How Is Advanced Prostate Cancer Treated
The primary treatment of prostate cancer is prostatectomy, which is a surgery to remove a part of the prostate gland or the entire prostate gland in younger patients.
Androgen deprivation therapy is usually the choice of treatment of metastatic prostate cancer. Also known as hormone therapy, it is also used for treating patients who are unfit or unwilling to undergo surgery or/and radiation therapy.
Examples of hormone therapies for advanced prostate cancer include
Prostate Cancer Survival Rates
Answering the question of how curable is prostate cancer? first requires understanding what doctors mean when they refer to curability. Regardless of the type of cancer, doctors consider cancer cured when a patient remains cancer-free for a specified period after treatment. The higher the number of patients who stay cancer-free for five years or longer, the higher the curability of that particular disease.
Prostate cancer, therefore, has one of the highest curability rates of all types of cancer, thanks in large part to early detection standards and advances in treatment, such as the stereotactic body radiation therapy offered by Pasadena CyberKnife. When the cancer is detected in the early local or regional stages that is, before the cancer has spread or when it has only spread to limited areas in the pelvic regions the five-year survival rate is nearly 100 percent.
Survival rates decline significantly when cancer is detected at later stages however, the good news is that only about five percent of men are diagnosed after the cancer has become widespread throughout the body. In short, more than 90 percent of men who are diagnosed with prostate cancer live for five years or longer after treatment, making it one of the most curable forms of cancer.
The Controversy About Using Psa For Prostate Cancer Screening
A delayed diagnosis of prostate cancer increases the chance of cancer spreading. How then, can anyone be opposed to PSA screening? Can an early diagnosis of cancer be bad? Surprisingly, experience has shown PSA is actually over-sensitive, leading to the unnecessary diagnosis of 100,000 men annually who have such harmless early-stage cancers that they are at practically zero risk for it spreading.
This would not be a problem if the medical system was prepared to simply monitor these harmless cancers. Unfortunately, due to these tiny specks of disease being called cancer, doctors and patients alike overreact and rush into unnecessary radical treatment, risking terrible problems with sexual and urinary function.
In fact, over-treatment of harmless prostate cancer has become such a gargantuan problem that in 2011, a government-sponsored team of experts, the U.S. Preventive Services Task Force, issued a dire warning recommending that routine PSA screening should cease. This task force concluded that the terrible cost of so many men being harmed by unnecessary treatment outweighed the benefit of lives saved by early detection. Many primary care physicians have taken this government recommendation to heart and have decided to forgo routine annual PSA screening since they believe it is causing more harm than good.
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What Is The Purpose Of The Gleason Score
Named after its creator, Dr. Donald Gleason, The Gleason score is a measurement that is given to indicate the aggressiveness of prostate cancer.
Aggressiveness is a medical term used to describe the likelihood of cancer spreading outside the prostate.
The Gleason scoring system was developed at a VA hospital in the 1960s and was quickly adopted all over the world as an effective predictor of the pace of prostate cancer growth.
When he created this measurement, Dr. Gleason assigned a number between 1 and 5 to the different patterns of prostate cancer cell growth. Prostate cancer cells display different patterns of growth, which reveal their aggressiveness.
When your pathologist checks your biopsy samples, they examine your prostate cells under the microscope and will look at the different patterns.
They will then choose the two most commonly appearing patterns and give you a score. The first number indicates the most common pattern in all the samples. The second is the second most common pattern. When these two scores are added together, the total is called the Gleason score.
What Are 5 Common Warning Signs Of Prostate Cancer
In many cases, prostate cancer does not produce clear symptoms in its initial stages of development. In fact, many men may have prostate cancer without even realizing it. However, there are some common warning signs that could indicate a person has prostate cancer. Five of the most common ones include:
Of course, these five symptoms are not the only potential warning signs of prostate cancer. Other possible indicators could include weak urine flow, and unexplained pain deep in the groin area when sitting down. If cancer has spread beyond the prostate, a man may also suffer lower body swelling, abnormal urinary or bowel habits, or inexplicable weight loss.
It’s important to note that most of these symptoms are not unique to prostate cancer, and may indicate a different condition that is not life-threatening.
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Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
How Do You Know If You Have Prostate Cancer
Theres no way of knowing if you have prostate cancer without visiting your doctor, as most men with early prostate cancer dont have any symptoms. And if you do have symptoms they can be caused by other things.
And you cant check for prostate cancer yourself.
You may want to speak to your GP if you’re over 50 , even if you don’t have any symptoms. These are all things that can increase your risk of prostate cancer. Your GP can give more information or tests if necessary.
If youre not sure about what to say to your GP, print and fill out this form and show it to them. This will help you have the conversation.
I thought I could be at risk after learning that African Caribbean men are more likely to get prostate cancer than white men.
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What Are The Symptoms Of Early
The following symptoms may be signs of early-stage prostate cancer.
- Needing to urinate more frequently
- Needing to rush to the toilet
- Straining or taking too long while urinating
- An interrupted or slow flow of urine
- Feeling that your bladder has not completely emptied
- Discomfort when Urinating
- Leaking urine
However, as can be seen in the following section, you can see that these heavily overlap with other, very common conditions. Nearly every male over the age of 50 will experience one or more of the above symptoms. So although these symptoms may be present, there is a good chance this does not indicate the presence of early-stage prostate cancer. That is why thorough, rigorous prostate cancer testing is required.
What Will Happen In The Last Few Days
It can help to know what is normal in the last few days of life so that you know what to expect. You might not be aware of these changes when they happen because you may be drowsy or unconscious.
If youre supporting someone who is dying, read about what you can do to help and how you can get support.
Many people worry about being in pain when they are dying. Some people do get pain if their prostate cancer presses on their nerves or makes their bones weak. But not everyone dying from prostate cancer has pain. And if you are in pain, there are things that can help to reduce and manage pain.
You should tell your doctor or nurse if youre in pain or if your pain gets worse. They can talk with you about how best to manage your pain and can help keep it under control.
You may find sitting or lying in some positions more comfortable than others, so ask if you need help getting into a different position.
Your doctor can give you medicines to help manage pain. The type of medicines they give you will depend on what is causing the pain and which medicines are suitable.
Your doctor will monitor how the pain medicines are working and may change the type of medicine or the dose. If youre still in pain or get pain in between taking medicines, its important to tell your doctor or nurse.
Sleeping and feeling drowsy
Changes in skin temperature or colour
Changes in breathing
Changes in urinating or bowel movements
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Other Psa Roles Besides Screening
Confusion about PSA can arise because it may be used for other purposes besides screening. Screening is the most familiar role and it is a big deal. Over 200,000 men are diagnosed annually because of PSA screening. However, there are other uses. One example is how PSA helps to define the cancers stage after prostate cancer is detected. In men with cancer, a PSA level under 10 is associated with a more indolent type of prostate cancer. On the other hand, a PSA level over 20 is characteristic of a more aggressive type of prostate cancer. PSA also plays an important role for cancer monitoring to determine the effectiveness of various treatments.
Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
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General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
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Table 1 Why A Low Psa Does Not Mean You Are Cancer
The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer in some cases, high-grade prostate cancer.
PSA level 13 *Note: A PSA level over 4.0 ng/ml traditionally triggers a biopsy. Adapted with permission from I.M. Thompson, et al. Prevalence of Prostate Cancer Among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004, Table 2.
This study inadvertently provided evidence not only that prostate cancer occurs more often than once believed, but also that PSA levels may not be a reliable indicator of which cancers are most aggressive. Both findings add weight to the growing consensus that many prostate tumors currently being detected may not need to have been diagnosed or treated in the first place.
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Tests To Identify Prostate Cancer Stage
After a prostate cancer diagnosis, your doctor will do tests to see how far the cancer has spread. Not all men need every test. It depends on the results of your biopsy, a test that checks tissue from your prostate gland for cancer. Tests that help your doctor figure out the stage of your prostate cancer include:
- CT scan of the abdomen and pelvis to see if the cancer has spread
- Nuclear medicine bone scan to see if the cancer has spread to your bones
- Surgery to check the lymph nodes in your pelvis for prostate cancer spread
The Top 7 Signs Of Advanced Prostate Cancer
In the early stages, you may not notice any symptoms related to prostate cancer. This is why screenings are important. Symptoms can sometimes be noticed for the first time when the cancer advances.
Advanced prostate cancer, also called metastatic cancer, means the cancer has spread to other areas of your body beyond your prostate gland. The most common areas for prostate cancer to spread are your bladder, rectum, and bones. It can also spread to your lymph nodes, liver, lungs, and other body tissues.
Whether youve just been diagnosed or youre in treatment, its also important to know the signs of advanced cancer. Cancer can behave differently depending on your genetics, so not every person will experience the same symptoms in the same way.
Read on to learn more about the seven top symptoms of advanced prostate cancer and how to spot them.
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After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
Staging And Grading Of Early Prostate Cancer
The stage of a cancer describes its size and how far it has spread, based on your test results. Doctors often use the TNM staging system or a number staging system.
A doctor decides the grade by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.
You and your doctors can then talk about the best treatment choices for you.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team .
Not everyone with early prostate cancer needs treatment straight away.
Your doctor will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.
The main treatments are the following:
You may also have some treatments as part of a clinical trial.
Find out more about prostate cancer treatments.
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What About Trans People
People assigned male at birth can develop prostate cancer whether they remain male or not.
Trans women who use hormone therapy such as estrogenmay have a lower risk, but the risk is still present.
Anyone assigned male at birth should speak to their doctor about screening for prostate cancer.
Knowing the stage of prostate cancer can help a person understand what to expect, and it will inform decisions about treatment. We list the stages below:
Stage 0: Precancerous cells are present, but they only affect a small area and are slow growing.
Localized : Cancer is only present in the prostate gland. Effective treatment is possible at this stage.
Regional : Cancer has spread to nearby tissues.
Distant : Cancer has spread to other parts of the body, such as the lungs or bones.
If a male has symptoms that may indicate prostate cancer, the doctor will likely:
- ask about symptoms
- ask about personal and medical history
- conduct a blood test to assess PSA levels
- carry out a urine test to look for other biomarkers
- carry out a physical examination, which may include a digital rectal exam
During a DRE, the doctor will check manually for any abnormalities of the prostate with their finger.
Learn more about prostate exams here.
Stage 3 Diagnostic Criteria
While we talk about stage 3 cancers as one monstrous thing, their diagnosis differs drastically based on cancer type. Generally, a stage 3 cancer diagnosis requires one or more of three features:
- Tumor growth beyond a specific size
- Spread to a specific set of nearby lymph nodes
- Extension of the tumor into nearby structures
Once diagnosed, a cancer stage never changes. Even if the doctor re-stages the cancer diagnosis, or it recurs , they keep the initial staging diagnosis.
The doctor will add the new staging diagnosis to the initial stage and differentiate it with letterslike c for clinical, p for pathological , or after treatments .
Some stage 3 cancers are subdivided to give a more precise classification. These sub-stages will differ based on the specific cancerous organ. For example, stage 3 breast cancer has three subcategories:
- The tumor is smaller than 5 centimeters but has spread to 4-9 nodes.
- The tumor is larger than 5 cm and has spread to 1 to 9 nodes.
3B: The tumor is any size but has invaded the chest wall or breast skin and is swollen, inflamed, or has ulcers. It may have also invaded up to 9 nearby nodes
3C: The tumor can be any size but has spread to either: 10 or more lymph nodes, nodes near the collar bones, or lymph nodes near the underarm and the breast bone
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