What Is Localized Prostate Cancer

What Is Localised Prostate Cancer

Localised prostate cancer is cancer thats inside the prostate and hasnt spread to other parts of the body. You may also hear it called early or organ-confined prostate cancer, or stage T1 or T2 prostate cancer.

Most localised prostate cancer grows slowly or doesnt grow at all and has a low risk of spreading. So it may never cause you any problems or affect how long you live. Because of this, localised prostate cancer might not need treatment. You might be able to have your cancer monitored with regular check-ups instead. This is to make sure the cancer isnt growing more quickly than expected.

But some men will have cancer that grows quickly and has a high risk of spreading. This is more likely to cause problems and needs treatment to stop it spreading outside the prostate.

What Factors Determine The Likelihood Of Recurrence

Several clinicopathological factors influence the risk of treatment relapse and how fast it occurs after treatment.

Especially, tumor characteristics observed at diagnoses, such as tumor stage and size, play essential roles in selecting treatment methods and predicting long-term treatment outcomes. Studies have consistently linked the following factors with an increased risk of recurrence:

Ethics Approval And Consent To Participate

As the data used was extracted from SEER dataset , Ethics approval and Consent to participate could be checked in SEER. We were permitted to have Internet access after our signed data-use agreement was approved by the SEER administration . The date collected from the Second Affiliated Hospital of Zhejiang University School of Medicine was approved by the Ethics Committee of Zhejiang University .

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How To Decide Between Radiation And Surgery For Localized Prostate Cancer

If youre like most men whove been diagnosed with prostate cancer, youve been told you have early-stage, localized prostate cancer, meaning the disease hasnt spread beyond the prostate. You may have also been told that you have choices about what you want to do next.

Unless your cancer is aggressive, youve probably been presented with three treatment options: active surveillance, radiation therapy or surgery. If you arent comfortable with active surveillance, or if its not an advisable option for you, you may have to decide between radiation therapy and surgery to treat your cancer.

Many men want to know whats the best treatment for their localized prostate cancer. But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.

Weve heard of some physicians telling men of their prostate cancer diagnosis and asking them to make a treatment decision at the same appointment. But prostate cancer progresses slowly, so most men have time to think about their options and shouldnt feel pressured into making an immediate decision.

How you feel about the big three possible side effects of treatmenturinary incontinence, sexual dysfunction and bowel healthmay be the deciding factor for you.

To help you through the process of making this decision, this article covers:

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 colleagues 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.

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Questions To Ask Your Doctor Or Nurse

• What is my Gleason score?
• What is the stage of my cancer?
• What treatments are suitable for me?
• Could my cancer be monitored instead?
• How quickly do I need to make a decision?
• What are the advantages and disadvantages of each treatment?
• What are the side effects?
• How effective is my treatment likely to be?
• What is the risk of my cancer coming back after treatment?
• Can I see the results of treatments youve carried out?
• Can I get copies of all my test results and letters about my treatment?
• Are all of the treatments available at my local hospital?
• If not, how could I have them?
• Can I join any clinical trials?
• If I have any questions or get any new symptoms, who should I contact?

How Common Is Recurrence Of Prostatecancer

Early diagnosis and treatment can cure localized prostate cancer, and most men will remain free of cancer for many years, potentially the rest of their life. Despite these favorable statistics and improvements in the available local therapies, up to 40% of men treated for prostate cancer will experience a recurrence.

Since the majority of these patients are already elderly, they are more likely to die from causes other than prostate cancer. This age-dependent effect reduces the need for immediate clinical intervention following recurrence.

It is noteworthy that more than 90% of prostate cancer cases present while the cancer is either localized in the prostate gland or has spread to areas around the gland .

Therefore, these men can expect to live at least five years after diagnosis, which is a much better outcome than other cancers. Among the 10% with advanced disease, about 30% can expect to reach the five-year survival mark.

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The risk of prostate cancer increases with age. It is very rare in men younger than 50.

The following tables show how likely it is that a man of a certain age will be diagnosed with prostate cancer within the next ten years and how likely it is that he will die of it. These numbers are averages: A mans individual risk will also depend on whether he has risk factors and if so which risk factors.

Table:being diagnosed with prostate cancer

Risk of in the next ten years:

Current age

What Is The Source Of The Information

Researchers funded by the Agency for Healthcare Research and Quality, a Federal Government research agency, reviewed studies on treatments for localized prostate cancer published between January 1, 2007, and March 7, 2014. The report included 52 studies and was reviewed by health care professionals, researchers, experts, and the public.

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Localized prostate cancer doesn’t cause any symptoms. It normally first becomes noticeable when it reaches a more advanced stage. Then it can lead to symptoms such as an increased urge to urinate or a weaker flow of urine. In most cases, though, problems urinating arent caused by cancer, but by a benign enlarged prostate. This is very common in men over the age of 50. In rare cases, blood in urine or in semen can also be a sign of prostate cancer.

Very advanced prostate cancer may also spread to other parts of the body through the lymphatic system or the blood vessels. This can lead to symptoms such as bone pain.

Cancer Staging May Miss Errant Cells

Once a pathologist confirms that cancer is present, the doctor will next determine how far the cancer extends a process known as cancer staging and discuss the implications with you. This is perhaps the most important information of all for you to obtain, as it determines whether the cancer is likely to be curable, or whether it has already spread to additional tissues, making prognosis much worse.

If you were my patient, I would ask you to consider two important points. First, cancer staging actually occurs in two phases: clinical and pathological . Of the two, pathological staging is more accurate.

A second point to understand, however, is that even pathological staging can be inaccurate . A cancer spreads, or metastasizes, once a primary tumor sheds cancer cells that travel elsewhere in the body and establish other tumor sites. Metastasis is a complex process that researchers do not fully understand. What is clear is that this process involves multiple genetic mutations and steps, and that each type of cancer spreads in a unique way.

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Surgery For Prostate Cancer

A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.

The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.

Tools To Help You Decide

The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasn’t spread.

It can’t tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.

To be able to use the tool you need to know the following about your cancer:

• PSA level

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What Should I Think About When Deciding On Treatment

There are several things to think about when deciding which treatment is right for you. You may want to talk with your doctors about:

• How likely your cancer is to grow, spread, or cause other problems in your lifetime
• Which type of treatment might be best for you
• The trade-offs between possible benefits and possible side effects of the treatments
• Discussing treatment options with your partner or other family members
• How often you will need to see your doctor for treatment

Ask your doctors

• How long may I live with my cancer?
• How likely is my cancer to grow and spread?
• Is watchful waiting or active surveillance an option for me?
• If I use active surveillance, how often should I come in for checkups? What will we do if the cancer starts to grow or spread?
• Which treatment do you think might be best for me based on my age, risk level, and other health issues?
• What is the chance that the treatment might help me to live longer?
• What will my quality of life be with the treatment?
• What side effects of treatment should I watch for and how will they be managed?
• How might treatment affect my sex life?
• If I have surgery to remove my prostate gland, how long might it take to recover?
• Are there local support groups I can join?

Survival Rate For Stage 4 Cancer Depends On Factors Like The Cancer Types Treatments Patients Health Condition Etc Work With Your Doctor For Best Results

When one is diagnosed to have Stage IV cancer, the immediate concern is if the person will be able to survive the disease. This concern, also medically known as the prognosis, depends on many factors, including availability of treatment and ones general health condition. Knowing what stage ones cancer is mostly determines his probability of surviving based on research. Cancer staging therefore helps the doctor to advise the patient about his condition and what forms of treatment are suitable, and to predict his survival rate in the next few years.

Cancer survival rate refers to the percentage of patients afflicted with a certain form of cancer who survive the disease for a specified amount of time. Statistics often refer to a five-year period where scientific surveys on these patients are based, although these data do not specify whether the patients are still undergoing treatment or are completely cancer-free after five years. An over-all five-year survival rate of 80% would mean that for every 100 patients with the disease, 80 would probably live for at least another five years, and 20 would probably not survive this period of time.

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What Is My Outlook

Many men will want to know how successful their treatment is likely to be. This is sometimes called your outlook or prognosis. No one can tell you exactly what will happen, as it will depend on many things, such as the stage of your prostate cancer and how quickly it might grow, your age, and any other health problems. Speak to your doctor about your own situation.

Most localised prostate cancer is slow-growing and may not need treatment or shorten a mans life. For many men who have treatment for localised prostate cancer, the treatment will get rid of the cancer. For some men, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.

For more information about the outlook for men with prostate cancer, visit Cancer Research UK. The figures they provide are a general guide and they cannot tell you exactly what will happen to you. Speak to your doctor or nurse about your own situation.

Why Is It Important To Know The Risk Level Of Your Cancer

Knowing whether your cancer is low-risk or higher-risk is important when you are making treatment choices.

The risk level of your cancer is based on the results from your tests and examinations, such as the PSA test, digital rectal examination, and prostate biopsy.

• Low-risk means that the cancer isn’t likely to grow right away. There is a chance it may grow so slowly that it never causes symptoms.
• Medium-risk means that the cancer is more likely to grow. Most men will likely need treatment with radiation therapy or surgery.
• High-risk means that the cancer will most likely grow right away. Men will likely need treatment with radiation therapy or surgery.

Your doctor can help you understand your test results and the risk level of your cancer. Then you can compare your treatment options and make the choice that seems best to you.

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Side Effects Of Radiation For Prostate Cancer

The primary potential side effects of radiation treatment for prostate cancer include bowel problems, urinary problems and sexual function issues.

According to patient-reported outcomes measuring quality of life from men who participated in the 10-year, randomized Prostate Testing for Cancer and Treatment trial, men who were treated with radiation reported little increase in urinary leakage after radiation therapy. They also reported less sexual dysfunction when compared to men who were treated with surgery. However, men treated with radiation reported a higher incidence of bowel problems, such as loose and bloody stools. These side effects are often short-term for most patients, but some experience long-term side effects.

Know Your Priorities When Deciding On Prostate Cancer Treatment

While this one study showed that people who get a prostatectomy may live longer, it’s important to understand the risks involved with each and to know your priorities. You may be quick to want to remove your prostate or get radiation treatment to get rid of the cancer right away, however, there are many quality of life issues to take into account:

• With active surveillance, your cancer may grow and spread.
• Choosing not to treat your cancer right away could lead to anxiety.
• Men who undergo radiation are more likely to have bowel problems.
• There is a chance you may lose bladder control after surgery.
• You may lose your ability to have an erection after surgery.

The decision about how you will treat your prostate cancer is not one to be taken likely. Discussing the risks and complications with your physician and your family, and thoroughly considering your priorities, can help you make a decision that feels right for you.

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Survival By Tumor Grade

One way cancer is staged is by looking at the grade of cancer. Grade refers to how cancer cells look like under a microscope.

Traditionally for prostate cancer, this has been done using the Gleason Score, which was developed in the 1960s. Under this system, cancerous cells are categorized on a scale from 1 to 5. Grade 1 cells are considered normal prostate tissues, while cells in the grade 5 range have mutated to such an extent they no longer resemble normal cells.

In determining a Gleason score, a pathologist will examine a biopsy sample under a microscope and give a Gleason grade using the above scale to the most predominant pattern displayed, then a second grade to the pattern that is the second most predominant. Those two grades are then added to form the overall Gleason score .

In theory, Gleason scores could range from 2 to 10, but pathologists today rarely give a score between 2 and 5 and are more likely to be in the range of 6 to 10 with 6 being the lowest grade of prostate cancer.

Under the Gleason Score system, a 6 is considered low grade, 7 is intermediate and scores of 8, 9, or 10 are considered high-grade cancers.

The higher the Gleason score, the more likely it is the prostate cancer will grow and spread quickly.

However, there have been some issues with the Gleason system, and a new grading system, to act as an extension of the Gleason system, has been developed.

Under this system Gleason scores are now categorized into grade groups: