Who Uses Cam Instead Of Medicine
So how would a decision to accept no treatment, or to only use alternative medicine, compare to conventional cancer care ? And what about delaying conventional cancer care to allow a trial of alternative medicine does it have a measurable effect? Answering this question isnt straightforward. In cancer research, new drugs are typically added to, or follow, established therapies, so all patients receive standard treatment options as part of their care. So we cant ethically randomize patients to nothing, when established treatments exist. But we can answer this question in a different way: Patients that voluntarily opt out of cancer treatment can be followed, and compared to patients that do take cancer treatment. While it isnt a prospective randomization, which would be the gold standard, its the best we can get. But even this approach is difficult. Most patients who decide to opt-out of cancer treatment, also opt-out of any follow-up evaluation. So tracking down patients, and their outcomes, is essential.
Nutrition And Dietary Supplements
Some studies have suggested that eating a healthy diet that is rich in vegetables and lower in animal fats might be helpful, but more research is needed to be sure. However, we do know that a healthy diet can have positive effects on your overall health, with benefits that extend beyond your risk of prostate or other cancers.
So far, no dietary supplements have been shown to clearly help lower the risk of prostate cancer progressing or coming back. In fact, some research has suggested that some supplements, such as selenium, might even be harmful. This doesnt mean that no supplements will help, but its important to know that none have been proven to do so.
Dietary supplements are not regulated like medicines in the United States they do not have to be proven effective before being sold, although there are limits on what theyre allowed to claim they can do. If you are thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that could be harmful.
Improvements In Life Expectancy
A decade ago, a man with metastatic prostate cancer would typically have a life expectancy of two to three years. Today, life expectancy for men with the same advanced disease is likely to be five to six years. In the UK the survival rate for men with stage 4 prostate cancer is approximately 50%, meaning that 50 out of every 100 men will survive their cancer for 5 years or more after they are diagnosed with stage 4 prostate cancer*. There is now a much broader range of chemotherapy drugs available for men with advanced disease with greater efficacy . We also have better treatments to control the symptoms of advanced prostate cancer, such as pain from metastases. In this section, we consider in more detail the different treatments that are available and evidence for their effectiveness.
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Getting More Information About What To Expect
- National Institute for Health and Care Excellence. Palliative care for adults: strong opioids for pain relief. Clinical guideline 140. 2012.
- National Institute for Health and Care Excellence. Prostate cancer: Diagnosis and treatment. NICE clinical guideline 175. 2014.
- Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, DAndrea G, et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res CR. 2005 Jun 24:2037.
- Thompson JC, Wood J, Feuer D. Prostate cancer: palliative care and pain relief. Br Med Bull. 2007 83:34154.
- Vinjamoori AH, Jagannathan JP, Shinagare AB, Taplin M-E, Oh WK, Van den Abbeele AD, et al. Atypical Metastases From Prostate Cancer: 10-Year Experience at a Single Institution. Am J Roentgenol. 2012 Aug 199:36772.
- Kate Bullen, Head of School for Applied Social Science, University of Brighton, Brighton
- Jackie Dawson, Community Palliative Care Clinical Nurse Specialist, Guys and St Thomas NHS Foundation Trust
- Hazel Parsons, Palliative Care Nurse Specialists, Dorothy House Hospice, Winsley, Bradford on Avon
- Elizabeth Rees, Lead Nurse for end of life care, Leeds Teaching Hospitals
- Our Specialist Nurses
Outcome Analysis Of Breast Cancer Patients Who Declined Evidence
Here is the recent paper I referred to above, which studied women with breast cancer in Northern Alberta who refused standard treatments. It was also a chart review with a matched pair analysis that compared survival with those that received conventional cancer care. Between 1980 and 2006 they identified 185 women that refused cancer care following diagnosis by biopsy. Women older than 75 were excluded from the analysis because this population is generally not included in clinical trials and active treatment regimens. In addition, women that accepted surgery, but rejected chemotherapy/radiation were excluded from the analysis. To qualify, women had to have rejected all conventional care. The final population studied was 87 women, most of whom presented with early disease. Most were married, over the age of 50, and urban residents. In this group, the primary treatment was CAM in 58%, and was unknown in the remainder. Some women in this group eventually accepted cancer care, and the average delay was 20-30 weeks due to CAM use.
The results were grim. The 5 year overall survival was 43% for women that declined cancer care, and 86% for women that received conventional cancer care. For cancer-specific survival survival was 46% vs. 85% in those that took cancer care. The survival curves are ugly:
All causes of deaths and deaths due to breast cancer only
The authors compared the CAM group to those where treatment plan was not known:
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Clues In Diet And Lifestyle
To clarify the prognosis for a tumor, HSPH researchers are homing in on other factors that might affect susceptibility to prostate cancer, especially the aggressive form of the disease. Edward Giovannucci, professor of nutrition and epidemiology, recently looked at nine diet and lifestyle factors. He found that smoking, obesity, and lack of physical activity raise the risk of developing a more virulent cancer. According to Giovannucci, The question is whether there are two types of prostate canceran aggressive and nonaggressive formor whether certain factors cause a nonaggressive form to become more aggressive. Evidence provided by HSPH researchers suggests that an increase in insulin in the bloodstream, caused by obesity and physical inactivity, may encourage tumor growth.
Other investigations have linked dietary factors to the disease. A 2011 study by HSPH research associate Kathryn Wilson, together with Mucci and Giovannucci, professor of nutrition and epidemiology Meir Stampfer, and other colleagues, found that men who drank coffee had a notably lower risk of aggressive prostate cancer. Those who consumed six cups or more a day were 20 percent less likely to develop any form of the disease, and 60 percent less likely to develop a lethal disease those who consumed one to three cups a day showed no difference in developing any form of the disease, but had a 30 percent lower risk of developing a lethal form.
Common Thoughts And Feelings
You may feel all sorts of things after you finish treatment. Some men are relieved and feel ready to put the cancer behind them and get back to normal life. But others find it difficult to move on. Adjusting to life after cancer can take time.
For some men, the emotional impact of what they have been through only hits them after they have finished treatment. You might feel angry for example, angry at what you have been through, or about the side effects of treatment. Or you might feel sad or worried about the future.
Follow-up appointments can also cause different emotions. You might find it reassuring to see the doctor or nurse, or you may find it stressful, particularly in the few days before your appointments.
Worries about your cancer coming back
You may worry about your cancer coming back. This is natural, and will often improve with time. There are things you can do to help manage your concerns, such as finding ways to reduce stress. Breathing exercises and listening to music can help you relax and manage stress. Some people find that it helps to share what theyre thinking with somebody else, like a friend. If you are still struggling, you can get help for stress or anxiety on the NHS you can refer yourself directly to a psychological therapies service or ask your GP.
If youre worried about your PSA level or have any new symptoms, speak to your doctor or nurse. If your cancer does come back, youâll be offered further treatment.
Feeling isolated
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.
How Your Doctor Monitors You After Treatment
After treatment you have follow up appointments, which usually include regular blood tests to check the levels of a protein called prostate specific antigen . They check to see if your PSA level rises. And they also look at how quickly it rises.
An increase in PSA can mean there are prostate cancer cells in your body. The cells might be in or around the prostate. Or they might have spread to other parts of your body. You might need treatment if it rises.
Prostate cancer that comes back after treatment is called recurrent prostate cancer.
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How Is Advanced Prostate Cancer Treated
The primary treatment of prostate cancer is prostatectomy, which is a surgery to remove a part of the prostate gland or the entire prostate gland in younger patients.
Androgen deprivation therapy is usually the choice of treatment of metastatic prostate cancer. Also known as hormone therapy, it is also used for treating patients who are unfit or unwilling to undergo surgery or/and radiation therapy.
Examples of hormone therapies for advanced prostate cancer include
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Patients Refusal Of Surgery Strongly Impairs Breast Cancer Survival
This was a Swiss study by Verkooijen et al, published in 2005 in the Annals of Surgery that looked at 5339 patients under the age of 80 with non-metastatic breast cancer. It didnt examine CAM, just the decision to refuse breast cancer surgery. It compared patients who refused breast cancer with those that those that accepted surgery. Only 1.3% of women refused surgery. Of that group, 37 had no treatment, 25 had hormone-therapy only, and 8 had other types of treatments. So only a small percentage refused all treatment. In this study, the five-year survival of women that refused surgery was 72% versus 87% of women who had surgery. Adjusting for prognostic factors, the authors estimated that women that refused surgery had a 2.1-fold increased risk of death from breast cancer compared to conventional treatment. The survival curves make this clear:
The bottom line in this paper was that a decision to forgo surgery for breast cancer is associated with dramatically worse outcomes and survival.
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What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
How Is Prostate Cancer Diagnosed
There are several tests your doctor may perform to check your prostate:
- Digital rectal examination : Your doctor inserts a gloved, lubricated finger into your rectum to feel the prostates size and check for anything unusual.
- Prostate Specific Antigen test: A simple blood test to measure a protein produced by your prostate. A high PSA might be a sign of prostate cancer, or another condition.
- MRI scan: A detailed scan of your prostate to help identify signs of cancer.
While these tests are helpful, a prostate biopsy is the only way to confirm a diagnosis of prostate cancer. A urologist, who your doctor will refer you to, removes some cells from your prostate using a thin, hollow needle. The cells are then examined under a microscope to check for cancer.
Confirmed prostate cancer is graded on a scale of 1 to 5 , based on how likely the cancer is to grow and spread to the rest of the body. Grade groups 4 to 5 are considered high risk.
An older system of grading, known as the Gleason score, grades the cancer from 1 to 10. A Gleason score of 8 to 10 is considered high risk.
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What About Other Treatments I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
What Are The Symptoms Of Prostate Cancer
Even if you have prostate cancer, you may not notice any symptoms unless the cancer grows large enough to cause problems.
Some symptoms of advanced prostate cancer include:
- needing to urinate frequently or suddenly
- finding it difficult to urinate
- discomfort when urinating
- pain in the lower back, upper thighs or hips
While these symptoms might not mean prostate cancer, if you notice any of them, check with your doctor.
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Prostate Cancer Risk Groups
Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .
Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.
The risk group of the cancer will help determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
Make The Right Choice And Schedule An Appointment With Z Urology
Whether you already know that you have prostate cancer or you are experiencing symptoms that are commonly associated with prostate cancer, you need to schedule an appointment with the team at Z Urology.
Our multilingual team understands that the idea of surgery is scary which is why we make our patients as comfortable and relaxed as possible. We take care of everything for you explain everything in detail so that you know exactly what to expect.
You can visit our website directly and schedule an appointment at your convenience or !
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What Happens If I Decide Not To Treat My Prostate Cancer
Should I treat my prostate cancer or leave it alone? The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present. But lets take a look at the natural history of prostate cancer if it is not treated
While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their doctors monitor their cancer, especially if its expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. This is called active surveillance, meaning doctors will initiate cancer treatment only if the cancer starts growing.
Others choose no cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits. This option is certainly OK and reasonable in the right circumstances requiring a careful and thoughtful discussion with your doctor and family.
What happens if prostate cancer is ultimately left untreated?
Where does prostate cancer spread?
Most cases of diagnosed prostate cancer, however, if left untreated, will grow and possibly spread outside of the prostate to local tissues or distantly to other sites in the body. The first sites of spread are typically to the nearby tissues.