The Initial Causes Prostate Cancer Standard Of Care
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
Surgery For Prostate Cancer
In some cases of advanced or recurrent prostate cancer, surgeons may remove the entire prostate gland in a surgery known as “salvage” prostatectomy. They usually do not perform the nerve-sparing form of prostatectomy. Often, surgeons will remove the pelvic lymph nodes at the same time.
Cyrosurgery may be used in cases of recurrent prostate cancer if the cancer has not spread beyond the prostate. Cryosurgery is the use of extreme cold to destroy cancer cells.
To reduce testosterone levels in the body, doctors may sometimes recommend removing the testicles, a surgery called orchiectomy. After this surgery, some men choose to get prosthetics that resemble the shape of testicles.
Doctors may also remove part of the prostate gland with one of two procedures, either a transurethral resection of the prostate or a transurethral incision of the prostate . This relieves blockage caused by the prostate tumor, so urine can flow normally. This is a palliative measure, which means it is done to increase the patient’s comfort level, not to treat the prostate cancer itself.
Chemotherapy For Prostate Cancer
The decision on when to start chemotherapy is difficult and highly individualized based on several factors:What other treatment options or clinical trials are available.How well chemotherapy is likely to be tolerated.What prior therapies you have received.If radiation is needed prior to …
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Surgery Versus Watchful Waiting
The most significant report comparing surgery with watchful waiting was produced by Bill-Axelson et al.2 in 2005. They reported the final results from the Scandinavian prostate cancer group study a randomised, prospective study following nearly 700 men with early prostate cancer over a 10-year period . Importantly, this is the only report to show a survival benefit with any singular modality treatment. During a median period of 8.2 years, death due to prostate cancer occurred in 14.4% of men assigned to watchful waiting versus 8.6% in the surgery group. Table 1 shows that the difference in the cumulative incidence of death due to prostate cancer increases from 2.0% after 5 years to 5.3% after 10 years, for a relative risk of 0.56. Admittedly these may be small benefits but, more significantly, results showed a considerable reduction in metastatic disease of 1.7% to 10.2% at 5 years and 10 years, respectively. Because clinical manifestations of disseminated disease virtually always precede death, this finding may herald a further lowering of the risk of death due to prostate cancer in the radical prostatectomy group after a longer period of follow-up.2
Alternative Treatment Recommendations For Localized Prostate Cancer
Other treatments that have been used in the initial management of localized prostate cancer include the following:
- Particle beam therapy
Cryotherapy:
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Cryotherapy involves using transrectal ultrasonographic guidance percutaneous cryoprobes are placed and used to freeze prostate tissue
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This treatment is not preferred as a standard curative treatment option but may be used in select patients with localized prostate cancer or as focal therapy in low-risk patients
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Can also be considered as salvage therapy after failed radiation therapy
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Complications include tissue sloughing, perineal ecchymosis, stricture or contracture, incontinence, impotence, and fistula formation between the urinary and gastrointestinal tracts
High-intensity focused ultrasound:
- Acoustic ablative technique that uses ultrasound to induces immediate and irreversible coagulative necrosis with sharply delineated boundaries performed under spinal anesthesia on an outpatient basis
- Widely used outside the United States approved for ablation of prostate tissue by the US Food and Drug Administration in 2015
- Used for both whole-gland treatment and focal therapy
Particle beam therapy :
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Treatments For Prostate Cancer
If you have prostate cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for prostate cancer, your healthcare team will consider:
- the type and stage of the cancer
- the grade or Gleason score
- prostate-specific antigen levels
- possible side effects of treatments
- your personal preferences
- your overall health and any existing medical conditions
- your age and life expectancy
- whether you have symptoms
Prostate cancer treatments can seriously affect your quality of life and cause side effects such as erectile dysfunction and incontinence . Many prostate cancers grow slowly and cause no symptoms or problems.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
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Treatment Recommendations For Locally Advanced Prostate Cancer
Very high risk:
-
Clinical stage T3b-T4 treatment options include radiation therapy with 3D-CRT/IMRT plus long-term neoadjuvant/concomitant/adjuvant ADT for 2-3 y or
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Radiation therapy with 3D-CRT/IMRT with daily IGRT plus brachytherapy with or without short-term neoadjuvant/concomitant/ADT for 4-6 mo or
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RP plus PLND for selected patients or
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ADT alone, in patients with T3 disease and/or node-positive disease and PSA doubling time less than 10 months
For biochemical recurrence of nonmetastatic castration-resistant prostate cancer with doubling time of less than 10 months, improvement in metastasis-free survival has been reported with use of the following androgen receptor inhibitors:
- Apalutamide 240 mg PO daily or
- Enzalutamide 160 mg PO once daily or
- Darolutamide 600 mg PO BID plus
- A gonadotropin-releasing hormone analog, unless the patient has had bilateral orchiectomy
Metastatic disease:
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Any T, N1: Treatment includes ADT or radiation therapy with 3D-CRT/IMRT with IGRT plus long-term neoadjuvant/concomitant/adjuvant ADT for 2-3y
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Any T, any N, M1: Treatment includes only ADT for patients with M1
The Initial Causes Standard Of Care Prostate Cancer
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
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Provenge For Advanced Prostate Cancer
Sipuleucel-T is a “vaccine” for advanced prostate cancer that helps prolong survival.
Provenge isn’t your everyday vaccine. It’s an immune therapy created by harvesting immune cells from a patient, genetically engineering them to fight prostate cancer, and then infusing them back into the patient.
It’s approved only for treatment of patients with few or no prostate cancer symptoms whose cancer has spread outside the prostate gland and is no longer responding to hormone therapy.
Once a cancer grows beyond a certain point, the immune system has a hard time fighting it. One reason is that cancer cells look a lot to the immune system like normal cells. Another reason is that tumors may give off signals that manipulate the immune system into leaving them alone.
Provenge bypasses these problems. The treatment first removes a quantity of dendritic cells from a patient’s blood. Dendritic cells show pieces of tumor to immune cells, priming them to attack cells that carry those pieces.
The patient’s doctor ships the cells to Provenge’s manufacturer, Dendreon, which then exposes them to Provenge. Provenge is a molecule made inside genetically engineered insect cells.
Once these cells have been exposed to Provenge, they’re shipped back to the doctor who infuses them back into the patient. This is done three times in one month. The first infusion primes the immune system. The second and third doses spur an anticancer immune response.
Standard Treatment For Prostate Cancer May Encourage Spread Of Disease
A popular prostate cancer treatment called androgen deprivation therapy may encourage prostate cancer cells to produce a protein that makes them more likely to spread throughout the body, a new study by Johns Hopkins researchers suggests.
Although the finding could eventually lead to changes in this standard treatment for a sometimes deadly disease, the Johns Hopkins researchers caution that their discovery is far too preliminary for prostate cancer patients or physicians to stop using it. The therapy is effective at slowing tumor growth, they emphasized.
David Berman, an assistant professor of pathology, urology and oncology at The Johns Hopkins University School of Medicine, and his colleagues identified the unsuspected potential problem with treatments that suppress testosterone after discovering that the gene that codes for the protein, called nestin, was active in lab-grown human prostate cancer cells.
Curious about whether prostate cancer cells in people also produce nestin, the researchers looked for it in cells taken from men who had surgery to remove locally confined cancers of their prostates and found none. But when they looked for nestin in prostate cancer cells isolated from patients who had died of metastatic prostate cancer – in which cancer cells spread out from the prostate tumor – they found substantial evidence that the nestin gene was active.
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The Grade Group And Psa Level Are Used To Stage Prostate Cancer
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.
The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
- Grade Group 1 is a Gleason score of 6 or less.
- Grade Group 2 or 3 is a Gleason score of 7.
- Grade Group 4 is a Gleason score 8.
- Grade Group 5 is a Gleason score of 9 or 10.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
Stages Of Prostate Cancer
A staging method can help the doctor determine how far cancer has spread.
Prostate cancer is staged using the American Joint Committee on Cancer TMN staging system. The system, like many other types of cancer, stages it by:
- the tumors size or location
- involvement of lymph nodes
Prostate cancer has 4 stages with stage 4 being the most advanced stage of the disease.
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Agents Related To Bone Health In Crpc
In a multicenter study, 643 men with CRPC and asymptomatic or minimally symptomatic bone metastases were randomized to intravenous zoledronic acid every 3 weeks or placebo.228 At 15 months, fewer men in the zoledronic acid 4-mg group than men in the placebo group had SREs . An update at 24 months also revealed an increase in the median time to first SRE .229 No significant differences were found in OS. Other bisphosphonates have not been shown to be effective for prevention of disease-related skeletal complications. Earlier use of zoledronic acid in men with castration-naïve prostate cancer and bone metastases is not associated with lower risk for SREs, and in general should not be used for SRE prevention until the development of metastatic CRPC.230
The randomized TRAPEZE trial used a 2×2 factorial design to compare clinical PFS as the primary outcome in 757 men with bone metastatic CRPC treated with docetaxel alone or with zoledronic acid, 89Sr, or both.231 The bone-directed therapies had no statistically significant effect on the primary outcome or on OS in unadjusted analysis. However, adjusted analysis revealed a small effect for 89Sr on clinical PFS . For secondary outcomes, zoledronic acid improved the SRE-free interval and decreased the total SREs compared with docetaxel alone.
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
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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.
Side Effects Of Hormone Therapy
Whether through surgery or medication, hormone therapy can cause side effects that include hot flashes, low sexual desire, erectile dysfunction, fatigue, mood changes, muscle loss, weight gain and anemia.
Patients on long-term hormone therapy also have a risk of osteoporosis . To maintain bone health, ask your doctor about taking a calcium or vitamin D3 supplement. Your blood levels should be evaluated, as low vitamin D levels are common, and some individuals require a higher dose of this supplement. You should also participate in weight-bearing exercise regularly, as it helps to maintain bone health and muscle tone as well as reduce fatigue.
In addition, ADT’s effects on metabolism may increase your risk of diabetes and heart disease. We strongly recommend both aerobic and resistance exercise to maintain metabolic health, cardiovascular health, bone strength and quality of life. While treatment for advanced prostate cancer can disrupt your daily routine, it’s important not to abandon the healthy diet and exercise practices that are key to wellness and survival.
ADT’s impact on sex life is as important as the other side effects, and we hope to provide an open, supportive environment for you to discuss your condition and concerns. UCSF offers a program for treating erectile dysfunction.
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