What Is Metastatic Prostate Cancer

How Does Prostate Cancer Metastasize Or Spread

Metastatic hormone sensitive prostate cancer

Metastatic prostate cancer is the result of cancer cells breaking free from the original tumor. These cells often go into the lymph nodes that filter bacteria and viruses. Cancer cells may settle in the lymph nodes. They can also make their way through the bloodstream to bones and organs. When cancer cells settle in these distant parts of the body, they start to multiply and form new tumors.

Stage 4 Prostate Cancer Life Expectancy

The five year survival rate for stage 1 prostate cancer is 100%, but stage 4 prostate cancer life expectancy is not very encouraging. While providing information on late stage prostate cancer life expectancy, this HealthHearty article also describes what is meant by staging and grading of prostate cancer.

Statistics show that more and more men are being diagnosed with prostate cancer every year. Various tests like PSA test, DRE test, ultrasound sonography, etc., help diagnose the cancer. Staging and grading of cancer not only help design the treatment but they also help determine how well the cancer may respond to the treatment. Staging, generally, is concerned with the spread of cancer. The Gleason grading system involves classification of cancer cells. It helps determine aggressiveness of the cells and their likelihood of spreading.

Questions To Ask Your Doctor Or Nurse

What type of hormone therapy are you offering me and why?
Are there other treatments I can have?
What are the advantages and disadvantages of my treatment?
What treatments and support are available to help manage side effects?
Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
How often will I have check-ups and what will this involve?
How will we know if my cancer starts to grow again?
What other treatments are available if that happens?
Can I join any clinical trials?
If I have any questions or get any new symptoms, who should I contact?

The Tnm System For Prostate Cancer Stages

As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:

Tumor. WhatÃ¢s the size of the main area of prostate cancer?
Nodes. Has it spread to any lymph nodes? If so, how far and how many?
Metastasis. How far has the prostate cancer spread?

Physical Emotional And Social Effects Of Cancer

Treatment options for localized and metastatic prostate ...

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.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

A PSA test every 3 to 6 months
A DRE at least once every year
Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Types Of Imaging Studies

If your healthcare provider 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 doctor’s appointment to help you ask the right questions.

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Can I Prevent A Prostate Cancer Recurrence

There isnt much you can do to keep prostate cancer from returning or spreading. One of the most important steps is to get frequent cancer screenings, so you can catch cancer spread quickly.

These lifestyle changes can have a positive effect on your overall physical and mental health:

cutting back on alcohol
staying physically active

Cytotoxics And Targeted Therapies

New treatment options in metastatic prostate cancer

are a relatively new class of cancer drugs that can overcome many of the issues seen with the use of cytotoxics. They are divided into two groups: small molecule and antibodies. The massive toxicity seen with the use of cytotoxics is due to the lack of cell specificity of the drugs. They will kill any rapidly dividing cell, tumor or normal. Targeted therapies are designed to affect cellular proteins or processes that are utilised by the cancer cells. This allows a high dose to cancer tissues with a relatively low dose to other tissues. Although the are often less severe than that seen of cytotoxic chemotherapeutics, life-threatening effects can occur. Initially, the targeted therapeutics were supposed to be solely selective for one protein. Now it is clear that there is often a range of protein targets that the drug can bind. An example target for targeted therapy is the BCR-ABL1 protein produced from the , a genetic lesion found commonly in and in some patients with . This has enzyme activity that can be inhibited by , a drug.

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 doesnt 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 dont 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.

Prostate Cancer Survival Rates Are Favorable Overall

Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.

To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides whats called the relative survival rate for prostate cancer.

Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, were not counting men with prostate cancer who die of other causes:

92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.

Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:

the relative 10-year survival rate is 98%
the relative 15-year survival rate is 96%

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How To Tell If Your Cancer Has Metastasized

Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.

Stages Of Prostate Cancer

Where prostate cancer spreads in the body affects survival ...

In order to determine the stage of a patients prostate cancer, most doctors start by using the TNM staging system, which helps describe different aspects of the cancers growth.

T the T category measures the size and extent of the Tumor
N the N category measures whether and how far the cancer has spread to the Lymph Nodes
M the M category whether the cancer has spread to other organs in the body (a process called Metastasis

The score for each of these categories is determined based on a pre-determined set of criteria. Your doctor cannot feel or see the tumor with a score of T1. A score of T3 means that the tumor has begun to grow outside of the prostate.

After calculating the TNM categories, doctors will combine the TNM score with the patients Gleason score and PSA levels assigning of a specific stage to the patients cancer.

Prostate cancer prognosis and survival rates can help give patients an idea of their chances of surviving the disease based on the stage and time of diagnosis. While some patients may find this information helpful, others may not want to know.

Treatment For Metastatic Cancer

There are treatments for most types of metastatic cancer. Often, the goal of treating metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well controlled. Other treatments may improve the quality of life by relieving symptoms. This type of care is called palliative care. It can be given at any point during treatment for cancer.

The treatment that you may have depends on your type of primary cancer, where it has spread, treatments youve had in the past, and your general health. To learn about treatment options, including clinical trials, find your type of cancer among the PDQ® Cancer Information Summaries for Adult Treatment and Pediatric Treatment.

Comparative Outcomes Of Surgery And Observation For Prostate Cancer

The Scandinavian Prostate Cancer Group Study 4 cited previously, compared radical prostatectomy to watchful waiting among men with localized prostate cancer diagnosed in the era prior to PSA screening. After 15 years of follow-up, men that underwent surgical treatment had significantly lower rates of distant metastatic disease and death from prostate cancer. This benefit of surgery was seen only among men below age 65 years, but not in those age 65 years and above in whom surgery did not provide a benefit in terms of freedom from metastatic disease or prostate cancer death. These data highlight an important aspect of prostate cancer management the unlikely probability that treatment will improve health outcomes for older men with low risk disease .

The PSA era Prostate Cancer Intervention versus Observation Trial , compared radical prostatectomy to watchful waiting among 731 men with localized prostate cancer. At 12 years, a subset of men with a PSA above 10 ng/ml and those with intermediate to high risk disease had a reduction in prostate cancer death with surgery as compared to watchful waiting.

The findings from the SPGS-4 and PIVOT should inform practice for the older man with low risk disease, especially those with associated comorbidities unlikely to benefit from curative intervention. For these men, no treatment may be the most rational initial management considering that harm is likely to outweigh any benefit .

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Changes In Psa Levels After Surgery

In patients with rising PSA levels after radical prostatectomy, the important prognostic factors are the :

pathologic stage
time taken post-operatively to reach detectable PSA levels
Gleason score at the time of prostatectomy
time required for doubling of PSA values

PSA doubling time of 15 months or more are better managed with surveillance. The have median time to metastatic disease in these years is about 8 years and the median survival is about 13 years. Patients with PSA doubling times of less than 3 months are at very high risk of prostate cancer related death and have a median survival of 5 to 6 years.

Treatments For Prostate Cancer Spread To Bones

Untreated Metastatic Prostate Cancer – 2021 Prostate Cancer Patient Conference

If prostate cancer spreads to other parts of the body, it nearly always goes to the bones first. Bone metastasis can be painful and can cause other problems, such as fractures , spinal cord compression , or high blood calcium levels, which can be dangerous or even life threatening.

If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.

Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause.

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History Of Untreated Prostate Cancer

The course of prostate cancer in the absence of treatment has been evaluated both in observational studies and randomized trials. Most of the evidence on the outcomes of men that are not treated for prostate cancer comes from those diagnosed in the era prior to when the disease was diagnosed at a more advanced state.

In Five Years A Major Treatment Shift

In men diagnosed with metastatic hormone-sensitive prostate cancer, the cancer is typically driven to grow and spread by androgens that are produced largely in the testes. For many years, treatments that block androgen production have been a mainstay for men initially diagnosed with metastatic prostate cancer.

Starting in 2014, that began to change after a large clinical trial showed that adding the chemotherapy drug docetaxel to ADT improved how long men with hormone-responsive disease lived. Shortly after, another clinical trial showed that adding abiraterone to ADT also improved survival in these men, although primarily in men with many metastatic tumors, known as high-volume disease.

However, docetaxel, which works by directly killing cancer cells, can have substantial side effects, and some patients arent healthy enough to tolerate it. And abirateronewhich blocks androgen production throughout the bodycan also cause side effects, including those that affect the liver. It also has to be given in combination with the steroid prednisone, which carries its own toxicity.

Doing so, Dr. Chi said during a presentation of the TITAN data at the ASCO meeting, might help stave off the typically inevitable development of hormone-resistant cancer, which is more difficult to treat and a key driver of prostate cancer deaths.

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Risks Of Over Treatment Of Prostate Cancer

Over diagnosis is the detection of a cancer that would otherwise not have been diagnosed in the lifetime of the host if the detection test had not been performed. Treatment of men who would otherwise not have known about their cancer in the absence of PSA testing and biopsy are over treated. Over treatment exacts a cost to the health care system and potential harm to a patient , with no benefit. Over treatment is most likely to occur when a low grade is detected, especially in an older man. Data from various sources suggest that in the PSA range where many men are undergoing prostate biopsy today , 15-25% will have prostate cancer detected, and 80-90% will be low grade.

The rate of in the U.S. is similar to the rate of over diagnosis since the majority of men undergo curative intervention after receiving a prostate cancer diagnosis. A range of estimates of over diagnosis between 23% and 42% have been reported based on U.S. incidence. Depending upon the age at diagnosis, and the disease characteristics, the likelihood that a screen detected cancer has been over diagnosed can vary from below 5% to more than 75%.