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Treatment For Stage 2 Prostate Cancer

Treatments To Help Manage Symptoms

Choosing a Treatment for Intermediate Risk Prostate Cancer | Prostate Cancer Staging Guide

Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:

This is the team of health professionals involved in your care. It is likely to include:

  • a specialist nurse
  • a therapeutic radiographer
  • other health professionals, such as a dietitian or physiotherapist.

Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.

Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.

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Radiation Therapy Versus Surgery

In 2014, the Agency for Healthcare Research and Quality found insufficient evidence to determine whether any type of radiation therapy results in fewer deaths or cancer recurrences than radical prostatectomy does in patients with clinically localized prostate cancer. The importance of dose escalation in disease control complicates the extraction of meaningful conclusions from current radiation therapy treatments .

Brachytherapy has also been compared with surgery in the management of early-stage disease. Direct comparisons are not readily available, but preliminary data from most centers suggest that permanent prostate implants yield comparable local control and biochemical disease-free rates.

Valid comparisons of surgery and radiation therapy are impossible without data from randomized studies that track long-term survival rather than PSA recurrence. Variation in radiation techniques and dosage administered the variable use of androgen ablation, which improves survival in intermediate- and high-risk disease and the variable impact on the quality of life complicate comparison using uncontrolled studies.

Bone Protection In Patients Receiving Androgen Blockade

Two drugs, the bisphosphonate zoledronic acid and the RANKL inhibitor denosumab, have been approved to treat osteoporosis secondary to androgen deprivation. Zoledronic acid is administered as an intravenous infusion. Denosumab is administered subcutaneously. These drugs are given along with supplemental vitamin D and calcium. Patients should be monitored regularly for hypocalcemia. Both agents are associated with a low incidence of osteonecrosis of the jaw. Both drugs delay the risk of skeletally-related events by relieving bone pain, preventing fractures, decreasing the need for surgery and radiation to the bones, and lowering the risk of spinal cord compression.

A double-blind, placebo-controlled, multicenter study in men with primary or hypogonadism-associated osteoporosis found that over a 14-month period, treatment with zoledronic acid reduced the risk of vertebral fractures by 67%. New morphometric vertebral fracture occurred in 1.6% of men taking zoledronic acid and in 4.9% taking placebo. Patients receiving zoledronic acid had significantly higher bone mineral density and lower bone-turnover markers. However, the rate of myocardial infarction was higher in the treatment group .

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Initial Treatment Of Prostate Cancer By Stage And Risk Group

The stage of your cancer is one of the most important factors in choosing the best way to treat it. Prostate cancer is staged based on the extent of the cancer and the PSA level and Gleason score when it is first diagnosed.

For prostate cancers that haven’t spread , doctors also use risk groups to help determine if more tests should be done and to help guide treatment options. Risk groups range from very-low-risk to very-high-risk, with cancers in the lower risk groups having a smaller chance of growing and spreading compared to those in higher risk groups.

Other factors, such as your age, overall health, life expectancy, and personal preferences are also important when looking at treatment options. In fact, many doctors determine a mans possible treatment options based not just on the stage, but on the risk of cancer coming back after the initial treatment and on the mans life expectancy.

You might want to ask your doctor what factors he or she is considering when discussing your treatment options. Some doctors might recommend options that are different from those listed here. Taking part in a clinical trial of newer treatments is also an option for many men with prostate cancer.

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Questions To Ask Your Doctor Or Nurse

Prostate Cancer Stages

You may find it helpful to keep a note of any questions you have to take to your next appointment. If youre choosing a treatment, you might find it helpful to ask your doctor or nurse some of these questions.

  • What treatments are suitable for me?
  • How quickly do I need to make a decision?
  • What are the advantages and disadvantages of each treatment? What are their side effects?
  • How effective is my treatment likely to be?
  • Can I see the results of treatments youve carried out?
  • Is the aim to keep my prostate cancer under control, or to get rid of it completely?
  • If the aim of my treatment is to get rid of the cancer, what is the risk of my cancer coming back after treatment?
  • If the aim of my treatment is to keep the cancer under control, how long might it keep it under control for?
  • What treatments and support are available to help manage side effects?
  • Are all of the treatments available at my local hospital? If not, how could I have them?
  • After treatment, how often will I have check-ups and what will this involve? How will we know if my cancer starts to grow again?
  • If my treatment doesnt work, what other treatments are available?
  • Can I join any clinical trials?
  • If I have any questions or get any new symptoms, who should I contact?

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Prostate Cancer Risk Groups

Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .

Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.

The risk group of the cancer will help determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer

Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.

There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective

Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.

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Should All Patients Receive Treatment Of Stage Ii Prostate Cancer

If prostate cancer is truly confined to the prostate, it is curable with surgery or radiation. However, in order to benefit from curative treatment, a patients life expectancy may need to be 10-20 years from the time of prostate cancer diagnosis. This is because many prostate cancers are slow growing and men will sometimes die from other causes before they succumb to prostate cancer. Individuals may ask themselves: If cure is possible, is it necessary? Treatment of prostate cancer is a very personal decision the choice of radiation versus prostatectomy is often based on weighing the possible complications of treatment and the relative inconvenience of the treatments. It is important to be seen by more than one physician to determine the likely treatment outcome associated with the various options available in your community. Before deciding on receiving treatment, patients should ensure they understand the answers to 3 questions:

  • What is my life expectancy and risk of cancer progression without treatment?
  • How will my prognosis be improved with treatment?
  • What are the risks or side effects of the various treatment options?

Finasteride In Treating Patients With Stage Ii Prostate Cancer Who Are Undergoing Surgery

The Five Stages of Prostate Cancer | Prostate Cancer Staging Guide
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
First Posted : February 22, 2007Results First Posted : March 9, 2016Last Update Posted : March 9, 2016
Condition or disease
Adenocarcinoma of the ProstateStage II Prostate Cancer Drug: FinasterideOther: PlaceboProcedure: ProstatectomyOther: Laboratory biomarker analysis Phase 2

PRIMARY OBJECTIVES:

I. Compare the frequency of discriminating molecular marker expression in Gleason grade 3 cores, adjusted for Gleason score at prostatectomy, in patients with stage II prostate cancer treated with neoadjuvant finasteride vs placebo.

SECONDARY OBJECTIVES:

I. Compare the frequency with which grade 3 and grade 4 tumors occur in these patients.

II. Determine the frequency of discriminating molecular signature expression in tissue microarray cores segregated by GS at prostatectomy in these patients.

III. Compare GG 3-appearing areas in patients treated with finasteride vs placebo.

IV. Compare GG 3-appearing areas in patients treated with finasteride vs placebo.

V. Compare GG 4-appearing areas in patients treated with finasteride vs placebo.

After completion of study treatment, patients are followed up for 30 days.

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What Is Stage 1 Prostate Cancer

Typically, stage 1 prostate cancer is the least advanced form of prostate cancer where the cancer is still small in size and has not spread beyond the prostate gland.

There are 4 stages of prostate cancer. Usually, stages 1 to 4 are written as the Roman numerals I, II, III, and IV. A general rule is that the higher the stage number, the more cancer has spread, and the lower the number, the less severe.

Stage 1 prostate cancer is defined by a prostate-specific antigen of less than ten ng/mL and a gleason score of 6.

The prostate-specific antigen or PSA test is a blood test used primarily to screen for prostate cancer, and it measures the amount of prostate-specific antigen in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate.

The Gleason score is a grading system used to help evaluate the outcomes of men with prostate cancer using samples from a prostate biopsy. On biopsy, doctors check how much cancer looks like healthy tissue when viewed under a microscope. Notably, less aggressive tumors generally look more like healthy tissue.

Radiation Therapy Plus Androgen Ablation Therapy

Androgen ablation has been shown to improve survival in men with localized disease who are treated with external radiation. DAmico et al reported higher overall survival with the combination of radiation therapy and 6 months of ADT in men with intermediate-risk prostate cancer. Median follow-up was 7.6 years.

A study by Jones et al found that for patients with stage T1b, T1c, T2a, or T2b prostate cancer and a PSA level of 20 ng/mL or less, short-term ADT increased overall survival in intermediate-riskbut not low-riskmen. The 10-year rate of overall survival was 62% with combination therapy, versus 57% with radiation therapy alone 10-year disease-specific mortality was 4% and 8%, respectively. In this study, ADT was given for 4 months, starting 2 months before radiation therapy.

In a study by Pisansky et al of 1489 intermediate-risk prostate cancer patients, disease-specific survival was not significantly different whether total androgen suppression was given for 8 weeks or for 28 weeks prior to radiation therapy. Patients in the study were randomized to 8 or 28 weeks of TAS with LHRH agonist, along with a daily nonsteroidal antiandrogen, prior to radiation treatment. This was followed in both groups by an additional 8 weeks of androgen suppression, administered concurrently with radiotherapy.

Taken together, radiation therapy is generally given for 4-36 months, depending on the risk group of the patient.

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Best Hospitals For Cancer Treatment In The World

Cancer and its complications pose a major challenge for the contemporary healthcare industry. Scientists and doctors are fighting ferociously against this terrible disease, moving step by step towards finding a cure that will make cancer therapy more effective.

Nowadays, the biggest oncological institutes and clinics are not only the facilities where people receive appropriate treatment, they are also the strongholds of science they develop new methods of fighting different kinds of cancer, conduct testing of various drugs, and elaborate new standards of diagnostics and therapy.

We have analyzed the information about the biggest and the most reputable cancer hospitals and composed a list of the best cancer clinics in the world with the special emphasis on the ones that are located in the United States.

The list was created in accordance with the following criteria:

  • Application of innovative and sparing methods of cancer therapy
  • High rate of successful cancer treatment
  • Professionalism and experience of medical personnel, including communication skills, quality of general and personal service, diligence, readiness to provide not only medical but also psychological help
  • Treatment cost and transparency of institutions financial operations
  • Overall quality of hospital stay
  • Range of medical services, from primary diagnostics and testing to post-discharge adjustment.

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Living With Prostate Cancer

Is Homoeo medicine effective for prostate cancer treatment? What is the ...

Receiving a prostate cancer diagnosis can be stressful. Even though most people who receive a diagnosis of prostate cancer live for many years after receiving the diagnosis, treatment can be exhausting and cause side effects that impact your quality of life.

Many resources are available to help you get through these difficult times:

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Who Remained Prostate Cancer Free

Intermediate Risk patients experience a wider range of results and approaches due to the risk of disease beyond the prostate. When selecting a course of action, consultations are recommended with a urologist or surgeon, radiation oncologist and medical oncologist. Different treatments have different results and side effects. It is important to understand the potential impact each treatment can have on your quality of life after treatment.

Intermediate Risk patients are at a higher risk for cancer relapse or recurrence than Low Risk patients. That means patients in this risk group are more likely to have their cancer return following initial treatment, which may require additional treatment. To understand how effective the treatment or combination of treatments, are in keeping patients in remission, Doctors perform periodic monitoring or testing PSA levels, following treatment. It is very unlikely that the cancer will ever return, if you remain in remission for 10-15 years after prostate cancer treatment. Click on Get the Study, to obtain your copy of Foundations work. Share this Study with your Doctor as you select your treatment plan.

Intermediate Risk is any of the following:

PSA greater than 10 less than 20

Gleason Score is 7

How to Use the Graph
About the Data

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Does It Matter Where Treatment Is Performed

A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We donât have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.

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Stage Ii Of Prostate Cancer:

In this stage, the cancer has spread within the prostate involving one or both the lobes of the prostate. These cancers do not spread beyond the prostate to nearby lymph nodes or other organs. Stage II of prostate cancer is broadly categorized into three further stages:

Stage IIA:

Here, the cancer has spread upto one complete lobe of the prostate. The Gleason score of these cancer is 6 or less than 6 and PSA levels are between 10 and 20.

When the cancer is found during biopsies, and not through general diagnostic tests, it is staged as cT1, N0, M0 Grade Group 1.

When the cancer can be found to be confined to one half of a lobe of the prostate, through screening or physical examinations and has not metastasized, it is staged as cT2a or pT2, N0, M0, Grade Group 1.

If the cancer is contained in more than half of one lobe of the prostate, but has not spread, it is staged as cT2a or pT2, N0, M0, Grade Group 1.

Stage IIB:

In this stage, the cancer has not spread beyond the prostate, but is contained in more than one lobe of the prostate, with a Gleason score of 7 and PSA levels up to 20. It is staged as T1 or T2, N0, M0, Grade Group 2.

Stage IIC:

This stage of stage II cancer is staged as T1 or T2, N0, M0, Grade Group 3 or 4 with a Gleason score of 7 or 8 and PSA levels less than 20. They are spread within the prostate, with the cancer contained in both the lobes.

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