Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The patients age.
- Whether the cancer has just been diagnosed or has recurred .
Treatment options also may depend on the following:
- Whether the patient has other health problems.
- The expected side effects of treatment.
- Past treatment for prostate cancer.
- The wishes of the patient.
Most men diagnosed with prostate cancer do not die of it.
There Are Different Types Of Treatment For Patients With Prostate Cancer
Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Drug Sequencing For Androgen
The availability of the above new agents presents a challenge for physicians and patients, who must decide on the best sequence and timing for each of them. So far, no studies have been done to determine the best approach. Studies in progress are likely to result in some change to the sequencing of these drugs.
As of October 2012, and excluding cost considerations, men with asymptomatic or minimally symptomatic progressive disease can start with immunotherapy using sipuleucel-T. Since no objective responses are expected, patients can then be given abiraterone acetate.
On September 11, 2014 the FDA expanded the approved use of enzalutamide for the treatment of men with late-stage , castrate-resistant prostate cancer prior to receiving chemotherapy. The expanded indication was based on a study in which patients who received enzalutamide reduced the risk of radiographic progression or death by 83% versus placebo, while significantly reducing the risk of death by 29%.
Without formal studies to guide recommendations, either drug may be used next, although enzalutamide does not require prednisone, and for that reason it may be most suitable. Hopefully, studies will be done to determine whether men are better off receiving either enzalutamide or abiraterone first or second. Men showing progression on those drugs should then be offered docetaxel followed by cabazitaxel.
For full discussion, see Metastatic and Advanced Prostate Cancer.
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 many 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.
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Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate
The prostate is agland in the malereproductive system. It lies just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland makes fluid that is part of the semen.
Prostate cancer is most common in older men. In the U.S., about 1 out of 5 men will be diagnosed with prostate cancer.
Followup By Primary Care Physicians
The American Cancer Society has released evidence- and expert-based guidelines for the management of prostate cancer survivors by primary care physicians , a response to the fact that as the number of men surviving prostate cancer has increased, reliance on PCPs for their care has grown as well. The guidelines address promotion of healthy lifestyles, surveillance for disease recurrence, screening for second primary cancers, and evaluation and management of adverse physical and psychosocial effects caused by the disease and its treatment. Recommendations include the following :
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Working With The Welsh Government To Deliver Better Outcomes
The CDP has only just been released, and as it stands, is a high-level plan showing how the Welsh Government wants to improve cancer services. With this in mind, we believe that there is opportunity to build on positive conversations with the Welsh Government as the CDP was developed to ensure improvements take place in prostate cancer. To help bring this about, Prostate Cancer UK will continue draw these issues to the attention of health leaders in Wales to 2020 and beyond.
This is only one area among many where we are working to drive improvements in prostate cancer care and support across the UK. Check out our campaign pages to see the other work that we are doing.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.
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What About My Physical And Emotional Wellness
Eating a healthy diet including a variety of foods, will ensure you have what your body needs to cope with treatment and recovery. Regular physical activity can improve your cancer recovery and reduce side effects such as fatigue.
- Don’t be afraid to ask for professional and emotional support.
- Consider joining a cancer support group.
- Learn to ignore unwanted advice and “horror stories”.
- Live day-to-day and remember that every day is likely to be different.
Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life or reduce pain. There is no evidence that these therapies can cure or prevent cancer. Some have not been tested for side-effects, may work against other medical treatments and may be expensive. Talk to your doctor about using complementary therapies.
Questions To Ask About Having Therapy Using Medication
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What type of treatment do you recommend?
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What is the goal of this treatment?
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How will this treatment be given?
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How long will it take to give this treatment?
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Will I receive this treatment at a hospital or clinic? Or will I take it at home?
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What side effects can I expect during treatment?
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Who should I contact about any side effects I experience? And how soon?
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What are the possible long-term effects of having this treatment?
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What can be done to relieve the side effects?
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Your Prostate Cancer Treatment Plan
At Henry Ford, we are leaders in the field of prostate cancer therapies and prostate tumor surgery, offering:
- Unmatched experience in innovative and minimally invasive prostate cancer surgery, including single-port robotic surgery for greater precision and shorter recovery times
- World-first MRI-guided radiation therapy that combines advanced technology with real-time tumor imaging to deliver accurate, precise treatment
- Non-invasive prostate cancer treatment, including cryotherapy, for men with localized prostate cancer
Laparoscopic Radical Prostatectomy For Prostate Cancer
During this operation, your surgeon will insert a special instrument through several small incisions in the abdomen to remove the prostate. The instrument has a small video camera on the end so that your surgeon can see inside the body. Many surgeons perform a robotic-assisted laparoscopic radical prostatectomy where they use a robotic system and arms to operate the instrument with greater precision.
Often Recommended for:
- Stage 1 or stage 2 prostate cancer
Possible Side Effects of LRP:
- Erectile dysfunction or sexual impotence
- Urinary incontinence
- Changes in orgasm
- Loss of fertility
- Lymphedema
- Changes in penis length
Pros & Cons of LRP for Prostate Cancer
Pros:
- Less blood loss and pain
- Shorter hospital stays
- Catheter removed sooner
- More maneuverability, visibility and precision
- Can be a curative option with a higher cure rate
- Nerve-saving approach may help prevent impotence
- Removed tissue helps accurately stage cancer
Cons:
- Recovery of bladder control might take slightly more time
- Requires more skills and doctor experience
- Cancer in nearby lymph nodes most likely cant be removed
- Prostate gland may not be removed if cancer has spread
- Surgical risks
- Unlikely to be performed after radiation
- Longer recovery times and activity restrictions
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There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
New Treatment Options For Prostate Cancer
New technologies, scientific advancements and clinical trials continue to develop and test additional and alternative forms of classical treatments. Often, the only way to access these newer treatments and procedures is through a clinical trial. Participating in these carefully controlled research trials is another way to get state-of-the-art care that you might not be able to get otherwise. Still, certain factors may cause ineligibility or personal discomfort with a lesser known treatment plan.
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Dosimetric And Statistical Treatment Plan Analysis
Four different treatment plans on each of the five sCT for each of the 32 patients were generated , adding up to a total of 160 treatment plans per IGRT, ART1, ART2 and ART3 approach. Mean dose-volume-histograms with point-wise standard deviations over all patients and treatment fractions for the four treatment planning approaches were generated. Furthermore, the most relevant dose-volume constraints of the PACE guidelines were compared. A treatment plan quality scoring system, as proposed by the ESTRO QUASIMODO group , was applied to characterize the overall benefit of plan adaptation per dose criterion and per treatment planning approach. The penalty score S was based on the percentage difference between an actual value of a dose-volume parameter M for a given dose distribution and the corresponding PACE-C based dose-volume constraint C . Only violations of dose criteria contributed to S which resulted in an optimal plan having a count of S=0:
The summation index n refers in the following to one of two different summations: First, a summation over all 160 treatment plans per dose criterion and second, a summation over all four dose criteria per patient . To test whether the results of a certain treatment adaptation approach were statistically different from the ones of a different treatment adaptation approach paired t-tests between the resulting dose-volume parameters were performed. A p-value of p< 0.05 was considered statistically significant.
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.
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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.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
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.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
Castrate Resistant Prostate Cancer
Eventually, almost all metastatic prostate cancers become resistant to androgen ablation. In patients with castrate serum testosterone levels , castrate-resistant prostate cancer is defined as 2-3 consecutive rises in PSA levels obtained at intervals of greater than 2 weeks and/or documented disease progression based on findings from computed tomography scan and/or bone scan, bone pain, or obstructive voiding symptoms.
Rarely, a rise in PSA may reflect failure of LHRH treatment to control testosterone secretion, rather than the development of castrate-resistant disease. Therefore, the testosterone level should be measured when the PSA rises. If the serum testosterone level exceeds castrate levels, changing the antiandrogen therapy may drop the PSA and delay the need for other therapy.
Prior to the development of the most recent therapies, the median time to symptomatic progression after a rise in the PSA level of more than 4 ng/mL was approximately 6-8 months, with a median time to death of 12-18 months. Since then, however, the latter figure has increased.
Little information is available about the impact of maintaining hormone suppression when androgen-independent progression occurs, but the general consensus among specialists is that the treatment should continue. The reasoning is that tumor cells are still hormone sensitive and may grow faster if the testosterone is permitted to rise.
- Megestrol
- Suramin
- Estrogen
Docetaxel
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