The Stages Of Prostate Cancer: What You Need To Know
After a prostate cancer diagnosis, your oncologist will refer to the stage of your cancer. All cancers are categorized into four distinct stages, each of which identifies the progress of the growth of cancerous cells within clinically defined standards. These stages help doctors determine the most appropriate care for each patient based on his or her condition, and can also provide easy-to-understand context for your diagnosis. Learn more about the stages of prostate cancer, how each stage will affect your treatment plan and the survival rates for each stage, then contact Regional Cancer Care Associates to schedule a consultation.
Symptoms Of Metastatic Cancer
Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:
- pain and fractures, when cancer has spread to the bone
- headache, seizures, or dizziness, when cancer has spread to the brain
- shortness of breath, when cancer has spread to the lung
- jaundice or swelling in the belly, when cancer has spread to the liver
Should I Make Any Lifestyle Changes Including In My Diet Or Physical Activity
Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. Both diet and exercise, he says, are things that are under a mans direct control.
A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.
While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.
If youre not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancers growth and keeping you as healthy as possible.
As an oncologist, Tagawa says he concentrates on treating the cancer itself, but hes aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.
And if youre on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.
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Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
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What About Other Treatments That I Hear About
When you have cancer you might hear about other ways to treat cancer or treat your symptoms. These may not always be standard medical treatments. These treatments can be vitamins, herbs, special diets, and other things. You may be curious about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to be helpful. A few have even been found to be harmful. Talk to your doctor about anything youâre thinking about using, whether its a vitamin, a diet, or anything else.
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Symptoms Of Prostate Cancer Spread To The Lymph Nodes
Lymph nodes are part of a system of tubes and glands in the body that filters body fluid and fights infection.
There are lots of lymph nodes in the groin area, which is close to the prostate gland. Prostate cancer can spread to the lymph nodes in the groin area, or to other parts of the body. The most common symptoms are swelling and pain around the area where the cancer has spread.
Cancer cells can stop lymph fluid from draining away. This might lead to swelling in the legs due to fluid build up in that area. The swelling is called lymphoedema.
When Metastatic Cancer Can No Longer Be Controlled
If you have been told your cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue treatment to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.
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How Do 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 spreading to 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.
What Does The Pain Feel Like When You Have Breast Cancer
Breast cancer can cause changes in skin cells that lead to feelings of pain, tenderness, and discomfort in the breast. Although breast cancer is often painless, it is important not to ignore any signs or symptoms that could be due to breast cancer. Some people may describe the pain as a burning sensation.
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How Liver Metastasis Is Treated
Liver metastasis, also known as secondary liver cancer, refers to cancer that has spread to the liver from the site of the original tumormost often the colon or rectum, although its possible for cancer that originates anywhere in the body to spread to the liver. This disease is considered advanced, or stage IV cancer, so in most cases, the goal of treatment is to shrink tumors, extend life expectancy, and boost quality of life rather than try to cure the cancer. Treatments for liver metastasis include surgery to remove the tumor, chemotherapy, biologic drugs, radiation, or a procedure called ablation which destroys cancerous lesions. If none of these treatments is an option, palliative care may be necessary.
Liver metastasis is different from metastatic liver cancer, which is the term used to refer to primary liver cancer that has spread to another site or sites in the body.
What Is Advanced Cancer
Advanced cancer is most often used to describe cancers that cannot be cured. This means cancers that wont totally go away and stay away completely with treatment. However, some types of advanced cancer can be controlled over a long period of time and are thought of as an ongoing illness.
Even if advanced cancer cant be cured, treatment can sometimes:
- Shrink the cancer
- Help relieve symptoms
- Help you live longer
For some people, the cancer may already be advanced when they first learn they have the disease. For others, the cancer may not become advanced until years after it was first diagnosed.
Advanced cancers can be locally advanced or metastatic.
Locally advanced means that cancer has grown outside the body part it started in but has not yet spread to other parts of the body. For example, some cancers that start in the brain may be considered advanced because of their large size or closeness to important organs or blood vessels. This can make them life-threatening even though they havent spread to other parts of the body. But other locally advanced cancers, such as some prostate cancers, may be cured.
Metastatic cancers have spread from where they started to other parts of the body. Cancers that have spread are often thought of as advanced when they cant be cured or controlled with treatment. Not all metastatic cancers are advanced cancers. Some cancers, such as testicular cancer, can spread to other parts of the body and still be very curable.
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What Happens To The Prostate After Radiation
The prostate gland will end up having a lot of scar tissue. It will shrink in size to about half its original weight within a couple years after finishing radiation. The urethra passes through the canter of the prostate gland like the hole of a doughnut. Sometimes this passage can widen, other times it can shrink after radiation. In summary, the prostate gland is heavily damaged from radiation and does not work normally afterwards.
Stage 4 Liver Cancer Substages
Stage 4 liver cancer is classified as substage 4A or 4B. Both classifications refer to a tumor or multiple tumors of any size, and depending on the substage, the treatment options will differ:
- Stage 4A: The cancer has invaded lymph nodes near the liver, but has not spread to distant locations in the body.
- Stage 4B: The cancer can be found in distant organs like the bones or lungs.
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Symptoms Of Prostate Cancer Spread To The Bones
The most common place for prostate cancer to spread to is the bones. This can include the:
The most common symptom if cancer has spread to the bone is bone pain. It is usually there most of the time and can wake you up at night. The pain can be a dull ache or stabbing pain.
Your bones might also become weaker and more likely to break .
When prostate cancer spreads to the spine, it can put pressure on the spinal cord and cause spinal cord compression. This stops the nerves from being able to work properly. Back pain is usually the first symptom of spinal cord compression.
Spinal cord compression is an emergency. You should contact your treatment team immediately if you are worried you might have spinal cord compression.
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Risk Factors For Formation Of Urethral Stenosis And Stricture
Post-radical prostatectomy
Radiotherapy
Risk factors include age, obesity, hypertension, diabetes, previous TURP , longer follow-up, higher radiation dose, HDR-BT, adjuvant RT and combination with BT . Delaying adjuvant RT for more than 9 months after RP may decrease stricture formation, however this is at the expense of an increase in cancer-specific mortality . Zelefsky found that intensity modulated RT increases the risk of late urinary toxicities including urethral stricture compared to 3-D conformal RT, but with lower rectal toxicity . However, a recent review found no difference in urethral stricture between 3-dimensional conformal radiotherapy and IMRT . Similar to ERBT, BT strictures affect the bulbomembranous urethra in the majority of cases, which could be due to a âhot spotâ in the distal bulbar urethra or due to caudal needle shifting in patients receiving HDR-BT , although Hindson found no relation between needle shifting and stricture incidence . A prospective, matched-pair analysis by Diez found no association between urethral stricture incidence and urethral dosimetry in patients receiving HDR-RT, however the number of events was too small to draw a definitive conclusion .
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Types Of Imaging Studies
If your doctor suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a bone scan and a CT scan of the abdomen and pelvis. An MRI might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.
Prostate Cancer Doctor Discussion Guide
Get our printable guide for your next doctorâs appointment to help you ask the right questions.
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Where Prostate Cancer Spreads In The Body Affects Survival Time
EMBARGOED FOR RELEASE until 4 p.m. on Monday, March 7, 2016
DURHAM, N.C. — Patients with lymph-only metastasis have the longest overall survival, while those with liver involvement fare worst. Lung and bone metastasis fall in the middle.
Smaller studies had given doctors and patients indications that the site of metastasis in prostate cancer affects survival, but prevalence rates in organ sites were small, so it was difficult to provide good guidance, said Susan Halabi, Ph.D., professor of biostatistics at Duke and lead author of the study published online March 7 in the Journal of Clinical Oncology.
With the large numbers we analyzed in our study, we were able to compare all of these different sites and provide information that could be helpful in conveying prognosis to patients, Halabi said. This information could also be used to help guide treatment approaches using either hormonal therapy or chemotherapy.
Halabi and colleagues from leading U.S. and international cancer research centers pulled data from nine large, phase III clinical trials to analyze outcomes of 8,736 men with metastatic prostate cancer. The patients had all undergone standard treatment with the chemotherapy drug docetaxel.
Site of metastases was categorized into four groups: lung, liver , lymph nodes only, bone with or without lymph nodes and no other organ metastases.
Halabi said more research is needed to understand how and why prostate cancer spreads to different organs.
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White Patients Derive A Larger Conditional Mortality Benefit Than Non
In order to determine whether race interacted with survival, we repeated our initial analyses after stratifying by race and by modeling an interaction term. Among patients with M1 disease, conditional mortality was similar between white and non-white patients . However, among patients with N1 disease, non-white patients did not have a significant reduction in conditional mortality at 5, 10, or 15 years of survival compared to diagnosis , while white patients had similar mortality as the overall cohort, with adjusted hazard ratios of 1.10 , 0.898 , and 0.712 , respectively. While non-white patients with T4 disease had improved 5-year PCSM after having survived 5, 10, or 15 years, their improvements were 20-39 % smaller than those of white patients .
What Treatments Are Available
If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.
Before you start treatment
Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.
If you have any questions, speak to our Specialist Nurses.
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Hormone Therapy In Older Patients
The backbone of prostate cancer treatment is hormonal therapy, which aims to limit the activation of the androgen receptor with testosterone. This limitation of AR activation may occur through agents that decrease circulating testosterone, such as gonadotropin-releasing hormone agonists or antagonists. The use of these agents also decreases testosterone precursors and other off-target effects of testosterone. Agents such as nonsteroidal anti-androgens block AR activation and yet preserve circulating testosterone levels.
Providers must carefully consider the toxicities of androgen deprivation therapy in a physiologically older population. These patients have less reserve to absorb additional imbalances or conditions that will impact their current steady state. In general, agents that result in a hypogonadal state can lead to toxicities within the following domains: metabolic and body composition sexual health and mood and central nervous system symptoms .
Liver Metastases: Symptoms Diagnosis And Outlook
Liver metastases are cancerous tumors that have spread to the liver from another part of the body where the cancer originated. Some healthcare professionals may call liver metastases secondary liver cancer.
The cancer cells that develop in liver metastases are not cells from the liver. They are cells from the part of the body where the cancer first developed.
Since the cancerous tumors have spread to the liver from another part of the body, a doctor may refer to liver metastases as stage 4, or advanced cancer.
Primary liver cancer is less common than liver metastases. Typically, people with primary liver cancer have risk factors such as cirrhosis or hepatitis.
may not present any noticeable symptoms. However, as the tumor in the liver advances, the liver may swell.
The swelling can cause an obstruction to blood and bile flow. When this occurs, a person may experience symptoms such as:
- jaundice, or yellowing of the skin and eyes
- nausea and vomiting
- pain in the right shoulder
- pain in the upper right side of the abdomen
A person with cancer in another area of the body who notices new symptoms should let a healthcare professional know as soon as possible.
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