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. Whatâs 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?
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.
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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How Quickly Does Prostate Cancer Spread
Prostate cancer is a cancer that develops in the prostate gland in men and it is one of the most common types of cancer. It is usually seen in men over the age of 50. The prostate is a small walnut-shaped gland in men, which produces seminal fluid required to nourish and transport the sperm. Prostate cancer is a slow-growing cancer and, more often, it is confined to the prostate gland, requiring minimal or no treatment.
In some cases, it can take up to eight years to spread from the prostate to other parts of the body , typically the bones. In many cases, prostate cancer does not affect the mans natural life span.
However, certain types of prostate cancer can be aggressive and spread quickly to other parts of the body. If prostate cancer is detected early and is confined to the prostate gland, the prognosis is excellent.
How To Make The Right Treatment Decision
Current expert guidelines for treatment of localized prostate carcinoma recommend potentially curative therapy for patients whose life expectancy is at least 10 years., Patients with limited life expectancy are more likely to die from health conditions other than prostate cancer. Men with a life expectancy of more than 10 years are more likely to die from progressive prostate cancer. This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.,
Conservative management proved to be an acceptable treatment option for men with low-grade Gleason scores, clinically localized disease, and life expectancies of less than 10 years. Increasing age was described as a risk factor for receiving inadequate treatment for prostate cancer. Thus, older men have been shown to receive potentially curative therapy less often than younger men., Radical prostatectomy is preferred treatment in men younger than 70 years, whereas radiation therapy is applied predominantly in patients older than 70 years. Conservative therapy such as watchful waiting or androgen deprivation by luteinizing hormone-releasing hormone analogs is preferentially applied in men older than 80 years. Watchful waiting or hormonal therapy is used to treat 82% of men older than 80 years.
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What Are Next Steps
Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But its important to remember that the numbers are only statistics.
The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.
Everyones cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.
How Will My Cancer Be Monitored
Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.
You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.
You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.
Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.
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Prostate Cancer Is A Common Type Of Cancer In Men According To The Mayo Clinic
Patients with the most aggressive form of pr. Prostate cancer is a common type of cancer in men, according to the mayo clinic. The vast majority of men diagnosed today with prostate cancer will survive for at least 15 years. Find the survival rates for prostate cancer here. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations. However, as with other types of cancer,. Prostate cancer is a leading cause of cancer in males. The earlier the detection of prostate cancer, the better the patients chance of survival is. It may grow slowly and its typically treatable. Although screenings for prostate cancer are one tool for early detecti. Prognosis is reflected by considering the patients psa score at presentation as well as thei. After lung cancer, prostate cancer causes th. The vast majority of men diagnosed today with prostate cancer will survive for at least 15 years.
The vast majority of men diagnosed today with prostate cancer will survive for at least 15 years. Here are 10 more facts about prostate cancer. Its one of the deadliest types of cancer for women in the united states, second only to lung cancer. But hearing the words can still be scary. One in seven men in the united states will receive a prostate cancer diagnosis during his lifetime.
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
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Family History And Genetic Factors
It is estimated that about 20% of patients with prostate cancer report a family history, which may develop not only because of shared genes but also for a similar pattern of exposure to certain environmental carcinogens and common lifestyle habits . Several studies reported that inherited genetic background is associated with increased risk for prostate cancer, contributing to about 5% of disease risks . Particularly, this risk is increased by several folds when high-penetrance genetic âriskâ alleles are inherited, conversely to more common low-penetrance loci that increase the risk only modestly.
The X chromosome is also believed to have a role in prostate cancer inheritance, because it contains the androgen receptor and because small deletions in Xq26.3-q27.3 region were noted in sporadic and hereditary forms of prostate cancer . More recent studies in 301 hereditary prostate cancer affected families defined a number of other loci that may contribute to hereditary prostate cancer .
Prediction Of Metastatic Prostate Cancer By Prostate
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Roles Formal analysis, Writing review & editing
Affiliations Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden, Department of Mathematics, Uppsala University, Uppsala, Sweden
- Hans Garmo,
Roles Conceptualization, Formal analysis, Methodology, Writing review & editing
Affiliations Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden, Kings College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
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Roles Data curation, Writing review & editing
Affiliation Department of Urology, Ryhov Hospital, Jönköping, Sweden
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Affiliation Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Hans David Ulmert,
Roles Writing review & editing
Affiliations University of California Los Angeles, Department of Molecular and Medical Pharmacology, Los Angeles, CA, United States of America, Ahmanson Translational Imaging Division, David Geffen UCLA School of Medicine, Los Angeles, CA, United States of America, Jonsson Comprehensive Cancer Center, David Geffen UCLA School of Medicine, Los Angeles, CA, United States of America
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Roles Conceptualization, Data curation, Methodology, Resources, Writing review & editing
Affiliation Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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What Are The Symptoms Of Prostate Cancer
Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:
- Frequent, sometimes urgent, need to urinate, especially at night.
- Weak urine flow or flow that starts and stops.
- Painful urination .
- Painful ejaculation and erectile dysfunction .
- Blood in semen or urine.
- Lower back pain, hip pain and chest pain.
- Leg or feet numbness.
Psa Levels In Metastatic Prostate Cancer
As part of your ongoing treatment, your care team will regularly test your PSA levels. PSA stands for prostate-specific antigen, which can be high in men who have prostate cancer. PSA tests are used not only for the initial cancer diagnosis but also to observe the advancement of the disease over time.
Generally, PSA levels are higher in men with metastatic prostate cancer. However, in rare cases, its possible to have a low PSA even if you have metastatic disease. For these patients, disease progression is better measured in other ways, such as through imaging tests and biomarker tools.
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Personal Treatment Of Metastatic Prostate Cancer Works Best
Patients with metastatic prostate cancer usually receive hormone therapy
Treatment of metastatic prostate cancer is best based on the genetic profile of the tumor. Niven Mehra, oncologist at Radboudumc, wants to demonstrate this in the PROMPT study, for which he and his colleagues are again raising funds this year through crowdfunding. This is necessary because screening of genetic profiles in prostate cancer is not yet reimbursed.
Patients with metastatic prostate cancer usually receive hormone therapy. If that stops working, some other therapies are available afterwards. But it is unclear which therapy is best for an individual patient. Niven Mehra, oncologist at Radboudumc, therefore prefers a personal treatment based on the genetic characteristics of the patients tumor. Many tumors have genetic mutations that can be treated very specifically with drugs. This makes personal treatment possible, which most likely also works better and in some cases has even led to a cure.
Hereditary cause?Screening for mutations in the BRCA genes has another advantage. In about half of the patients with such a BRCA prostate tumor, it is a hereditary condition. The mutation can be passed on from parent to child. Mehra: Then it may also be relevant for the patients brothers, sisters and other relatives. Screening family members for the mutation can save lives in this case.
What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
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Chemotherapy For Metastatic Prostate Cancer
Chemotherapy may be used for patients with metastatic prostate cancer, with the aim of slowing any further spread of cancer and improving quality of life.
The most commonly used chemotherapy medications, typically given via an intravenous line, are docetaxel combined with prednisone. However, there are several chemotherapy drugs available, so ask your doctor which types may be most appropriate for your treatment.
In some cases, these treatments are considered palliative, intended to relieve difficult symptoms and improve quality of life.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
Enzalutamide Improves Survival In Patients With Metastatic Prostate Cancer
Summary
In an international randomizedphase III clinical trial, the hormone therapy enzalutamide extended survival in men with metastatic prostate cancer that had progressed during treatment with androgen deprivation therapy. Participants in the trial had not received chemotherapy.
New England Journal of Medicine, June 1, 2014.
Background
Early in their development, prostate cancers need relatively high levels of male sex hormones to grow. The testes are the main source of androgens, and treatments that stop the testes from producing male sex hormonesknown as hormone therapy or androgen deprivation therapy are therefore a common treatment for androgen-sensitive prostate cancer. However, most prostate cancers eventually become castrate resistantthat is, they can grow even when androgen levels in the blood are very low. ADT does not block production of the small amount of androgen that is made by the adrenal glands and by prostate cancer cells themselves, and this low level is sufficient to fuel the growth of castrate-resistant prostate cancers.
Enzalutamide is among several hormone therapies that have been developed to prevent the androgen-fueled growth of castrate-resistant prostate cancers. This drug works by keeping androgens from binding to the androgen receptors on prostate cancer cells.
The Study
Men in the trial were randomly assigned to receive 160 mg of enzalutamide or a placebo taken orally once daily.
Results
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