How Will My Cancer Be Monitored
Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.
You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.
You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.
Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.
What Is My Outlook
If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.
While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.
No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.
How Is Prostate Cancer Staged
With these tests, a stage is assigned to help decide the treatment plan. The stage of cancer, or extent of disease, is based on information gathered through the various tests as the diagnosis and work-up of the cancer is being performed.
Prostate cancer is most commonly staged using the TNM system plus the Gleason score. The TNM system is used to describe many types of cancers. In prostate cancer it has four components:
- T- Describes the extent of the “primary” tumor .
- N- Describes if there is cancer in the lymph nodes.
- M- Describes if there is spread to other organs .
- G- Describes the Gleason score and takes into account the PSA and the histologic grade of the tumor.
The staging system is very complex. The entire staging system is outlined at the end of this article. Though complicated, the staging system helps healthcare providers determine the extent of the cancer, and in turn, make treatment decisions for a patient’s cancer.
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Chances Of Developing Metastatic Prostate Cancer
About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.
A small percentage of men aren’t diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it’s metastatic cancer when they take a small sample of the tissue and study the cells.
What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Bones
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
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How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
Distant Metastatic Prostate Cancer
Distant metastatic prostate cancer is more advanced, having spread to areas outside the pelvic region. The most common distant places where prostate cancer spreads include the:
- Bones
- Lungs
- Liver
Less commonly, prostate cancer may spread to the adrenal glands, kidneys, brain, pancreas or another organ. It is important to note that it is still considered prostate cancer when it spreads to other regions, as the cancer cells in distant areas are the same as the original cancer cells in the prostate gland, even if the prostate gland was previously removed. A biopsy may be recommended to confirm this.
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Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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Epidemiology Of Advanced Prostate Cancer
Approximately 12.5% of men will develop prostate cancer in their lifetime, with the likelihood increasing with age prostate cancer is most often diagnosed in men age 65 to 74 years, and the median age at diagnosis is 67 years. Since the advent of prostate-specific antigen screening, prostate cancer is being detected and treated earlier.
Overall, incidence rates of prostate cancer began declining in 2000. Acceleration in the decline began in 2008, when organizations began recommending against routine PSA screening From 2011 to 2015, the rate decreased by about 7% per year.
A review of almost 800,000 cases of prostate cancer diagnosed from 20042013 found that although the incidence of low-risk prostate cancer decreased from 2007-2013 to 37% less than that of 2004, the annual incidence of metastatic prostate cancer during those years increased to 72% more than that of 2004. The increase in metastatic prostate cancer was greatest in men aged 5569 years.
At diagnosis, 77% of prostate cancer cases are localized in 13%, the cancer has spread to regional lymph nodes, and 6% have distant metastasis. The 5-year relative survival rate for localized and regional prostate cancer is 100%, compared with 30.5% for metastatic cases.
The mortality rate associated with prostate cancer continues to increase in Europe and in countries such as Australia, Japan, and Russia.
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Where Can I Find Support
It can be very difficult to deal with a diagnosis of advanced prostate cancer. Its natural to wonder if youre doing all you can to fight the cancer and how to handle guilt, intimacy with a partner, and concerns about masculinity. And finding and paying for the best care can, of course, be a challenge.
But emotional and practical support can help you move forward. An important thing to remember is that youre not alone. There are many kinds of help available, and the right cancer resources can make a world of difference.
Ask your doctor for resources you can contact, including social workers and support systems in your community. The Patient Navigator Program of the ACS can be reached at 1-800-227-2345 youll be connected to a patient navigator at a cancer treatment center who can help you with practical and emotional issues.
The Prostate Cancer Foundation has links to in-person and online support groups around the country, and the ACS lists nationwide support programs as well. The PCF also offers resources ranging from help with housing during cancer treatment to finding ways you can look good and feel better while living with cancer.
Treatment In Clinical Trials
Clinical trials offer treatments that are not yet available to the public. A clinical trial might be the main treatment for metastases, or just one of the options. Only 3% to 5% of adults with cancer take part in clinical trials. The clinical trial treatment may or may not help. But even if it does not, it gives researchers information that could help future patients. Learn more about clinical trials and talk with your health care team if you are interested in participating in one.
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How Important Is Early Diagnosis And What Happens When Prostate Cancer Spreads To The Bones
There are no two cases of prostate cancer that are the same. Some grow slowly while others progress rapidly. Without treatment, slow-growing cancer can spread only slightly over time, but aggressive prostate cancer can overwhelm the prostate, cause unpleasant symptoms, or even metastasize.
Metastatic growth occurs when cancer spreads from one part of the body to another when cancer cells separate from one tumor and travel to a nearby lymph node or blood vessel. From that point, it can attach to another part of the body such as a bone or organ and grow to form a second tumor. Prostate cancer most commonly spreads to the bones and lymph nodes.
The five-year survival rate for men with local prostate cancer that has not spread to other areas is nearly 100%. The five-year survival rate for men with metastatic prostate cancer is about 30%a steep decline that underscores the importance of detecting prostate cancer before it spreads to the bones and other areas of the body.
Treatments For Prostate Cancer Spread To Bones
If prostate cancer spreads to other parts of the body, it nearly always goes to the bones first. Bone metastasis can be painful and can cause other problems, such as fractures , spinal cord compression , or high blood calcium levels, which can be dangerous or even life threatening.
If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.
Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause.
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How To Spot Prostate Cancer Early
There are two types of screening that your doctor may recommend: the first requires blood collection to measure the level of the prostate-specific antigen PSA. Higher levels often indicate the presence of prostate cancer.
The second test is a physical examination in which a doctor puts on gloves, lubricates the finger and inserts it into the rectum to see if the prostate is enlarged. If any of the results indicate the possibility of prostate cancer, your doctor will recommend further tests.
âEarly-stage prostate cancer typically does not have any physical signs or symptoms,â said Dr. Salim Cheriyan, a urologist with Baylor St. Lukeâs Medical Group. âThis is why discussing the risks and benefits of screening with your physician is an important part of detecting prostate cancer.â
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Staging Of Prostate Cancer
The stage of a cancer describes its size and how far it has spread. The results of your tests help your doctors decide on the stage and plan your treatment.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. We’re here if you need someone to talk to. You can:
Macmillan is also here to support you. If you would like to talk, you can:
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What Are Bone Metastases With Prostate Cancer
The ACS describes bone metastases as areas of bone containing cancer cells that have spread from another place in the body. In the case of prostate cancer, the cells have spread beyond the prostate gland. Since the cancer cells originated in the prostate gland, the cancer is referred to as metastatic prostate cancer.
The cancer cells spread to the bones by breaking away from the prostate gland and escaping attack from your immune system as they travel to your bones.
These cancer cells then grow new tumors in your bones. Cancer can spread to any bone in the body, but the spine is most often affected. Other areas cancer cells commonly travel to, according to the ACS, include the pelvis, upper legs and arms, and the ribs.
Why Cancer Cells Tend To Spread To The Parts Of The Body They Do
Where a cancer starts is linked to where it will spread. Most cancer cells that break free from the primary tumor are carried in the blood or lymph system until they get trapped in the next downstream organ or set of lymph nodes. This explains why breast cancer often spreads to underarm lymph nodes, but rarely to lymph nodes in the belly. Likewise, there are many cancers that commonly spread to the lungs. This is because the heart pumps blood from the rest of the body through the lungs blood vessels before sending it elsewhere.
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Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
How We Treat Prostate Cancer
The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.
What Is A Normal Psa Test Result
There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer . In addition, various factors can cause a mans PSA level to fluctuate. For example, a mans PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugsincluding finasteride and dutasteride , which are used to treat BPHlower a mans PSA level. PSA level may also vary somewhat across testing laboratories.
Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of White men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group.
In general, however, the higher a mans PSA level, the more likely it is that he has prostate cancer. Moreover, a continuous rise in a mans PSA level over time may also be a sign of prostate cancer.
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Signs That Prostate Cancer Has Spread
We mentioned in this article active surveillance as one way to deal with prostate cancer. This type of management relies on signs, symptoms, and diagnostic tests to control cancer.
These patients would likely run PSA tests and digital rectal exams every six months. Doctors may recommend they get recurrent prostate biopsies every 1-3 years.
But signs and symptoms are also important. Thus, it is worthwhile to consider the following alarm signs:
- Bone pain: It is the most critical sign of bone metastases. It can be located in any part of the body, more commonly long bones of the extremities and the back. Prostate cancer bone metastases lead to a high risk of spinal cord compression and other complications.
- Jaundice: In this case, it is a sign of liver involvement. There are many causes of jaundice, and one of them is liver metastasis.
- Chronic fatigue: It is a sign of advanced prostate cancer, whether locally spread or metastatic.
- Significant weight loss: More pronounced weight loss is a sign of more advanced disease.
Keep in mind that we should treat the prostate cancer before these symptoms show up. Once they do, the prognosis can be poor.