Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan 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.
What Will This Summary Tell Me
This summary will tell you about:
- What localized prostate cancer is
- Common treatment options for localized prostate cancer
- What researchers found about how the treatments compare
- Possible side effects of the treatments
- Things to talk about with your doctor
This summary does not cover:
- How to prevent prostate cancer
- Less common treatments for localized prostate cancer, such as high-intensity focused ultrasound , cryotherapy , proton-beam radiation therapy , and stereotactic body radiation therapy
- Herbal products or vitamins and minerals
- Treatments for cancer that has spread outside the prostate gland
*In this summary, the term doctor refers to your health care professional, including your primary care physician, urologist, oncologist, nurse practitioner, or physician assistant.
Keep A Positive Attitude
Learning more about prostate cancer and its treatments can help you develop a positive attitude. As you become informed about your options and what they mean for you, and as you talk with men who are thriving after their treatments, feelings of hope and optimism will emerge more frequently. Recognize that everyone copes differently and benefits from different types of support. Become aware of what feels most supportive to you.
Try to be with people and incorporate activities that bring you a sense of joy, peace and healing. This may mean joining a support group, spending more time with family, embracing individual counseling, varying your daily routine, setting aside special days for yourself or spending time in nature. Schedule pleasant events to boost your mood and cultivate perspective.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
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Make Smart Lifestyle Moves
A healthy diet, regular exercise, and weight management are important for keeping you healthy through prostate cancer treatment and preventing other diseases that can come along with getting older.
Another way to look at it, says Canfield, is that diet and exercise help the immune system and prostate cancer does seem to be somewhat affected by the immune system. A healthy lifestyle certainly can’t hurt your prognosis, and it may be helpful.
Here are some specific diet recommendations from the UCSF:
- Eat a variety of vegetables, including cooked tomatoes and cruciferous vegetables like broccoli and cabbage, which some studies suggest may reduce the risk of developing aggressive prostate cancer.
- Avoid processed meat and poultry. Instead, choose healthier protein sources, including salmon and other fish that contain omega-3 fatty acids.
- Focus on good fats. Instead of fried foods and saturated fat, go for olive oil, nuts, and other vegetable fat sources.
- Get plenty of calcium from low-fat sources, such as skim milk, vegetables like kale and spinach, and fortified foods like whole-grain cereals and soy or nut milks.
In addition to what you eat, aim for vigorous physical activity for at least 30 minutes on days when youre feeling able, maintain a healthy weight, and dont smoke.
Who Is At Risk For Prostate Cancer
All men are at risk for prostate cancer. Risk factors are conditions that increase your chances of developing a disease.
Assessing specific risk factors for prostate cancer can help you evaluate your situation and whether you should get screening. Its important to note that some men with risk factors may never get prostate cancer.
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Guide To Coping With Prostate Cancer
Learning that you have prostate cancer can be a shock. You may have felt numb, frightened, confused or angry. You may not have believed or even heard what the doctor was saying. You may have felt all alone, even if family or friends were in the room with you. These feelings are normal.
The first few days and weeks after diagnosis are often especially difficult. You may have trouble thinking, eating or sleeping. You and people close to you may experience a wide range of emotions, which can change often and without warning. You may swing between a sense of helpless despair and an impulse to take immediate action against your cancer. Becoming knowledgeable about prostate cancer and your treatment options can diminish this distress and will enable you to make informed decisions. You will also benefit emotionally from learning how to take charge of your treatment.
This process of educating yourself is easier with support from family, friends and health care professionals. The most important step you can take is to seek help as soon as you realize that you could use some help coping. Don’t go through this experience alone. Let your family, trusted friends and your doctors and their staff know about your struggles and any mood changes.
A variety of sources can provide information to help you during diagnosis, treatment and beyond, including:
- Your doctors and other members of your care team
- Books and articles
Consider Your Life When Making Decisions
Everyones treatment decision is personalyours is no different. Lifestyle, health history, and age are all factors to consider. For instance, if youre in your 70s, an operation could result in significant side effects and may not be the best option for you, or you may not want to jump into a routine of invasive treatments. So consider weighing the pros and cons of treatment through the quality-of-life lens. Maybe the better bet is to hold still and that way, avoid the distinct side effects of treatments, Dr. Rashid says.
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Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
Urologists Help Men Maintain Overall Health
Many men have questions about their prostate, including whether they need to see a urologist. A urologist is a doctor who has specialized training in the urinary tract and male reproductive organsincluding the prostate gland, which surrounds the urethra and produces fluid that nourishes sperm. Urologists are part of your team of doctors if you have been diagnosed with prostate cancer, but they also play an important role in maintaining your overall health.
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Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
Surgery To Remove The Prostate Gland
In this type of surgery, the surgeon removes the prostate gland and seminal vesicles . The prostate gland surrounds the upper part of the urethra . So, that part of the urethra must be removed as well. The remaining urethra is reattached to the bladder. The surgeon may also remove lymph nodes or other tissues around the prostate gland to check if the cancer has spread.
Before surgery to remove the prostate gland
After surgery to remove the prostate gland
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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.12,14 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.14 This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.15,16
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.17 Thus, older men have been shown to receive potentially curative therapy less often than younger men.18,19 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.
What Is The Survival Rate For Prostate Cancer
It is estimated that about 34,500 men will die from prostate cancer this year. Prostate cancer is second only to lung cancer as a leading cause of cancer death in the United States.8
Fortunately, about 80-85% of prostate cancers are found when the disease is localized to the prostate. For men whose prostate cancers are found early and confined to the prostate, the 5-year survival rate is nearly 100%. The ten-year survival rate is 98%, and the fifteen-year survival rate is 95%. These numbers assume the cancer does not grow in the meantime.
Stage IV prostate cancer has a five-year survival rate of 28%.9 When prostate cancer spreads to distant locations, the 5-year survival rate is 31%.10
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What Happens During The Exam
You will be asked to wear a hospital gown during the MRI scan.
As the MRI scan begins, you will hear the equipment making a muffled thumping sound, which will last for several minutes. Other than the sound, you should notice no unusual sensations during the scanning.
Certain MRI exams require an injection of a dye . This helps identify certain anatomic structures on the scan images.
Before the exam, feel free to ask questions and tell the technician or doctor if you have any concerns.
People who get anxious when in tight spaces may benefit from talking to their doctor before the procedure. Some options include taking a prescription medication before the procedure to relieve anxiety or having the exam done in one of the newer and less confining MRI units, called an open MRI, when available.
White Patients Derive A Larger Conditional Mortality Benefit Than Non
In order to determine whether race interacted with survival, we repeated our initial analyses after stratifying by race and by modeling an interaction term. Among patients with M1 disease, conditional mortality was similar between white and non-white patients . However, among patients with N1 disease, non-white patients did not have a significant reduction in conditional mortality at 5, 10, or 15 years of survival compared to diagnosis , while white patients had similar mortality as the overall cohort, with adjusted hazard ratios of 1.10 , 0.898 , and 0.712 , respectively. While non-white patients with T4 disease had improved 5-year PCSM after having survived 5, 10, or 15 years, their improvements were 20-39 % smaller than those of white patients .
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How To Do Active Surveillance Right
After a diagnosis of low-risk prostate cancer, you may be presented with a range of treatment options. Considering the slow progress of most prostate cancer, active surveillance is a reasonable choice for many men. Even if you live a long time after your diagnosis, your cancer may neverbecome aggressive and cause harm. Often, low-risk prostate cancer hardly progresses at all, even over decades.
If you choose to go the active surveillance route, do it the smart way. Dr. Hu recommends that for the first two years after your diagnosis
- Get a PSA test every six months.
- Have an office visit that includes a digital exam every six months.
- Within the first two years after diagnosis, get at least one follow-up biopsy as well as magnetic resonance imaging and precision medicine tests to reduce the risk of missing more aggressive cancer.
What happens next depends on those first two years. If it looks like your cancer is stable and not progressing, your doctor may suggest less frequent follow-ups. But if there is evidence that the cancer is becoming more aggressive, then you can decide at that time whether radiation, surgery, hormone therapy or some combination of these treatments is right for you. You may never need treatment, but if you do, youll get it when its still highly effective.
What Causes Prostate Cancer
Researchers don’t know for sure what causes prostate cancer. They do know that it happens when there are changes in the genetic material .
Sometimes these genetic changes are inherited, meaning that you are born with them. There are also certain genetic changes that happen during your lifetime that can raise your risk of prostate cancer. But often the exact cause of these genetic changes is unknown.
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To Treat Or Not To Treat
Up until now, with a few notable exceptions, doctors have myopically focused on treating prostate cancer, says Adami. They are willing to spend tens of thousands of dollars on chemotherapy that has minimal effects on cancer mortality, often with substantial side effects. But we ignore entirely the fact that large groups of prostate cancer patients die from other causes that actually are preventable.
Among older patients especially, that activity can take the form of vigorous walking. Recently, Mucci has spearheaded an intervention with Adami and other colleagues in Sweden, Iceland, and Ireland in which men walk in groups with a nurse three times a week. In a pilot study, researchers found improvements in just 12 weeks in body weight, blood pressure, sleep, urinary function, and mental health.
Scientists at HSPH are also searching for genetic and lifestyle markers that help predict how aggressive a patients prostate cancer will be. For example, an ongoing project led by Mucci and Adami draws on detailed cancer registries in Nordic countries, including an analysis of 300,000 twins, to tease out the relative contribution of different genes to prostate cancer incidence and survival.
is a Boston-based journalist and author of The Coke Machine: The Dirty Truth Behind the Worlds Favorite Soft Drink.
Work Out A Treatment Plan With Your Urologist
When active surveillance is no longer a viable option and you have to choose between radiation and surgery, its important to work out a strategic treatment plan with a urologist.
Its worth noting that your age plays a key role in determining which treatment option can deliver the best result. For example, older patients tend to get better results from radiotherapy as opposed to surgery. There are several reasons for this.
First of all, the older you are, the riskier surgical removal of the prostate becomes. Another reason why radiotherapy is preferable to elderly men is the fact that surgery is more likely to induce impotence, incontinence, or both in older patients.
Conversely, younger patients tend to benefit more from surgical treatment options. Thats because younger people are more likely to survive a surgical procedure. They are also less likely to suffer from side effects like impotence or incontinence upon having their prostate surgically removed.
The key to choosing the best treatment option starts with choosing the best doctor to manage your prostate cancer which brings us to our next discussion.
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Find Prostate Cancer Care Throughout Hampton Roads And Eastern North Carolina
If you or a loved one has been newly diagnosed with prostate cancer and are seeking treatment in the Hampton Roads and Eastern North Carolina area, we are here to help you every step of the way, including providing you resources with helpful tips and what to expect during the prostate cancer journey. The prostate cancer specialists at Virginia Oncology Associates will work with you to create a personalized treatment plans based on your specific diagnosis. Find an oncologist near you to request an appointment.
Money And Financial Support
If you have to reduce or stop work because of your prostate cancer, you may find it hard to cope financially.
If you have prostate cancer or are caring for someone who does, you may be entitled to financial support.
Find out early what help is available to you. Speak to the social worker at your hospital, who can give you the information you need.
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