Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
What Happens If Prostate Cancer Comes Back
The prostate is a small gland about the size of a walnut that helps make seminal fluid. Its intertwined with your urinary tract system, resting below your bladder and surrounding the urethra. As you age, this gland continues to grow, sometimes resulting in benign prostatic hyperplasia. While this growth is normal, cancerous growth is not. Cancer occurs when the cells in your prostate gland begin to grow out of control.
While prostate cancer is common, especially among older men, its got a fairly positive outcome. When caught early and treated, most men survive and continue on with remission after five years. Unfortunately, for a small percentage of men, the cancer returns. To give you some clarity on this situation, heres what happens if prostate cancer comes back.
What Causes Prostate Cancer And Am I At Risk
Every man is at risk for prostate cancer as he ages. Although prostate cancer can affect younger men, about 6 out of 10 cases are diagnosed in men over the age of 65. The average age of diagnosis is 66. After non-melanoma skin cancer, prostate is the most common cancer diagnosed in men in the United States. The American Cancer Society estimates there will be 248,530 new cases of prostate cancer each year.
Although there are several known risk factors for getting prostate cancer, no one knows exactly why one man gets it and another doesnt. Some important risk factors for prostate cancer are:
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Is The Psa Test Recommended For Prostate Cancer Screening
Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.
Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
An Increased Psa Level
A biochemical relapse is when your PSA level rises after having treatment that aims to cure your cancer.
You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly to see if your PSA rises quickly or stabilises. You might have a scan if your PSA rises quickly.
The choice about whether to have treatment and what treatment to have will depend on:
- the treatment you have already had
- your general health
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Symptoms Of Prostate Cancer
- Frequent urge to pass urine, especially at night
- Weak or interrupted urine stream
- Pain or burning when passing urine
- Blood in the urine or semen
- Painful ejaculation
- Nagging pain in the back, hips, or pelvis
Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.
What Causes Prostate Cancer
Researchers do not know exactly what causes prostate cancer. But they have found some risk factors and are trying to learn just how these factors might cause prostate cells to become cancer cells.
On a basic level, prostate cancer is caused by changes in the DNA of a normal prostate cell. DNA is the chemical in our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look.
Some genes control when our cells grow, divide into new cells, and die:
- Certain genes that help cells grow, divide, and stay alive are called oncogenes.
- Genes that normally keep cell growth under control, repair mistakes in DNA, or cause cells to die at the right time are called tumor suppressor genes.
Cancer can be caused by DNA mutations that keep oncogenes turned on, or that turn off tumor suppressor genes. These types of gene changes can lead to cells growing out of control.
DNA changes can either be inherited from a parent or can be acquired during a persons lifetime.
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General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
How To Involve Your Spouse Or Partner In Your Advanced Prostate Cancer Care
Whether diet can impact either your risk of getting prostate cancer or your prognosis is an area of active study, but there have been few answers so far. Clearer evidence exists with regard to supplements, with the general consensus being that theyre not helpful. The best advice so far: Follow a diet thats good for the heart and focus on whole foods.
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People Are Also Reading
When a PSA level that was previously undetectable after treatment such as surgery starts rising, it is almost always due to recurrence of cancer. However, this doesnt seem to be the case for you. I suspect the very low levels you see now are either due to a very small amount of normal prostate tissue left after surgery or other tissues making PSA. Levels below 0.1 ng/mL are of uncertain significance, and the fact that they have stayed low for 10 or more years is good evidence that there has been no recurrence of cancer.
Dear Dr. Roach In 1976 I lost a lung to cancer. I have enjoyed my life and never had a problem. Recently, I fell on the golf course, and landed on my chest on the good lung side. When I hit the ground, I heard a loud crack. I had an X-ray that day, and was so happy the X-ray showed no broken bones. It did show two or three calcium spots in the remaining lung.
Over the years I have had numerous X-rays, and they have all been clear. My doctor didnt seem concerned. I remember having pneumonia as a kid, but that was 75 years ago. Can you explain where these deposits come from? Should I be concerned? S.C.A.
Stages Of Prostate Cancer
Doctors combine the T, N, and M results with the Gleason score and PSA level in a process called stage grouping. The system uses Roman numerals from I to IV . The stage helps your doctor choose the best course of treatment for you.
Stage I
- The cancer is growing in your prostate but hasnât spread beyond it.
- In most cases, the doctor canât feel the tumor during a DRE or see it in imaging tests.
- The Gleason score is 6 or less, and the PSA level is less than 10.
- The tumor is in half or less of one side of the prostate.
Stage IIA
- The cancer is growing in your prostate but hasnât spread beyond it.
- The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
- The tumor can touch more than half of one lobe of the prostate but doesnât involve both lobes.
- The Gleason score is 7 or less, and the PSA level is less than 20.
Stage IIB
- The cancer is growing in your prostate but hasnât spread beyond it.
- The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
- The tumor can be in one or both lobes of the prostate.
- The Gleason score is 7, and the PSA level is less than 20.
Stage IIC
- The cancer hasnt spread beyond the prostate.
- The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
- The tumor can be in one or both lobes of the prostate.
- The Gleason score is 7 or 8, and the PSA level is less than 20.
- The cancer cells appear more abnormal than in stage IIB.
Stage IIIA
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Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
How We Treat Prostate Cancer
The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.
Understanding The Recurrent Prostate Cancer
Recurrent prostate cancer is when prostate cancer returns after the initial treatment or partial to complete remission has occurred. This is due to the reemergence of surviving prostate cancer cells that have grown large enough to be detected.
Following a prostatectomy, your prostate-specific antigen levels being to decrease. Eventually, they are no longer detectible, which is an indication that prostate cancer is no longer present. However, there is no clear reference for a normal PSA. It differs between men and can be affected by a number of factors. Following your initial prostate cancer treatment, PSA levels should stabilize and be low enough to where theyre not detected on blood tests. In some cases, PSA levels begin to rise again, indicating a need for further tests.
Even if youve had a prostatectomy, prostate cancer can recur in the immediately surrounding tissue, lymph nodes, seminal vesicles, muscles that control urination, the rectum, the wall of the pelvic, or metastasize into lymph nodes and bones further away.
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Types Of Prostate Cancer
Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells .
Other types of cancer that can start in the prostate include:
- Small cell carcinomas
- Neuroendocrine tumors
- Transitional cell carcinomas
- Sarcomas
These other types of prostate cancer are rare. If you are told you have prostate cancer, it is almost certain to be an adenocarcinoma.
Some prostate cancers grow and spread quickly, but most grow slowly. In fact, autopsy studies show that many older men who died of other causes also had prostate cancer that never affected them during their lives. In many cases, neither they nor their doctors even knew they had it.
Who Is At Risk For Prostate Cancer
Certain men are at higher risk than others for prostate cancer, which may affect when they should start being screened. The risk increases with age, particularly after age 50. Some risk factors include:
- African American men are twice as likely as white men to develop the disease.
- Having a family history a father or a brother diagnosed with prostate cancer, particularly if it is at a relatively early age increases the risk.
- Having a family history of breast and ovarian cancer may also be associated with an inherited risk of developing prostate cancer
- High-fat diet and/or obesity
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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.
- Stages I & II: The tumor has not spread beyond the prostate. This is often called early stage or localized prostate cancer.
- Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called locally advanced prostate cancer.
- Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called advanced prostate cancer.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . If prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer. Stage IV prostate cancer is not curable, but there are many ways to control it. Treatment can stop advanced prostate cancer from growing and causing symptoms.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
If your Prostate Specific Antigen level has risen after the first treatment but you have no other signs of cancer, you have biochemical recurrence.
Castration-Resistant Prostate Cancer
Metastatic Hormone-Sensitive Prostate Cancer
Digital Rectal Exam And Psa Test
Two tests are particularly helpful in screening for prostate cancer.
Digital rectal exam
A DRE is done to determine if the prostate is enlarged and is either soft, has bumps or is very firm . During a digital rectal exam, a doctor checks for prostate abnormalities using a gloved, lubricated finger .
PSA Test
Another test is done on a blood sample to determine the level of a protein produced by prostate cells. The PSA test may indicate a person has a higher chance of having prostate cancer but controversies about the test exist . The patient and his doctor need to carefully consider the meaning and the use of these test results.
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The Gleason Score: What Does It Mean
The Gleason score functions as a measurement of the aggressiveness of prostate cancer.
Aggressiveness is the medical term used to describe the likelihood of the tumor spreading outside the prostate gland.
You will get receive a Gleason score after having a prostate biopsy.
Your doctor may recommend a biopsy if your PSA level rises or there is cause for concern after your annual checkup or a digital rectal exam , such as an increase in prostate volume or nodules and legions.
Modern biopsies are typically performed using transrectal ultrasound guidance, whereas older methods were unassisted these are called random needle biopsies. By using ultrasound guidance, the doctor can take a more accurate and evenly distributed sample from the prostate gland.
Normally twelve separate cores are extracted. After which they are sent to a laboratory.
At the laboratory, a pathologist examines the tissue cores using a microscope to see if they contain cancerous cells.
If the pathologist finds evidence of prostate cancer cells in the sample, he will attempt to match your samples with Gleason guidelines. These guidelines are scored between one and five.
Your Gleason score is made up of two of these guidelines, and therefore, your score can range from two to ten.
It is then put into a pathology report sometimes called a biopsy report, that will be sent to your primary care physician.
For more information on prostate biopsies click here.
Detecting Prostate Cancer Recurrence
If you have recurrent prostate cancer, its usually detected during follow up appointments. Once you undergo initial prostate cancer treatment, youll need to see your urologist once every few months to monitor your PSA levels and discuss any new symptoms. If your PSA levels begin to rise, it can be an indication that the cancer has returned. Your doctor will use imaging tests to try and locate the cancer and determine the best course of action for a second round of treatment. Tools for detection are continually improving, so be open to suggestions from your doctor.
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What Is The Psa Test
Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a mans blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the US Food and Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the use of the PSA test in conjunction with a digital rectal exam to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing to help doctors determine the nature of the problem.
In addition to prostate cancer, a number of benign conditions can cause a mans PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis and benign prostatic hyperplasia . There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.