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What Is Done For Prostate Cancer

When Should I See My Doctor

What is prostate cancer? | Cancer Research UK

See your doctor if you notice any unusual or ongoing changes in your toilet habits . Most often, these wont mean you have cancer, but finding cancer early improves the odds of treating it successfully.

If you dont have any symptoms but are concerned about your risk, your doctor can also explain the risks and benefits of prostate cancer screening, such as having a PSA test.

Prostate Cancer Surgery Should Be Individualized To Each Patient

Not every prostate cancer can be treated with a single-port approach or retzius-sparing surgery, but there are other choices. We have a large and expanding repertoire of treatment options that allow us to personalize treatment to each patients needs, says Dr. Sprenkle.

The potential options include several different surgical approaches and robots, as well as the alternative of radiation therapy, which uses high-energy rays or particles to kill cancer cells, delivered in precisely targeted external beam treatments or an implanted radioactive seed. For small tumors, another approach is focal therapy, a term for noninvasive techniques for eliminating the tumors while leaving the prostate gland itself intact.

“Patients come to my office concerned about the potential side effects of surgerythey are afraid they will become incontinent or have erectile dysfunction, says Isaac Kim, MD, PhD, MBA, professor and chair of the Department of Urology at Yale School of Medicine.

The best candidates for single-port surgery are men whose cancer is classified as favorable intermediate risk, Dr. Sprenkle says. He wouldnt recommend it for men with unfavorable intermediate or high-risk cancer, because the approach doesnt provide easy access for pelvic lymph node dissection to assess whether the cancer has spread.

Some simply favor other approaches, Dr. Sprenkle says.

Who Is More Likely To Develop Prostate Cancer

Anyone who has a prostate can develop prostate cancer. But certain factors can make you more likely to develop it:

  • Age. Your chance of developing prostate cancer increases as you get older. Prostate cancer is rare in people under age 50.
  • Family health history. Your risk of prostate cancer is higher if you have a parent, sibling, or child who has or has had prostate cancer.
  • Race. African Americans are more likely to get prostate cancer. They’re also more likely to:
  • Get prostate cancer at a younger age.
  • Have more serious prostate cancer.
  • Die from prostate cancer.

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Eight Types Of Standard Treatment Are Used:

Watchful waiting or active surveillance

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.

Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.

Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.

Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.

Surgery

Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:

What Should Patients Know About Msks Approach To Treating Prostate Cancer

Prostate Cancer Stages

At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.

Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.

The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.

We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.

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Physical Emotional And Social Effects Of Cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Can The Gleason Score On My Biopsy Really Tell What The Cancer Grade Is In The Entire Prostate

Because prostate biopsies are tissue samples from different areas of the prostate, the Gleason score on biopsy usually reflects your cancers true grade. However, in about 1 out of 5 cases the biopsy grade is lower than the true grade because the biopsy misses a higher grade area of the cancer. It can work the other way, too, with the true grade of the tumor being lower than what is seen on the biopsy.

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When Is Brachytherapy Alone The Right Choice

For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.

This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.

Radiation Therapy Versus Surgery

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In 2014, the Agency for Healthcare Research and Quality found insufficient evidence to determine whether any type of radiation therapy results in fewer deaths or cancer recurrences than radical prostatectomy does in patients with clinically localized prostate cancer. The importance of dose escalation in disease control complicates the extraction of meaningful conclusions from current radiation therapy treatments .

Brachytherapy has also been compared with surgery in the management of early-stage disease. Direct comparisons are not readily available, but preliminary data from most centers suggest that permanent prostate implants yield comparable local control and biochemical disease-free rates.

Valid comparisons of surgery and radiation therapy are impossible without data from randomized studies that track long-term survival rather than PSA recurrence. Variation in radiation techniques and dosage administered the variable use of androgen ablation, which improves survival in intermediate- and high-risk disease and the variable impact on the quality of life complicate comparison using uncontrolled studies.

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Does Overdiagnosis Lead To Overtreatment Of Older Men

The widespread use of PSA screening has led to an increase in the diagnosis and treatment of early localized prostate cancer. Data from the US Cancer of the Prostate Strategic Urological Research Endeavor database suggest a significant decrease in risk in the last 2 decades in the United States, with more patients being identified with low-risk disease at diagnosis, but the role of active treatment of low- and intermediate-risk disease in elderly men remains controversial.

The median time from diagnosis to death from prostate cancer for men with nonpalpable disease is approximately 17 years., Considering that the US male life expectancy at the age of 65 years is 16 years, aggressive therapy will hardly extend life expectancy of older men with no palpable prostate cancer at the time of diagnosis. Twenty to 30% of prostate cancers detected by PSA screening programs show Gleason scores of 6 or lower and, thus, are not poorly differentiated and have volumes smaller than 0.5 cm3.

Histologic evaluation of radical prostatectomy specimens demonstrated that about 20% to 30% of cancers are small volume, show low Gleason scores, and are consequently clinically harmless., Many of these cancers pose little threat to life, especially for older men. Has PSA screening resulted in prostate cancer overdiagnosis?

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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How Common Is Prostate Cancer

About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.

Treatment Option Overview For Prostate Cancer

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In This Section

Local treatment modalities are associated with prolonged disease-free survival for many patients with localized prostate cancer but are rarely curative in patients with locally extensive tumors. Because of clinical understaging using current diagnostic techniques, even when the cancer appears clinically localized to the prostate gland, some patients develop disseminated tumors after local therapy with surgery or radiation.

Treatment options for each stage of prostate cancer are presented in Table 6.

Table 6. Treatment Options by Stage for Prostate Cancer

Stage Standard Treatment Options
EBRT = external-beam radiation therapy LH-RH = luteinizing hormone-releasing hormone PARP = poly polymerase TURP = transurethral resection of the prostate.
Stage I Prostate Cancer
PARP inhibitors for men with prostate cancer and BRCA1, BRCA2, and/or ATM mutations

Side effects of each of the treatment approaches are covered in the relevant sections below. Patient-reported adverse effects differ substantially across the options for management of clinically localized disease, with few direct comparisons, and include watchful waiting/active surveillance/active monitoring, radical prostatectomy, and radiation therapy. The differences in adverse effects can play an important role in patient choice among treatment options. Detailed comparisons of these effects have been reported in population-based cohort studies, albeit with relatively short follow-up times of 2 to 3 years.

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Are You At Risk For Prostate Cancer

Here are the risk factors which make you more susceptible to prostate cancer.

  • If people in your family have had prostate cancer or breast cancer then you have a higher chance of having prostate cancer.
  • The chances of developing prostate cancer increases as you age. Prostate cancer seldom affects young men. It is more common in older men.
  • If you are an African American male, then you have a higher chance of developing prostate cancer. Men in some races are more prone to prostate cancer than others.
  • Sometimes it is the genetic changes that occur in your body that can lead to you becoming more prone to having prostate cancer.
  • Research shows that those men who do not get enough vitamin D may be at a higher risk of having prostate cancer than other men.
  • If you are obese, then your chances of developing prostate cancer are increased manifold. Mostly, obese mens prostate cancer is tougher to treat.
  • Some studies have reported that men who eat high-fat dairy products and red meat more often are more likely to develop prostate cancer.

What About My Physical And Emotional Wellness

Eating a healthy diet including a variety of foods, will ensure you have what your body needs to cope with treatment and recovery. Regular physical activity can improve your cancer recovery and reduce side effects such as fatigue.

  • Don’t be afraid to ask for professional and emotional support.
  • Consider joining a cancer support group.
  • Learn to ignore unwanted advice and “horror stories”.
  • Live day-to-day and remember that every day is likely to be different.

Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life or reduce pain. There is no evidence that these therapies can cure or prevent cancer. Some have not been tested for side-effects, may work against other medical treatments and may be expensive. Talk to your doctor about using complementary therapies.

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Screening Tests For Prostate Cancer

The main screening test for prostate cancer is the prostate-specific antigen test. It’s a blood test that measures how much PSA is in your blood. And you will probably have a digital rectal exam. A high PSA level may mean that you have an enlarged prostate, an infection or, less often, prostate cancer.

The prostate-specific antigen test can help find prostate cancer early. But experts recommend that you discuss the benefits and risks of the test with your doctor before you decide whether to have this test. It may not help you live any longer than if you had no screening. And it could lead to harmful treatments that you don’t need.

Talk with your doctor about your health, your risk factors for prostate cancer, and the pros and cons of PSA testing.

Tips For Talking With Your Partner

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Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:

  • Bring your partner with you to doctors visits. Being part of the conversation may help them understand what youre experiencing.
  • Listen to your partners concerns, too. Remember that this issue affects both of you.
  • See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
  • If sex is a problem right now, its possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.

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Biochemical Recurrence Without Metastatic Disease After Exhaustion Of Local Treatment Options

Biochemical recurrence is defined as a rise in PSA to 0.2 ng/mL and a confirmatory value of 0.2 ng/mL or greater following radical prostatectomy, or a rise of 2ng/mL or more above the nadir PSA after radiation therapy. Not all men who have a rising PSA will develop metastases, and for that reason not all such men require treatment. The risk of metastases and death depend on the patients Gleason score, the length of time between the nadir PSA and the onset of the PSAs rise, and the PSA doubling time.

Patients who have PSA failure following radical prostatectomy and have no evidence of metastatic disease have the options of watchful waiting, radiation therapy, or hormone ablation as salvage therapy. Similarly, patients who have PSA failure following radiation therapy have the following options:

  • Watchful waiting
  • Hormone ablation

The pretreatment Gleason score, clinical stage, PSA level, and percentage of positive core biopsy results have been found to be reliable predictors of failure following local therapy. Unfortunately, no means of identifying recurrences limited to the pelvis is reliable. Although a Gleason grade of 7 or less is associated with a better prognosis than a grade of 8 or more, the survival likelihood associated with a rise in the PSA level is greater if the rise occurs more than 2 years after local treatment than if it occurs less than 2 years afterward.

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