Death From Other Causes
The mean age at metastatic prostate cancer diagnosis in the study was roughly 71 years. Most of the cohort was White and had a diagnosis of stage M1b metastatic prostate cancer , which means the cancer had spread to the bones.
Among men in the cohort, the rates of death from septicemia, suicide, accidents, COPD, and cerebrovascular diseases were significantly increased compared with the general US male population, the team observes.
Thus, the study authors were concerned with not only with death from metastatic prostate cancer, but death from other causes.
That concern is rooted in the established fact that there is now improved survival among patients with prostate cancer in the US, including among men with advanced disease. âPatients tend to live long enough after a prostate cancer diagnosis for noncancer-related comorbidities to be associated with their overall survival,â they write.
The editorialists agree: prostate cancer âhas a high long-term survival rate compared with almost all other cancer types and signals the need for greater holistic care for patients.â
As noted above, cardiovascular diseases were the most common cause of non-prostate cancer-related deaths in the new study.
As in the management of other cancers, there is concern among clinicians and researchers about the cardiotoxic effects of prostate cancer treatments.
The study had no specific funding. The study authors and editorialists have disclosed no relevant financial relationships.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
What Is Localized Prostate Cancer
Prostate cancer is the abnormal growth of cells in the prostate gland. Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesnât cause symptoms.
Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.
Men of African descent have the highest rates of both prostate cancer and deaths from it.
About 21,000 men are diagnosed with prostate cancer in Canada every year.footnote 1 In the United States, about 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime in their lifetime.footnote 2 But most men who are diagnosed with prostate cancer donât die from prostate cancer.
Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery.
Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.
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Evolving Definition Of Advanced Prostate Cancer
Currently, younger and healthier men are being diagnosed with prostate cancer and treated with a variety of modalities for locally advanced disease, as well as older men with rising PSA levels years after being treated with a radical prostatectomy. Both scenarios define current advanced disease and underscore the necessity of modifying the disease definition and treatment plans to reflect this broader spectrum of patients and disease states.
Age migration: Decreasing age of patients diagnosed with prostate cancer. Data from Department of Defense Center for Prostate Disease Research.
Mri With A Tesla 30 Magnet Age Of Friend
Speak with the urologist about prescribing a Tesla 3.0 MRI . This test is very effective in indicating if there is any nodule involvement, if there is involvement in one or two lobes, will show size of prostate, any evidence of extracapular extension, will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. There are certain major hospitals that have MRI machines with a 3.0 Tesla magnet. In my laymans opinion it is advisable to have such a test before any surgery or another active treatment which is a localized one. If the cancer is outside the prostate these type treatments may not be a best decision for treatment since additionally treatment will still be required, and side effects of various treatments are cummulative.
The side effects of surgeries are basically greater than other active treatment types. Surgery is less successful among older men than younger so for example a doctor may perform an excellent surgery for a 50 year old, who will have no side effects and the exact same surgery for a 70 year old who will have side effects.
How old is your friend?
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What You Can Do
Its important that you learn all you can about advanced prostate cancer so you can make informed decisions. Be open with your doctors and others on your healthcare team. Express your concerns and feel free to advocate for yourself and your quality of life. Get another medical opinion if you feel its necessary.
Some complementary therapies may prove helpful in coping with advanced cancer. For example:
- tai chi, yoga, or other movement therapy
- meditation, breathing exercises, or other relaxation techniques
A variety of services can help you with everything from lodging while youre getting treatment to getting some help around the house. Communicating with online or in-person groups are a good way to share information and lend mutual support.
Cytotoxic Chemotherapy For Metastatic Pca
Cytotoxic chemotherapy plays an important role in the management of metastatic PCa. There are three FDA approved chemotherapies: mitoxantrone, docetaxel, and cabazitaxel. Mitoxantrone is a synthetic anthracenedione that inhibits DNA topoisomerase II, and was the first chemotherapy approved in advanced PCa. Mitoxantrone in combination with hydrocortisone was compared to hydrocortisone alone in the CALGB 9182 trial approval was based on improvements in QOL and bone pain.17 However, mitoxantrone failed to demonstrate an OS advantage, with median OS 12.3 versus 12.6 months compared with hydrocortisone alone. Largely due to newer approved agents that carry improvements in OS, mitoxantrone use in PCa has declined over the last decade.
Docetaxel is a semi-synthetic taxane, and is the most commonly used chemotherapy in PCa. The approval of docetaxel in advanced PCa was originally based on a significant survival benefit compared with mitxanterone.18 The TAX-327 trial randomized 1006 men to docetaxel 75 mg/m2 every 3 weeks, docetaxel 30 mg/m2 weekly , or mitoxantrone 12 mg/m2 every 3 weeks. Docetaxel showed improved outcomes with median OS of 18.9 months versus 17.4 months versus 16.5 months in the mitoxantrone group. Docetaxel was also associated with an improvement in QOL. Side effects were similar to mitoxantrone, but docetaxel was associated with higher frequency of neutropenia and neutropenic fever.
Managing Symptoms Of Advanced Prostate Cancer
Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.
You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.
Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.
Mayo Clinic Researchers Identify Drug Resistance Factors For Advanced Prostate Cancer
ROCHESTER, Minn. In a new study published in Molecular Cancer Research, Mayo Clinic researchers identified critical genomic changes in response to abiraterone acetate/prednisone, a standard treatment option for men with progressive, incurable and castration-resistant prostate cancer.
Liewei Wang, M.D., Ph.D.
“We defined a potential strategy for both responders and nonresponders of the drug that may help men overcome resistance and prolong survival,” says Liewei Wang, M.D., Ph.D., the Bernard and Edith Waterman Director, Pharmacogenomics Program, Mayo Clinic’s Center for Individualized Medicine. Dr. Wang is the corresponding author of the study.
Dr. Wang explains that while several drug choices are available to control disease progression, many questions remain over which drugs to use in individual cases. Also, predictive biomarkers for drug resistance and sensitivity remain primarily unknown.
Abiraterone acetate is a standard treatment option for men with castration-resistant prostate cancer. However, the response rate is limited, no known biomarkers predict prognosis, and alternative therapies for those who failed treatment are unavailable.
Dr. Sicotte says biomarkers based on the stage-specific landscape of genomic changes in prostate cancer are under investigation.
Early Versus Delayed Treatment
In the years following the introduction by Huggins and Hodges of hormone therapy for prostate cancer, early institution of such treatment was recommended based on comparison with historical controls.
Later, the Veterans Administration Cooperative Urology Research Group studies reversed the recommendation of early hormone therapy instead, hormone therapy was deferred until symptomatic progression. In addition, prolongation of survival was believed to be secondary to the alteration of the nature of metastatic lesions, thereby creating earlier androgen resistance, rather than a result of early hormone manipulation.
In more recent years, the old controversy of appropriate androgen-deprivation therapy timing has gained new and stronger popularity because of the advent of less-toxic and well-tolerated pharmaceutical agents, such as luteinizing hormone-releasing hormone agonists and antiandrogens. Laboratory studies have demonstrated that early hormone therapy does not confer early resistance. An update of the VACURG study by Byar and Corle determined that disease progression from stage C to stage D was decreased from 50% to 10% with diethylstilbestrol therapy. Crawford and associates also showed a benefit of early hormone therapy in patients with distant metastases.
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:
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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Types Of Cancers That Are More Likely To Go Undetected
Some cancers are more easily detected than others. For example, certain types of skin cancer can be diagnosed initially just by visual inspection though a biopsy is necessary to confirm the diagnosis.
But other cancers can form and grow undetected for 10 years or more, as one study found, making diagnosis and treatment that much more difficult.
This table provides an overview of common cancers that often display little or no symptoms early on, and how theyre typically detected and diagnosed:
|Type of cancer|
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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.
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Castrate Refractory Prostate Cancer: A Wider Range Of Options
In this section, we explain the treatments available at Birmingham Prostate Clinic for patients once their disease becomes resistant to hormone treatment, called castrate refractory prostate cancer. Two types of treatments are needed to:
- Control the cancer and preventing further spread of cancer
- Control or prevent the symptoms caused by the spread of prostate cancer to the bones
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When Treatments For Advanced Prostate Cancer Fail
Most men with advanced prostate cancer can live for a long time because of the treatments available. During this time, men will receive palliative care and/or end of life care.
The purpose of palliative care is to quickly identify and treat physical symptoms of the disease and side effects of treatment, as well as to help the person manage the effects of the disease on their emotional, social and spiritual wellbeing. Research suggests that palliative care reduces pain and distress, improves comfort, mood and feelings of wellbeing, and may also help to extend survival times.
Palliative care also helps partners, family and friends who love and care for the man with prostate cancer to better manage the impact of the disease. Studies have shown that it benefits not only the person with cancer, but the whole family.
Prostate Cancer Foundation of Australia Understanding Advanced Prostate Cancer may be helpful to read.
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Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
- a chemotherapy nurse
- a diagnostic radiographer
- a therapeutic radiographer
- other health professionals, such as a dietitian or physiotherapist.
Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.
Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.
Does Undergoing A Vasectomy Cause Prostate Cancer
The link between prostate cancer and vasectomy is controversial. A 2020 study in the Journal of the National Cancer Institute suggests that undergoing a vasectomy may result in a small increased risk of prostate cancer that persists for at least three decades, regardless of the age at vasectomy. However, other studies have not found this to be true and more research is needed, according to the American Cancer Society.
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Treatment For Advanced Prostate Cancer
Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.
A multidisciplinary team will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.
The main treatments are:
- Hormonal therapy
Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.
Chemotherapy uses anti-cancer drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.
Radiotherapy is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. Its given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.
Surgery to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.
Your doctor or nurse will usually ask you to sign a form giving your permission for them to give you the treatment. They cannot give treatment without your consent.