Survival Analyses After Propensity Score Matching
Based on the propensity matched cohorts of 879 chemotherapy-exposed vs 1611 chemotherapy-naïve patients, overall survival rates at 18 and 30 months were 76.3 vs 70.5% and 61.6 vs 56.0%, favoring chemotherapy-exposed patients .
In multivariable Cox regression models, chemotherapy exposed patients exhibited lower overall mortality compared to chemotherapy naïve patients . The effect of better survival in chemotherapy-exposed remained unchanged after landmark analyses was applied in the propensity score matched cohort .
Table 2 Multivariable Cox regression models predicting overall mortality in de novo metastatic prostate cancer patients according to chemotherapy status prior to and after propensity score matching.
How Is Chemotherapy Given
Chemo drugs for prostate cancer are typically given into a vein , either as an infusion over a certain period of time. This can be done in a doctors office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
Many different kinds of CVCs are available. The most common types are the port and the PICC line.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
The length of treatment for advanced prostate cancer is based on how well it is working and what side effects you have.
Impact Of Age On Treatment
The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests.10 Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.11,12
Chodak and associates12 evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.
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Prostate Cancer Expert In Concord Nc
Dr. Richard Natale, our board-certified urologist here at Carolina Urology Partners, works in tandem with our medical team to provide hope and care for men living with prostate cancer and all other types of reproductive cancers. Just as we have helped countless men in Concord and beyond, we can work with you to help you achieve full remission, thrive with, or even beat your cancer.
To see Dr. Natale, call us at 786-5131, or request your consultation right here on our website.
Getting Chemotherapy Through An Iv
If you are getting chemotherapy medicines that are given through an I.V. , you will go to a clinic on the day you are scheduled to have your chemotherapy. If your blood test shows that you can get your chemotherapy, a chemotherapy nurse will start you on an I.V. A thin needle is carefully placed into one of the veins in your arm or in the back of your hand. The needle will be taken out of your arm when your chemotherapy treatment is finished. This needle will be connected to two bags of liquid by a small tube. One bag contains your chemotherapy medicine. The second bag contains a fluid that will be used: 1) to wash all the chemotherapy medicine out of the tubing and into your body and 2) to make sure that you have fluid going into your vein until the nurse removes the needle. This extra fluid will help you feel better during your treatment. The chemotherapy nurse will give the medicine to you slowly through the I.V. Everything will probably go well during your treatment. If you have a problem during your treatment, there will be a nurse nearby who will check on you while you get your chemotherapy. Do not be afraid to tell the nurse if you do not feel good or if your arm starts to hurt at the place where the needle goes into your vein.
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What Can Be Done To Treat Or Reduce Side Effects
Once chemotherapy treatment is complete, its side effects will typically cease. However, steps can be taken to combat any side effects as they occur. For instance, medications can help prevent nausea and vomiting, laxatives or stool-binding medications can manage constipation or diarrhea, respectively, and numbing gel can soothe mouth sores. Additionally, chemotherapy dosages can be changed or alternative chemo drugs can be considered, if appropriate.
Dispelling Six Myths About Prostate Cancer And Chemotherapy
Some prostate cancer patients shy away from or choose not to utilize chemotherapy. Their hesitation may result from an outdated understanding of chemotherapy side effects and its effectiveness against prostate cancer.
In this blog, lets explore the myths driven by common misperceptions about chemotherapy and find out the facts.
MYTH #1: Chemotherapy is a last resort.
Some patients believe that we use chemotherapy when we are out of options. Far from a last resort, there are currently promising studies utilizing chemotherapy earlier in the treatment of prostate cancer. For instance, in men with newly diagnosed metastatic disease, chemotherapy significantly improves survival.
MYTH #2: Chemotherapy is a single and outdated option.
Chemotherapy is not a single drug. In fact there are many chemotherapies, both oral and intravenous, and new chemotherapies are being developed and approved regularly.
In prostate cancer, there have been continuous improvements over the past few years. In the past, an older drug called mitoxantrone was approved by the FDA to relieve cancer symptoms only. Then something important happened in 2004: docetaxel chemotherapy was shown to be the first drug to improve overall survival for men with metastatic prostate cancer that became resistant to hormone treatments. This was a critical milestone, as no drugs to that point could lengthen survival. In 2010, the FDA approved another chemotherapy drug for prostate cancer called cabazitaxel.
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Side Effects Of Chemotherapy
All chemotherapy drugs work in slightly different ways, making it challenging to predict side effects for individual patients. Dosages, drug combinations and drug responses will vary from patient to patient.
The American Cancer Society lists the following as the most common side effects of chemotherapy:
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Increased risk of infections
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Easy bruising or bleeding
Will Chemotherapy Cure My Prostate Cancer
No, chemotherapy will not cure your prostate cancer, because it does not kill all of your prostate cancer cells. But chemotherapy helps control your prostate cancer. It may:
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Where You Go For Chemotherapy
You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctors office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. For more information on side effects and how to manage them, see the section on side effects.
What Can Affect My Outlook
No one can tell you exactly what will happen. How prostate cancer affects you will depend on many things.
- Your stage Whether your cancer is localised, locally advanced, or advanced.
- Your Gleason score or grade group The higher your Gleason score, the more aggressive the cancer, and the more likely it is to spread.
- Your treatment options You may be able to have treatment aimed at getting rid of the cancer. Or you may be able to have treatment to keep the cancer under control. Read more about choosing your treatment.
- Your health If you have other health problems, you may have fewer treatment options. And you may be more likely to die from another condition, such as heart disease.
- Your PSA level After youve been diagnosed, PSA tests are a good way of monitoring your prostate cancer and seeing how youre responding to treatment.
- How successful your treatment is Your treatment may be successful at getting rid of your cancer or keeping it under control. But for some men, treatment may not work as well as expected.
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Secondary Cancer In The Bones
After the lymph nodes, the most common place for prostate cancer to spread to is the bones. Prostate cancer may spread to bones, such as the:
It may affect different areas of the bones rather than only one area.
- Pain
The first sign of a secondary cancer in the bones is usually an ache in the bone. This is often in the hips or in the back. A secondary cancer in the bone may gradually make the bone weaker. Bones that are very weak may break more easily. There are treatments you can have to help strengthen the bones and reduce pain.
- Spinal cord compression
If the bones in the spine have cancer in them, the cancer may press on the spinal cord. This is called Malignant spinal cord compression . It usually affects your legs and may cause:
- numbness or tingling in your legs.
Spinal cord compression is not common. But if you notice these symptoms, you should contact your doctors straight away even at the weekend or during a holiday period. If you cannot contact your GP or cancer doctor, you should go to the nearest emergency department .
Prostate cancer can sometimes spread from the bone to the bone marrow. Bone marrow is the spongy material in the middle of our bones where our blood cells are made. This includes red blood cells, which carry oxygen around the body.
If the bone marrow cannot produce enough red blood cells, you may become anaemic. This can make you feel very tired and breathless, and you may look very pale.
How Chemotherapy May Affect You
Chemotherapy affects people in different ways. How you feel depends on
- the type of chemotherapy you are getting
- the dose of chemotherapy you are getting
- your type of cancer
- how advanced your cancer is
- how healthy you are before treatment
Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.
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What Are Common Side Effects Of Chemotherapy
Chemo attacks normal cells as well as cancer cells. This can cause side effects. The side effects depend on the amount and type of medicine used. Talk with your healthcare providers about what to expect. Side effects may occur in the days or weeks while you are having chemo. Once your treatment has ended, the side effects usually go away. The side effects may include:
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Nausea and vomiting
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Tingling, burning feelings, or numbness in the hands or feet . Sometimes this can last for a while or be lifelong .
Talk with your providers about any side effects you have. They may be able to help lessen them.
What Can I Expect If I Am Receiving Internal Radiation Treatment For Cancer
Sessions for internal radiation therapy last longer than external beam radiation treatments, but there are fewer of them. Internal radiation therapy for cancer may be completed in one session or a series of three to five sessions about a week apart.
During internal radiation therapy, you will be given local anesthetic to numb the area being treated. A catheter or catheters small tubes sometimes called ports or applicators will be placed at the site of the tumor. Radioactive material is then delivered directly to the tumor through the catheters. The radiation therapy comes in many forms, including pellets, seeds, ribbons, wires, needles, capsules, balloons, or tubes. Depending on the type of radioactive material used, it will be left in place for only a couple of minutes and then removed or it may be left in permanently. Radioactive material that is left in permanently gradually wears off over the course of a few weeks until it no longer gives off radiation.
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Before You Start Chemotherapy
You need to have blood tests to make sure its safe to start treatment. You usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.
What Is Prostate Cancer
Prostate cancer is cancer that affects the prostate gland in men. Prostate cancer is the second-leading cause of cancer deaths for men in the US.
Growth in the prostate can be of two types
Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.
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Transurethral Resection Of The Prostate
This surgical procedure is used to relieve blockages in the urinary tract. It helps with symptoms of more advanced prostate cancer, such as the need to pass urine more often and a slow flow of urine.
If you have localised cancer, TURP may be used before radiation therapy to relieve symptoms of urinary blockage. TURP is also used to treat benign prostate hyperplasia.
Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
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Having Chemotherapy For Locally
The chemotherapy is given into a vein . Find out more about how chemotherapy is given.
The drug gets into the blood and can reach cancer cells all over the body. The drug that is used is called docetaxel . You usually have docetaxel every 3 weeks for 6 sessions.
Your doctor or nurse will explain the most common and serious side effects of docetaxel . They will tell you how they can be treated or managed. Always tell them about your side effects.
Some common side effects of docetaxel include:
- risk of infection
- bruising and bleeding
Most side effects stop or slowly go away when chemotherapy finishes. We have more information about the side effects of docetaxel.
When Will I Start Getting Radiation Therapy
After you leave your first appointment with your radiation oncologist, they will use your scans to map out the exact location of the cancer within your body as well as noting the location of any surrounding healthy organs that need to be avoided during treatment. Computer modeling is then used to simulate the dose of radiation that will be delivered to the tumor during treatment, and the model is reviewed before your treatment begins. This process can take up to two weeks before you return for your first actual radiation therapy treatment.
When your treatment plan is developed, it will outline whether you will be receiving radiation therapy before, during, or after other treatments. Once you are ready to begin radiation therapy, you can usually be seen within one to two days at Rocky Mountain Cancers Centers.
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Can I Take Other Medicines While I Am Getting Chemotherapy
It is important for you to let your doctor know about any medicines that you are taking, even over-the-counter medicine like vitamins or aspirin that you are taking along with your chemotherapy medicine. Some medicines may interfere or react with your chemotherapy. Your doctor can tell you if you should stop taking any of these medicines before you start chemotherapy. Make a list of all the medicines you are taking and how often you take them. Call your doctor or health care team if you have any questions about the medicine you are taking.
Planning Before You Start Chemotherapy
- What medications are you taking? You can speak about them with your doctor.
- Do you have any allergies that you need to tell your doctor about?
- What type of chemotherapy will you have?
- If you are getting I.V. chemotherapy, where do you need to go? Write down the place and your appointment times.
- If you are taking chemotherapy orally, how often do you need to take your medicine? List the medicine you need to take and how often you need to take them.