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Treatment For Aggressive Prostate Cancer

Impact Of Age On Treatment

Study Finds Surgery Effective for Patients with Aggressive Prostate Cancer – Mayo Clinic

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.10 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.11,12

Chodak and associates12 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 Will Happen After Treatment

Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.

Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.

You cant change the fact that you have cancer. What you can change is how you live the rest of your life, making healthy choices and feeling as good as you can.

Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough

  • By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.

Now, newly published results from a phase 3 clinical trial are providing some needed guidance.

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Stage 4 Prostate Cancer Life Expectancy

The five year survival rate for stage 1 prostate cancer is 100%, but stage 4 prostate cancer life expectancy is not very encouraging. While providing information on late stage prostate cancer life expectancy, this HealthHearty article also describes what is meant by staging and grading of prostate cancer.

The five year survival rate for stage 1 prostate cancer is 100%, but stage 4 prostate cancer life expectancy is not very encouraging. While providing information on late stage prostate cancer life expectancy, this HealthHearty article also describes what is meant by staging and grading of prostate cancer.

Statistics show that more and more men are being diagnosed with prostate cancer every year. Various tests like PSA test, DRE test, ultrasound sonography, etc., help diagnose the cancer. Staging and grading of cancer not only help design the treatment but they also help determine how well the cancer may respond to the treatment. Staging, generally, is concerned with the spread of cancer. The Gleason grading system involves classification of cancer cells. It helps determine aggressiveness of the cells and their likelihood of spreading.

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What Are The Treatment Options For Low

A better approach to aggressive prostate cancer?

Men with low-risk prostate cancer have four treatment options: active surveillance, external radiotherapy, internal radiotherapy and surgery to remove the prostate.

  • Active surveillance involves monitoring the prostate cancer, and only treating it if there are signs that it is progressing. This approach is based on the fact that low-risk prostate cancer often grows very slowly or doesnt grow at all, so treatment often isnt needed.
  • In external radiotherapy, the cancer is exposed to radiation from outside the body, through the skin.
  • In internal radiotherapy , the cancer is exposed to radiation from slightly radioactive seeds that are implanted inside the body.
  • The aim of surgery wird is to remove the tumor, together with the whole prostate, seminal vesicles and outer capsule.

Radiation and the surgical removal of the prostate are also referred to as curative treatments because the aim is to remove all of the tumor cells. But a few cancer cells may stay in the body, or new cancer cells might develop. For this reason, men who have had radiotherapy or surgery are still advised to have regular PSA tests.

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If Treatment Does Not Work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

Are There Side Effects

The treatments for prostate cancer also can affect your body in other ways. Side effects can include:

  • Bowel problems
  • Loss of your ability to get a woman pregnant
  • Leaky bladder or loss of bladder control. You might also need to pee a lot more often.

Side effects are another thing to think about when youâre choosing a treatment. If theyâre too tough to handle, you might want to change your approach. Talk to your doctor about what you can expect. They can also help you find ways to manage your side effects.

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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.

Emerging Therapies For Prostate Cancer

Dealing with aggressive prostate cancer

Researchers are pursuing several new ways to treat advanced prostate cancer. Vaccines that alter the body’s immune system and use genetically modified viruses show the most promise. One vaccine technique works by manipulating blood cells from the patient’s immune system and causing them to attack the prostate cancer.

Blood is drawn from the patient. From the blood sample, cells that are part of the immune system are exposed to cells that make up prostate cancer. Then the blood cells are placed back in the body, with the hope that they will cause other immune system cells to attack the prostate cancer. In a more traditional type of vaccine, the patient is injected with a virus that contains PSA. When the body is exposed to the virus, it becomes sensitized to cells in the body that contain PSA and their immune system attacks them.

Immune or genetic therapy have the potential to deliver more targeted, less invasive treatments for advanced prostate cancer. This would result in fewer side effects and better control of the prostate cancer.

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Transitional Cell Prostate Cancer

This is also known as urothelial carcinoma. This cancer starts in the cells that line the urethra .

Studies of men with transitional cell prostate cancer show that PSA levels can be low or high. More research is needed before we can know whether PSA tests can help to diagnose transitional cell prostate cancer.

Men with this cancer often have difficulty urinating and find blood in their urine. This is because the cancer grows around the urethra , causing it to narrow. So transitional cell carcinoma is often diagnosed when men have surgery called transurethral resection of the prostate to treat their urinary problems. Tissue removed during surgery is looked at under the microscope to confirm you have transitional cell prostate cancer. Youll also need scans to see if your cancer has spread.

If the cancer has not spread outside the prostate , then you may be offered surgery and radiotherapy.

If the cancer has spread to areas just outside the prostate or to more distant areas of the body such as the bones then chemotherapy and radiotherapy may be an option.

In the UK, docetaxel is the standard chemotherapy drug for men with advanced prostate cancer that is no longer responding to hormone therapy. But if you have transitional cell prostate cancer you may have other types of chemotherapy, called carboplatin or cisplatin chemotherapy. If you have cisplatin chemotherapy, you will probably have it alongside another chemotherapy drug called gemcitabine.

Antiandrogens For Prostate Cancer

These prostate cancer drugs work by blocking the effect of testosterone in the body. Antiandrogens are sometimes used in addition to orchiectomy or LHRH analogs.This is due to the fact that the other forms of hormone therapy remove about 90% of testosterone circulating in the body. Antiandrogens may help block the remaining 10% of circulating testosterone. Using antiandrogens with another form of hormone therapy is called combined androgen blockade , or total androgen ablation. Antiandrogens may also be used to combat the symptoms of flare . Some doctors prescribe antiandrogens alone rather than with orchiectomy or LHRH analogs.

Available antiandrogens include abiraterone acetate , apalutamidebiclutamide , darolutamideenzalutamide , flutamide , and nilutamide . Patients take antiandrogens as pills. Diarrhea is the primary side effect when antiandrogens are used as part of combination therapy. Less likely side effects include nausea, liver problems, and fatigue. When antiandrogens are used alone they may cause a reduction in sex drive and impotence.

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Watchful Waiting Or Active Surveillance

Your doctor might suggest waiting to see if your tumor will grow or spread before you treat it. Most prostate cancer grows slowly. Some doctors think itâs better not to treat it unless it changes or causes symptoms. In watchful waiting, your doctor will closely track how the disease makes you feel. With active surveillance, youâll also get regular tests to check on the cancer.

What Are The Treatment Options For Aggressive Prostate Cancer

Younger men with prostate cancer benefit from more aggressive treatment ...

The majority of people with prostate cancer nearly 80% are diagnosed early and cured by their treatment, most often radiation or surgery.

But one in five of those diagnosed with prostate cancer has a more aggressive form of the disease. Even before the individual has received any treatment or experienced a recurrence, doctors can identify whether the cancer is likely to be more dangerous and aggressive.

Prostate cancer is determined to be high risk if it is distinguished by any of the following characteristics:

  • A larger primary tumor
  • A prostate-specific antigen blood test result higher than 20
  • Very abnormal cells in the prostate biopsy when looked at under a microscope, placing the cancer at Gleason grade 4 or 5.
  • Physicians perform biopsies or take X-rays to determine a cancers grade and stage. The stage is based on the size of the primary tumor or the extent it has spread in the body. The grade describes the appearance of the cancer cells and tissue under a microscope: the more abnormal they are, the higher the grade.

    What are the main treatment options for people with aggressive or high-risk prostate cancer and can the sequencing, or order in which different treatments are given, make a difference in overall effectiveness of these therapies?

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    Stage Iv Prostate Cancer Prognosis

    Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.

    New Model Improves Life Expectancy Estimates In Prostate Cancer Population

    Investigators have developed and validated a simple prediction model for other-cause mortality among US patients with prostate cancer. These life expectancy estimates may outperform Social Security Administration life tables, according to a recent report.

    The other-cause comorbidity-adjusted mortality model, which incorporates 8 predictors of OCM , provides more precise estimates of life expectancy. It can be used in accordance with National Comprehensive Cancer Network guidelines and has high potential to improve quality of care when patient life expectancy is a factor, a team led by Elizabeth C. Chase, PhD, of the University of Michigan in Ann Arbor, concluded in a paper published in BJU International.

    NCCN guidelines generally recommend that men with prostate cancer who have a life expectancy of 10 years or more receive more aggressive treatment appropriate to their cancer stage, whereas men with a life expectancy less than 10 years receive less aggressive treatment. The NCCN recommends using SSA actuarial tables to predict life expectancy, but Dr Chase and colleagues pointed out that research suggests the SSA tables overestimate life expectancy of patients with distant disease and do not adjust for patient comorbidities, which can have a notable effect on life expectancy.

    Reference

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    Questions To Ask Your Doctor Or Nurse

    Aggressive Treatment of Aggressive Prostate Cancer ~ A/Prof Henry Woo
    • 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?

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    Recurrent Prostate Cancer Treatment

    For most patients, initial prostate cancer treatment includes either radiation therapy or surgery. If a patients prostate cancer returns, the other treatment option may be used. In addition, doctors may recommend the use of systemic therapies , like hormone therapy and possibly chemotherapy.

    In some cases, patients can have what is known as biochemical recurrence. These patients have elevated PSA levels that indicate the disease has returned, but imaging exams do not show any cancer. Patients with biochemical recurrence are given intermittent hormone therapy and are monitored closely for further changes.

    How We Treat Prostate Cancer

    The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.

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