Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
What Are My Treatment Options With Advanced Prostate Cancer
The treatments your doctor recommends will depend on factors specific to you, from your overall health to how advanced your cancer was when it was first diagnosed.
Many men receive ADT, a type of hormone therapy, which deprives the body of the male hormones that the cancer needs to keep growing.
For most men, however, hormone therapy stops working at some point. Alternatives to hormone therapy were approved by the Food and Drug Administration in 2018, and Tagawa often starts men on these therapies as soon as theyre diagnosed with bone metastases. Other treatment options may be available through clinical trials.
In addition, chemotherapy, surgery, and immunotherapy as well as radiation treatments, like external beam radiation, which directly target bone problems may be considered. Major cancer centers, such as Memorial Sloan Kettering Cancer Center in New York City and MD Anderson Cancer Center in Houston, have teams of prostate cancer specialists, as well as sophisticated radiation and other treatment equipment consolidated in one place, which can help with the coordination of care.
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
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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:
A Different Way To Detect Metastases
Most men diagnosed with prostate cancer have localized disease, meaning the cancer appears to be confined to the prostate gland. However, certain factors have been linked to a higher risk of the cancer eventually spreading .
Currently, in the United States and many other countries, most men diagnosed with high-risk localized prostate cancer undergo additional testing to see if there is evidence of metastatic cancer. For many years, that has been done with a conventional CT scan and a bone scan , the latter because prostate cancer often spreads to the bones.
But both imaging technologies have limitations. Neither is particularly good at finding individual prostate cancer cells, and thus can miss very small tumors. And bone scans can detect bone damage or abnormalities that were caused by something other than cancer , resulting in false-positive findings that can lead to unnecessary additional testing.
So, researchers have been developing and testing other imaging agents that can find prostate cancer cells specifically in the body, Dr. Shankar explained.
As their name implies, PET-CT scans combine a CT scan with a PET scan, another type of nuclear imaging test that requires patients to receive intravenous injections of a radioactive tracer that can be detected on the scan.
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How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
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 recurrence or biochemical recurrence.
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Are There Side Effects
The treatments for prostate cancer also can affect your body in other ways. Side effects can include:
- 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.
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.
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About The Cancer Center
The Cancer Center at Sheba Medical Center is not only part of the largest hospital in Israel but is the absolute leader in cancer treatment in Israel.
We take a truly comprehensive approach in our fight against cancer, putting our patients first and providing for not only their medical requirements, but for their psychological, social, and palliative needs with our many support services.
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Should I choose surgery or radiation for my prostate cancer?
For men deciding between surgery and radiation for prostate cancer treatment, that may help you weigh the pros and cons of each option.
Genomic testing and prostate cancer
Genomic tests can help determine how aggressive your prostate cancer is, and this may influence your treatment decisions. Genomic testing can also help you and your doctor learn more about how your cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively, therefore influencing treatment decisions.
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Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
Locally Advanced Prostate Cancer
Locally advanced prostate cancer is cancer that has started to break out of the prostate, or has spread to the area just outside the prostate.
What are my treatment options?
Treatments for locally advanced prostate cancer will aim to get rid of the cancer, or to keep it under control, depending on how far the cancer has spread.
The treatment options for locally advanced prostate cancer are:
A small number of men may be offered high dose-rate brachytherapy on its own, but this isnt very common.
Choosing a treatment
Depending on how far your cancer has spread, you may have a choice of treatments. If so, your doctor or nurse will talk you through your treatment options and help you choose the right treatment for you. You might not be able to have all of the treatments listed above.
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Treatment For Prostate Cancer
Your treatment depends on a number of factors including how big the cancer is, whether it has spread anywhere else in your body and your general health. A team of doctors and other professionals discuss the best treatment and care for you.
This section is about treatment for prostate cancer that hasn’t spread to another part of your body.
We have separate information about treatment for cancer that began in the prostate and has spread to another part of the body. This is metastatic or advanced prostate cancer.
Treatment Options For Prostate Cancer
There are a number of different treatments for prostate cancer. You may have a choice of treatments such as surgery or radiotherapy. Or your doctor might suggest that you have monitoring of your cancer instead of treatment straight away. Your doctor will recommend the best treatment for you.
This page is about treatment for people who have prostate cancer that hasnt spread to other parts of the body. We also have information about treatment for people who have prostate cancer that has spread to other parts of the body. This is metastatic or advanced prostate cancer.
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What Are Some Emerging Therapies For Prostate Cancer
Because prostate cancers can act so differently, they need different types of treatment. New research is focusing on precision medicine. The goal is to have tailored treatment for each person from the very beginning. Since there are so many different types of prostate cancer, precision medicine needs to cover a lot of bases. Its important to remember that not all emerging therapies are right for everyone. And the FDA hasnt approved some of these treatments yet. If you have advanced prostate cancer, talk to your team about whether you should try these emerging therapies:
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PARP inhibitors: These medications stop prostate cancers from growing. They can help people with metastatic prostate cancer who have mutations in their BRCA1, BRCA2, and DDR genes.
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Prostate membrane-specific antigen radionuclide therapy: PSMA radionuclide therapy delivers radiation directly to prostate cancer cells. A recent study showed that people with metastatic prostate cancer who received this therapy lived longer.
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Focal therapies: Focal therapies use heat, cold, or electricity to kill cancer cells in the prostate gland and limit damage surrounding tissues. Therapies include focal irreversible electroporation, high-intensity focused ultrasound, cryotherapy, and focal laser ablation. These therapies are still investigational .
Nutrition And Lifestyle Changes
Many studies have looked at the possible benefits of specific nutrients in helping to treat prostate cancer, although so far none have shown a clear benefit. Some compounds being studied include extracts from pomegranate, green tea, broccoli, turmeric, flaxseed, and soy.
One study has found that men who choose not to have treatment for their localized prostate cancer may be able to slow its growth with intensive lifestyle changes. The men in the study ate a vegan diet and exercised frequently. They also took part in support groups and yoga. After one year the men saw, on average, a slight drop in their PSA level. It isnt known if this effect will last since the report only followed the men for 1 year. The regimen may also be hard for some men to follow.
Its important for men thinking about taking any type of nutritional supplement to talk to their health care team first. They can help you decide which ones you can use safely while avoiding those that might be harmful.
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Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.