The Cambridge Prognostic Groups
In the UK, doctors divide prostate cancer into 5 prognostic groups. This is the Cambridge Prognostic Group . The 5 groups are from CPG 1 to CPG 5. Your CPG depends on:
- the tumour stage. This is from the T stage from the TNM staging
- what the cancer cells look under a microscope. This is the Grade Group or Gleason score
- your PSA blood test level
The CPG helps your doctor recommend if you need treatment and the type of treatment you need. Doctors also consider other factors when recommending the best treatment for you:
- your age and general health
- how you feel about the treatment and side effects
If you cant have treatment because of your age or other health issues, your doctor might monitor the cancer with watchful waiting. They will only recommend treatment if the cancer starts to cause you symptoms.
The Staging Guide Video Series
Hi, Im Dr. Scholz. Lets talk about prostate cancer.
Weve been going through a series of short videos about the management of Teal otherwise known as intermediate risk prostate cancer. In this video were going to cover the comparison of all the different treatment options for Teal, and try to give you a little hierarchygive you a kind of number 1, 2, 3 in terms of options that I would be thinking of if I was in this situation.
First, when youre talking about Teal you have to realize there are three subtypes, the Teal subtype we divide at PCRI into Low, Basic, and High. So when we talk about many options for treating teal, were really talking about Basic-Teal. Why is that? Well, Low-Teal those men are candidates for active surveillance. High-Teal are going to get better cure rates with combination therapythat is a seed implant plus IMRT and a short course of hormone blockade . For Basic-Teal were really talking about having a broad selection of therapy amongst surgery, radiation therapy which could be IMRT, proton therapy, SBRT stereotactic body radiation CyberKnife, two different types of seed implants, and even primary hormone blockade , or just TIP alone which was very popular before radiation technology got a lot better. So the remainder of the video is really going to be talking about options or Basic-Teal, comparing the pros and cons of all these different treatments.
So lets move on and talk about that, lets talk about discomfort and inconvenience.
Living With Prostate Cancer
Receiving a prostate cancer diagnosis can be stressful. Even though most people who receive a diagnosis of prostate cancer live for many years after receiving the diagnosis, treatment can be exhausting and cause side effects that impact your quality of life.
Many resources are available to help you get through these difficult times:
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Stage 1 Prostate Cancer
Stage 1 is early-stage prostate cancer and means that the cancer is small, only in the prostate, and contains low grade cancer cells. Its also called localized prostate cancer. By the TNM system, it is T1 , N0, M0 and the Gleason group grade 1. Typically, it will have a PSA level of less than 10 ng/ml .
According to the American Cancer Society, the survival rate of localized prostate cancer is excellent, with almost 100% of people still alive five years after their diagnosis .
Stage 2 Cancer Prognosis
After a stage 2 cancer diagnosis, patients may want to learn more about their outlook. Survival rate estimates for cancer patients vary based on several factors, including:
- Overall health before beginning cancer treatment
Because stage 2 cancer has grown into nearby tissue, its considered more serious than stage 1, but not as serious as stage 3 or 4. The patients care team can share specifics about the stage 2 survival rate for his or her specific cancer type after assessing the cancer grade, location and other details about the patients health.
Expert cancer care
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Figure 1 Location Of The Prostate Gland
This location creates challenges in both diagnosis and treatment. During a digital rectal exam, for example, a doctor is able to feel only the back portion of the prostate. If cancer has developed in the apex, base, or deep inside the prostate, it may not be palpable.
As you evaluate treatment options, Id suggest that you think not only about your situation today, but also about where you expect to be in five or 10 years because chances are, youll still be alive. And you need to be sure that you would make the same treatment decision five or 10 years from now as you will right now.
Will you be able to deal with impotence if it occurs? What about incontinence ? How will the possible side effects of treatment affect your relationship with your wife or significant other and your very sense of self? Its vital to really think about these issues: In my experience, truly informed patients are much better able to deal with adverse consequences than patients who are uninformed or rush into making a decision.
Its also important to understand the limits of current medical knowledge about prostate cancer.
Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
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Stages Of Prostate Cancer
If you have been diagnosed with prostate cancer, your doctor will describe the severity of cancer as stage 1, stage 2, stage 3, or stage 4. Here is a breakdown of each of the four stages of prostate cancer.
Stage 1
Stage 1 prostate cancer is localized to the prostate and has not spread. Stage 1 prostate cancer can be challenging to detect because it cannot be felt on a digital rectal exam and often does not cause a significant increase in PSA. The cancer is likely slow-growing if the PSA is less than 10 and the Gleason score is less than 6.
Stage 2
In stage 2 prostate cancer, cancer has not spread beyond the prostate but is more advanced than in stage 1. Stage 2 prostate cancer can be further broken into stage 2A and stage 2B. Stage 2A prostate cancer is found on only one side of the prostate, while stage 2B prostate cancer is found on both sides of the prostate.
Stage 3
Stage 3 prostate cancer has spread outside the prostate capsule and into other surrounding tissues. Stage 3 prostate cancer can also be called locally advanced prostate cancer.
Stage 4
In stage 4 prostate cancer, cancer has spread to distant body parts. Stage 4 cancer often invades nearby lymph nodes, the spine or pelvis, the bladder, the liver, or the lungs.
Side Effects Of Chemotherapy
- Digestive issues such as nausea, vomiting and diarrhea
While on chemotherapy, patients are also susceptible to infections because their white blood cell counts are lower. Other common side effects include bruising or bleeding due to fewer blood platelets and fatigue due to the lowered red blood cell count.
Its also possible to experience a severe allergic reaction to some of the drugs used to treat prostate cancer, especially Taxotere® and Jevtana® . The patients care team may recommend medicines before each session to help prevent a reaction.
The prostate chemotherapy drug mitoxantrone may cause leukemia later in life, but this is rare. The prostate chemotherapy drug Emcyt® may increase the risk for blood clots.
During chemotherapy, doctors may also offer supportive care services to help ease side effects. For example, naturopathic providers may suggest supplements to reduce nausea. Also, a mind-body therapist may recommend techniques to help the patient relax and feel less anxious during prostate cancer chemotherapy treatments.
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Hormone Therapy Side Effects
Testosterone is the primary male hormone, and plays an important role in establishing and maintaining typical male characteristics, such as body hair growth, muscle mass, sexual desire, and erectile function, and contributes to a host of other normal physiologic processes in the body. The primary systemic …
How Is Stage Ii Prostate Cancer Treated
In stage II of prostate cancer, the cancer is small and is confined to the prostate gland and the growth and spread may be slow and it may never show symptoms. The course of action depends on the age of the patient and their overall health and if they can withstand the treatment. The following are the treatment methods generally preferred for stage I prostate treatment:
Active surveillance:
Because this cancer type grows very slowly, men may often not require any treatment immediately if not throughout their lifetime. Active surveillance is a method of monitoring the cancer closely regularly. PSA blood test, DRE , prostate biopsies may be done once in six months or so. If the results show signs of the cancer spreading, the treatment options are reviewed to eliminate the cancer.
External beam radiation:
It is a type of radiation therapy, a treatment method that involves use of high beams of X rays to kill cancerous cells. In external beam radiation therapy, also called EBRT, beams of radiation are focused on the prostate gland from a machine outside the body and it is used to treat the early stages of cancer.Read more about radiation therapy of prostate cancer here.
Brachytherapy:
Radical prostatectomy:
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Hyperthermia Therapy Supercharges Treatment
Hyperthermia is the application of heat to parts of the body to increase blood flow and enhance the efficient delivery of oxygen and nutrients. It also super-charges & enhances our low-dose chemotherapy protocol.
For decades weve witnessed the miraculous benefits of I-Therm as part of a comprehensive cancer treatment program cancerous tumors shrink pain is alleviated neurological conditions improve and healing occurs more rapidly.
Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
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Prostate Cancer Survival Rates
Answering the question of how curable is prostate cancer? first requires understanding what doctors mean when they refer to curability. Regardless of the type of cancer, doctors consider cancer cured when a patient remains cancer-free for a specified period after treatment. The higher the number of patients who stay cancer-free for five years or longer, the higher the curability of that particular disease.
Prostate cancer, therefore, has one of the highest curability rates of all types of cancer, thanks in large part to early detection standards and advances in treatment, such as the stereotactic body radiation therapy offered by Pasadena CyberKnife. When the cancer is detected in the early local or regional stages that is, before the cancer has spread or when it has only spread to limited areas in the pelvic regions the five-year survival rate is nearly 100 percent.
Survival rates decline significantly when cancer is detected at later stages however, the good news is that only about five percent of men are diagnosed after the cancer has become widespread throughout the body. In short, more than 90 percent of men who are diagnosed with prostate cancer live for five years or longer after treatment, making it one of the most curable forms of cancer.
Stage 2 Breast Cancer
In stage 2 breast cancer, the tumor measures between 2 cm and 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. The cancer cells have spread beyond the original location and into the surrounding breast tissue, and a tumor may be detected during a breast self-exam as a hard lump.
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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 Are The Treatment Options For Stage Ii Prostate Cancer
If prostate cancer has progressed to Stage 2, that generally means that your doctor has found a lump or nodule on the prostate. Usually the prostate must be removed. There are several ways surgeons can do this. Dr. Howard Tay is a Urologist experienced with prostate cancer. He goes over these Stage II prostate cancer treatments in the video below. The type of procedure that is right for you depends on several factors. Talk to your doctor about your treatment options.
Video Transcripts
Howard P. Tay: These are the treatment options for stage 2 prostate cancer.
If its within the prostate, then in most cases more than likely we are looking at a potential cure, however, if its outside of the prostate, then the patient may need further treatment and so that is potentially one of the benefits of surgical removal. The other option also includes radiation therapy where radiation can be delivered externally from a source directly into the prostate to destroy the cancer or you can also apply radioactive pellets that can be placed within the prostate itself to destroy the tissue. Finally, there is also a treatment called cryotherapy where probes are placed within the prostate itself and a treatment is performed on the prostate to freeze and kill the tissue. These probes are then removed after the treatment and then it is usually a therapy that is done as an outpatient therapy.
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Figure 2 Why Understaging May Occur
When the prostate is removed, a pathologist examines slices of the gland for evidence of cancer. A. Under a microscope, the pathologist can distinguish tiny tumors, consisting of clumps of visibly abnormal cells. B. With current imaging technology, it is not yet possible for a pathologist to identify micrometastases individual cancer cells shed from the primary tumor that have gone on to seed adjacent tissue. In this image, for example, cancer cells have already penetrated the capsule and migrated to adjacent tissue, even beyond the margin of tissue removed during surgery.
Individual prostate cancer cells can spread to more remote areas of the body in three ways . Whats more, they can do so without being detected with our current technology, essentially escaping under the radar. So its always possible even if you are diagnosed with early-stage prostate cancer that the cancer has already spread and will manifest in the coming years. How likely is it that an early-stage prostate cancer will become active without treatment? A small study provides some clues .
Access The Right Treatments At The Right Time
When it comes to treating prostate cancer, it is important to have access to the best expertise possible so you can receive the right treatments at the right time. The University of Maryland Cancer Network gives you the opportunity to connect with the best treatment options available.
Led by the University of Maryland Greenebaum Comprehensive Cancer Center , the UM Cancer Network provides you access to nationally renowned experts, the latest treatments, and promising clinical trials close to home. When you work with a UM Cancer Network cancer center, your community hospital will work in partnership with UMGCCC to help you beat cancer.
Find out more about prostate cancer treatments.
Find an UMMS cancer center near you.
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Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment. If youre choosing a treatment, you might find it helpful to ask your doctor or nurse some of these questions.
- What treatments are suitable for me?
- How quickly do I need to make a decision?
- What are the advantages and disadvantages of each treatment? What are their side effects?
- How effective is my treatment likely to be?
- Can I see the results of treatments youve carried out?
- Is the aim to keep my prostate cancer under control, or to get rid of it completely?
- If the aim of my treatment is to get rid of the cancer, what is the risk of my cancer coming back after treatment?
- If the aim of my treatment is to keep the cancer under control, how long might it keep it under control for?
- What treatments and support are available to help manage side effects?
- Are all of the treatments available at my local hospital? If not, how could I have them?
- After treatment, how often will I have check-ups and what will this involve? How will we know if my cancer starts to grow again?
- If my treatment doesnt work, what other treatments are available?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?