How Serious Is My Cancer
If you have prostate cancer, the doctor will want to find out how far it has spread. This is called the stage of the cancer. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what types of treatment might be best for you.
The stage is based on the growth or spread of the cancer through the prostate, and if it has spread to other parts of your body. It also includes your blood PSA level and the grade of the cancer. The prostate cancer cells are given a grade, based on how they look under a microscope. Those that look very different from normal cells are given a higher grade and are likely to grow faster. The grade of your cancer might be given as a Gleason score or a Grade Group . Ask your doctor to explain the grade of your cancer. The grade also can helpdecide which treatments might be best for you.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside the prostate.
If your cancer hasn’t spread to other parts of the body, it might also be given a risk group. The risk group is based on the extent of the cancer in the prostate, your PSA level, and the results of the prostate biopsy. The risk group can help tell if other tests should be done, and what the best treatment options might be.
What Questions Should I Ask My Doctor
Learning about your condition can empower you to make informed decisions. Some people only want to know the basics, while other people prefer to know every detail about their prognosis. Here are some questions you may want to ask your healthcare provider:
- Are there things I can do to improve my prognosis?
- What are my treatment options?
- Are there clinical trial options that might be appropriate for me?
- Will palliative care continue even if I stop cancer treatments?
- How often will I need to schedule follow-up appointments?
- Do I need to consider hospice care?
- Should I choose a person to make medical decisions for me when Im unable to make them for myself?
- What legal documents should I have in place?
- What resources are available to help me cope with my prognosis?
A note from Cleveland Clinic
A metastatic cancer diagnosis is one of the scariest things you may ever encounter. If you or a family member has been diagnosed with advanced cancer, youre probably feeling a lot of complicated emotions. While most metastatic cancers arent curable, there are treatments that can ease your symptoms and prolong your life. Ask your healthcare provider for resources and consider joining a local support group. Talking with other people who are going through the same thing can be healing during this emotionally difficult time.
Last reviewed by a Cleveland Clinic medical professional on 12/20/2021.
References
Where Does Prostate Cancer Usually Spread First
Once prostate cancer cells start spreading, they are most likely to affect the bones first and foremost. At this point, patients receive the diagnosis of prostate cancer with bone metastases.
This prognosis indicates a stage 4 case of prostate cancer, which is the most advanced type of cancer. When this occurs, patients feel bone pain, and their bones are weakened. The risk of getting bone fractures becomes incrementally higher.
Today, there are no cures to completely treat stage 4 prostate cancer. Nonetheless, patients are recommended to consider palliative care. This type of treatment focuses on pain alleviation and on soothing other symptoms.
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Risk Factors For Formation Of Urethral Stenosis And Stricture
Post-radical prostatectomy
Radiotherapy
Risk factors include age, obesity, hypertension, diabetes, previous TURP , longer follow-up, higher radiation dose, HDR-BT, adjuvant RT and combination with BT . Delaying adjuvant RT for more than 9 months after RP may decrease stricture formation, however this is at the expense of an increase in cancer-specific mortality . Zelefsky found that intensity modulated RT increases the risk of late urinary toxicities including urethral stricture compared to 3-D conformal RT, but with lower rectal toxicity . However, a recent review found no difference in urethral stricture between 3-dimensional conformal radiotherapy and IMRT . Similar to ERBT, BT strictures affect the bulbomembranous urethra in the majority of cases, which could be due to a âhot spotâ in the distal bulbar urethra or due to caudal needle shifting in patients receiving HDR-BT , although Hindson found no relation between needle shifting and stricture incidence . A prospective, matched-pair analysis by Diez found no association between urethral stricture incidence and urethral dosimetry in patients receiving HDR-RT, however the number of events was too small to draw a definitive conclusion .
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Signs And Symptoms Of Spreading Prostate Cancer
Not all developments in the prostate are malignant, and not all prostate issues suggest cancer. Furthermore, early-stage prostate cancer hardly ever triggers signs. These issues might be more noticeable as the illness advances:
- Weak urine circulation or circulation that begins and stops.
- Regular, often immediate, require to urinate, specifically in the evening.
- Unpleasant urination .
- Blood in semen or urine.
- Lower pain in the back, hip discomfort and chest discomfort.
- Leg or feet pins and needles.
- Uncomfortable ejaculation and impotence .
Screenings are the most efficient method to capture prostate cancer really early. Furthermore, if you are not predisposed, youll most likely have your first prostate screening at the age of 55. Your doctor might begin evaluating even earlier if you have a household history of the illness.
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Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
How Can I Choose From Among The Options
In addition to talking with family and friends, you will need a team of physicians to help advise you. It is advisable that you meet with all of the specialists involved in your cancer treatment planning prior to making a decision regarding treatment, including:
- your primary care physician as well as a urologist to discuss surgery
- a radiation oncologist to discuss radiation therapy.
Once you have met with these doctors, you will be able to make a more informed decision regarding your treatment options. If you have an early-stage cancer or moderately advanced cancer and there is no evidence of spread to other organs , the two major options for treatment are surgery or radiation therapy .
If your cancer is advanced and you require hormonal suppression therapy or chemotherapy, then you will also need a medical oncologist, who administers these drugs. Hormone-ablation therapy, which is often used to treat more advanced prostate cancer by suppressing your androgen hormones since most prostate cancer growth is stimulated by androgen or testosterone. The androgen suppression treatment can be administered by your internist, urologist, radiation oncologist or medical oncologist. Depending on the stage of the cancer, hormone suppression therapy may be used in addition to radiation therapy to help control the cancer. Hormone suppression therapy may be administered for as little as four to six months, or for as long as two to three years.
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For Patients With Metastatic Cancer What Kinds Of Clinical Trials Does Msk Offer
At MSK, were fortunate to have many clinical trials available to patients. These trials may be testing a new surgical procedure, a different kind of radiation treatment, or a new drug or combination of drugs. Many of the treatments that are now considered standard for treating metastatic cancer began with clinical trials led by doctors at MSK. This includes many types of targeted therapies as well as immunotherapies.
Many of the clinical trials open at our main campus in Manhattan are also open at MSK Commack, where I see patients, as well as MSKs other Regional Care Network sites on Long Island and in Westchester and New Jersey. This means that patients can participate in these trials without traveling into the city. There are some trials that are available exclusively at our main campus in Manhattan, but were continually opening more trials at our regional sites.
How You Might Feel
When prostate cancer is advanced, it can no longer be cured. But treatment can control it for some time and help to relieve symptoms.
Finding out that your cancer cant be cured is distressing and can be a shock. Its common to feel uncertain and anxious. It’s normal not to be able to think about anything else.
Lots of information and support are available to you, your family and your friends. It can help to find out more about your cancer and the treatments you might have. Many people find that knowing more about their situation can make it easier to cope.
Talk to your doctor or nurse to understand:
- what your diagnosis means
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Diagnosing Cancer Of The Lymph Nodes
In addition to a biopsy, the TNM system is commonly used to issue a diagnosis and determine which type of treatment is best. The T refers to the size of the tumor or cancerous growth. The N refers to the number of lymph nodes that contain cancerous cells. And, the M is for metastasis, which refers to cancer thats spread to areas far from the originating tumor.5
This categorization is used in addition to other diagnostic tests and tools to determine the cancer stage such as:
- Imaging tests X-rays, CT scans, MRIs, and other types of imaging tests can provide a clearer picture and more information about where the cancer is located and how much is present.
- Endoscopy exams An endoscope is a thin, lighted tube with a video camera attached that looks around on the inside of the body for cancerous areas.
In general, cancers assigned as Stage I are less advanced and have a better prognosis and response to treatment. Whereas, a higher stage indicates that the cancer has spread further and requires a more intense or multiple types of treatment. Other factors that affect treatment are:
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What Are The Chances Of Getting Metastatic Prostate Cancer
About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.
A small percentage of men aren’t diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it’s metastatic cancer when they take a small sample of the tissue and study the cells.
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Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
What Are My Treatment Options With Advanced Prostate Cancer
The treatments your doctor recommends will depend on factors specific to you, from your overall health to how advanced your cancer was when it was first diagnosed.
Many men receive ADT, a type of hormone therapy, which deprives the body of the male hormones that the cancer needs to keep growing.
For most men, however, hormone therapy stops working at some point. Alternatives to hormone therapy were approved by the Food and Drug Administration in 2018, and Tagawa often starts men on these therapies as soon as theyre diagnosed with bone metastases. Other treatment options may be available through clinical trials.
In addition, chemotherapy, surgery, and immunotherapy as well as radiation treatments, like external beam radiation, which directly target bone problems may be considered. Major cancer centers, such as Memorial Sloan Kettering Cancer Center in New York City and MD Anderson Cancer Center in Houston, have teams of prostate cancer specialists, as well as sophisticated radiation and other treatment equipment consolidated in one place, which can help with the coordination of care.
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What Are The Most Common Sites Of Metastatic Cancer
The most common sites for cancers to metastasize include the lungs, liver, bones and brain. Other places include the adrenal gland, lymph nodes, skin and other organs.
Sometimes, a metastasis will be found without a known primary cancer . In this situation, your healthcare provider will search extensively for the primary cancer source. If none can be found, its called cancer of unknown primary .
What Are Common Symptoms Of Metastasis
Cancer that has spread may not cause any signs or symptoms. If you do experience any signs or symptoms of metastasis, the type and severity depends on where the cancer has spread.
Cancer that has spread to the bone. Signs and symptoms that cancer has spread to the bone include pain, fractures, bowel and bladder problems, muscle weakness, and hypercalcemia, which is more calcium in the blood than normal. Learn more in this fact sheet about cancer that has spread to the bone.
Cancer that has spread to the brain. Signs and symptoms that cancer has spread to the brain include include headache, seizures, dizziness, muscle weakness, balance problems, vision problems, and nausea. Cancer that spreads to the brain can also cause affect how a person’s brain processes information, including personality changes, confusion, impaired judgement, memory loss, and socially inappropriate behavior. Learn more in this fact sheet about cancer that has spread to the brain.
Cancer that has spread to the liver. Signs and symptoms that cancer has spread to the liver include appetite loss, fatigue, fever, jaundice , bloating, and swelling in the legs.
Cancer that has spread to the lungs. Signs and symptoms that cancer has spread to the lungs include coughing, coughing up blood, chest pain, breathing problems, and fluid around the lungs.
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What Are The Most Common Places For Cancer To Spread Or Metastasize
Lymph nodes are one of the most common places for cancer to spread. The liver, lungs, and bones are also common sites of metastasis. Certain types of cancer are more likely to spread to certain organs. For example, prostate cancer has a tendency to spread to bones. Melanoma, the most dangerous type of skin cancer, frequently spreads to the brain and lungs.
Stages Of Prostate Cancer
Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of the cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome . The following staging information is for adenocarcinoma, which makes up 95% of all prostate cancers. Other types of prostate cancer are staged differently.
The most common staging system for prostate cancer is the AJCC/UICC TNM system. Doctors often also use a simple staging system that describes whether the cancer has spread and if so, where it has spread. Doctors further classify prostate cancers into risk groups based on whether they are likely to come back .
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Treatment For Advanced Prostate Cancer
Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.
A multidisciplinary team will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.
The main treatments are:
- Hormonal therapy
Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.
- Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.
- Radiotherapy
Radiotherapy is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. Its given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.
- Surgery
Surgery to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.
Your doctor or nurse will usually ask you to sign a form giving your permission for them to give you the treatment. They cannot give treatment without your consent.