MVAC. It is a combination of four medications given in cyclical form.
Oncologists currently prescribe MVAC in a dose dense fashion. This means the patient takes the drugs more frequently than was previously done in the accepted treatment schedule, as well as taking growth factors to help the blood counts to recover faster from the effects of the chemotherapy drugs. The older schedule for MVAC therapy is no longer recommended according to the National Comprehensive Cancer Network.
Some patients with heart disease may not be in a condition to receive Adriamycin and may receive CMV instead
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What Treatments Are Available
If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.
Before you start treatment
Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.
If you have any questions, speak to our Specialist Nurses.
Metastases: Whether The Cancer Has Spread
The spread of cancer is measured in two ways: by lymph node involvement, and by its appearance in other organs or parts of the body, or metastasis.
Lymph node staging, or N-staging, determines whether the cancer is present in nearby lymph nodes. Lymph nodes are tiny organs that are part of the immune system.NX: The regional lymph nodes cannot be evaluated.N0: The cancer has not spread to lymph nodes in the immediate area.N1: The cancer has spread to lymph nodes in the pelvic region.
The M in the TNM system indicates whether the prostate cancer has spread to other parts of the body, such as the lungs or the bones. This is called distant metastasis.
MX: Metastasis cannot be evaluated.M0: The cancer has not metastasized beyond the immediate prostate region.M1: The cancer has metastasized deeper into the body.
- M1a: The cancer has spread to lymph nodes away from the groin area.
- M1b: The cancer has spread to the bones.
- M1c: The cancer has spread to another part of the body, with or without spread to the bones.
The combination of your full staging results, including your grade and your T, N, and M stages, paints a more complete picture of how the cancer is progressing. This enables your doctors to determine which treatments have the best chance or controlling or eradicating your cancer.
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A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.
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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, such as urinary incontinence and erectile dysfunction.
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.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
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