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What Does It Mean To Have Stage 4 Prostate Cancer

Treatment Of Metastatic Stage Iv Or D2 Prostate Cancer

Gleason 4+4=8 Prostate Cancer Treatments | Ask a Prostate Expert, Mark Scholz, MD

Prostate cancer that has spread to distant organs and bones is treatable, but not curable with current standard therapies. Hormone therapy has been the standard treatment of metastatic prostate cancer for many years. Metastatic prostate cancer can be controlled with hormone therapy for many years and new treatment options continue to become available.

How Doctors Find Metastatic Prostate Cancer

When you are diagnosed with prostate cancer, your doctor will order tests such as:

These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.

If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spread in your bones.

Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.

PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate a prostate infection, trauma to the perineum, or sexual activity can also cause PSA level to be high.

If youâve been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait seve,ral weeks after surgery before checking PSA levels. A rise in PSA after treatment may suggest the possibility cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.

Though very rare, itâs possible to have metastatic prostate cancer without a higher-than-normal PSA level.

Psa And Gleason Score

Two other important factors that doctors and specialists use to assess cancer cells are the prostate specific antigen and the Gleason score.

PSA levels: PSA is a protein that appears in higher levels in the bloodstream when there is a problem with the prostate. Normally, PSA levels in the blood are very low, and a test cannot detect them. However, in some circumstance, such as prostate cancer, PSA levels start to rise.

Screening for prostate cancer uses a blood test for PSA. If PSA levels are high, the doctor may recommend further tests to see if prostate cancer is present.

There are various other reasons why PSA levels may rise, including sexual stimulation or an infection.

The grade and Gleason score: Different types of cancer cell act differently. Some types, or grades, are more aggressive and can spread more easily. The Gleason score and grade are different measures, but they both reflect how likely it is that a tumor will spread, and how quickly it will do so. Either a biopsy or surgery can determine the types of cancer cells present in the prostate tissues.

Nearly 50% of males have a condition known as prostatic intraepithelial neoplasia by the time they are 50 years old. PIN is when there are changes in the cells that line the prostate gland.

High grade PIN is not cancer, but the cells can become cancerous in the future. For this reason, a doctor may recommend treatment to remove the cells.

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What Is Metastatic Prostate Cancer

Sometimes cancer cells will escape the prostate and grow quickly, spreading to nearby tissue, or metastasizing. Nearby lymph nodes are often the first destination for a spreading cancer. If prostate cancer has spread to your lymph nodes when it is diagnosed, it means that there is higher chance that it has spread to other areas of the body as well.

If and when prostate cancer cells gain access to the bloodstream, they can be deposited in various sites throughout the body, most commonly in bones, and more rarely to other organs such as the liver, lung, or brain. Bone metastases are seen in 85% to 90% of metastatic cases.

No matter where a cancer turns up in the body, it is always identified by the tissue type in which it started. Prostate cancer can metastasize to other organs, but it is always prostate cancer, because it consists of mutated prostate cells.

Men diagnosed with metastatic prostate cancer , will often not undergo local treatments of the primary prostate tumor, such as surgery or radiation. Instead, their therapeutic journey might start with hormone therapy, and from there follow a similar path as men who were diagnosed at an earlier stage and had subsequent disease progression.

Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.

Can I Survive Advanced Prostate Cancer Whats The Prognosis

What Does Cancer Stages Mean / Staging Of Prostate Cancer

Prostate cancer is the second leading cause of death from cancer in men, according to the National Cancer Institute. While theres no cure, men can live with it for years if they get the right treatment. Each man with advanced prostate cancer is different, of course. You and your cancer have unique qualities that your doctor takes into consideration when planning the best treatment strategy for you.

According to Harvard Medical School, the prognosis for men with advanced prostate cancer is improving because of newer medications that help them get past a resistance to androgen-deprivation therapy that typically develops after a few years of treatment. With these medications, many men are living longer, and a number of men diagnosed with advanced prostate cancer are dying with the cancer, not from it.

Promptly treating prostate cancer bone metastases with the newest medication can help change a mans prognosis dramatically, Tagawa says. There are men who do well for decades, he says. Some men can even stop treatment, go on to live many years, and actually die of something unrelated.

Tagawa says that cancer specialists who use sophisticated imaging technologies, like positron-emission tomography scans, have gotten very good at finding even tiny bone metastases, which is valuable in diagnosing and removing early stage metastases.

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What Are The Treatment Options For Low

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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Quality Of Life With Advanced Stage Prostate Cancer

Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues55 reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.

Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.56

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What Should You Ask Your Doctor About Treatments

The American Cancer Society recommends that you ask questions like these:

  • What treatment might be best for me?
  • What are the possible benefits of getting it?
  • How soon would I need to start treatment?
  • Will I need to get surgery as part of my treatment? If so, what will it be like and who will do it?
  • Will I need other treatments, too? If so, how might they benefit me?
  • What side effects could my treatments cause? And what should I do if I get them?
  • Is there a clinical trial that might be a good option for me?
  • Can you review any vitamins or diet Iâm on to make sure it wonât interfere with my cancer treatment?

Stage 2 Prostate Cancer

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In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still .

The PSA score for stage 2 is less than 20 ng/mL.

Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:

  • Gleason score: 6 or less

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Prostate Cancer Stages Range From 1 To 4

The most easy-to-understand staging system groups cancer into stages 1 to 4, the American Cancer Society says, with stage 1 the earliest prostate cancer and stage 4 when the cancer has spread throughout the body. This is used for many cancers. Your doctor is likely to tell you your stage of cancer using this system.

Treatments To Control And Prevent Further Cancer Spread In Patients With Castrate Refractory Advanced Prostate Cancer:

At BPC we offer:

Other treatment options ongoing clinical studies:

  • Autologous cellular immunotherapy, which is in late trial stage and although not currently available outside a trial setting in the UK, is likely to be licensed soon.

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What If You Have Metastatic Hormone

If your doctor tells you that you have this type of metastatic prostate cancer, it means your cancer responds to hormone therapy

Most prostate cancer cells need male sex hormones, including androgens like testosterone, to grow. A type of hormone therapy like androgen deprivation therapy could slow the growth of mHSPC by lowering the level of these hormones.

You could also ask your doctor if youâre eligible for any clinical trials.

Still, some people with mHSPC prefer to avoid or delay getting treatment with an option called active surveillance. Thatâs when your doctor keeps close tabs on your health but doesnât give you treatment unless test results show your cancer is getting worse.

You could ask your doctor if watchful waiting is an option for you.

The Role Of Bone Morphogenetic Protein

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Bone morphogenetic protein belongs to the TGF- superfamily, which functionally stimulates the replication and differentiation of normal cells in the osteoblast lineage. It also plays a crucial role during the process of mesoderm induction, neural tissue differentiation, and morphogenesis of various tissues . Interestingly, BMPs are not only synthesized by osteoblasts but also secreted by prostate cancers. The unusual expression of BMPs in prostate cancer has been implicated in the progression of the disease.

Taken together, BMP expressions are detectable in either normal prostate tissue or prostate cancer cells. The pattern of BMP expression has a close relationship with the progression of prostate cancer and contributes to the onset of bone lesions. It is clear that BMPs play a role in the vicious cycle of metastatic bone formation from prostate cancer. BMPs produced by prostate cancer will induce osteoblastic activities and promote osteoblastic lesions. On the other hand, BMPs synthesized by osteoblasts subsequently enhance the growth of prostate cancer cells allowing further production of BMPs from prostate cancer.

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What Is The Difference Between Prostate Cancer And Advanced Prostate Cancer

Prostate cancer occurs when cells in the prostate gland begin to grow out of control. In the early stages of prostate cancer, the cancer cells are only present in the prostate and have not spread to nearby tissues.

Advanced prostate cancer, also known as stage 4 prostate cancer, occurs when cancer cells have spread to other areas of the body.

How Does Prostate Cancer Spread

Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries — tiny blood vessels — at some distant location.

The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.

Most breakaway cancer cells form new tumors. Many others don’t survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.

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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.

Stage 4 Prostate Cancer Prognosis

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Doctors need to know how far the cancer has advanced, or its stage, in order to choose the best treatment. A pathologist, a specialist who specializes in studying cells obtained from a prostate biopsy, will provide two starting points: the cancers grade and Gleason score.

  • Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
  • Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.

After a biopsy reveals prostate cancer, the patient may be subjected to additional testing to determine whether the disease has spread to other regions of the body via the blood or lymph nodes. These are typically imaging examinations, such as a bone scan, positron emission tomography scan, or computed tomography scan.

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When Prostate Cancer Risk Is All In The Family

Your familial risk of prostate cancer is greatest if you have a first-degree relative who had the disease, especially if they were diagnosed at a relatively young age. Having multiple first degree relatives with prostate cancer also increases risk. Having multiple second-degree relatives and third-degree relatives adds to the risk, Carroll explains. Its more concerning when we see all cancers on one side of the family, in one blood line, she adds.

In one study, researchers found that men with a brother who had prostate cancer were more than twice as likely as men in the general population to be diagnosed with the disease themselves, and they faced nearly twice the risk of developing aggressive prostate cancer by age 75. Also, men with both a father and brother who had prostate cancer faced about a threefold greater risk of prostate cancer and developing aggressive disease by age 75 compared with the general population.

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First Line Treatment For Advanced Prostate Cancer

The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.

There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.

Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.

Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.

Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.

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