How Soon Can We Detect This
One of the main advantages of surgery over radiotherapy for prostate cancer is that following prostate removal, the PSA should be very low , which we can of course detect with blood tests. If metastasis occurs, because the metastatic cells originated in the prostate and therefore make PSA, the PSA level in the blood starts to rise. Once it has reached a given threshold additional or salvage treatment will be discussed.
A PSA level of more than 0.2 ng/ml defines biochemical recurrence. At this stage the cancer is still much too small to be seen on scanning. If it can be seen on a scan it is termed clinical recurrence, which generally does not occur until the PSA level is more than 0.5 ng/ml. Symptoms, such as bone pain, dont usually occur until the PSA is more than 20 ng/ml.
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
Should I Get A Second Opinion About My Gleason Score And Prostate Cancer Diagnosis
It is always the patients right to obtain a second opinion about a cancer diagnosis or any other medical condition. Talking to a radiation oncologist will allow them to review your pathology report and request any other tests they may need to make sure you have the right information to make a decision about your treatment plan.
If you would like one of our radiation oncologists to review your pathology report, you only need to sign a release so we can have your biopsy material sent to us. We can then determine the Gleason score our team sees. Most of the time, the Gleason score we determine is the same, but not always. Because the Gleason score is the most important issue about your particular cancer, we want it to be as accurate as possible.
Its critical to personally research prostate cancer treatment options to make an informed decision that is best for you and your family. And, with few exceptions, your first treatment gives you the best chance for success. If your urologist has told you that you have a Gleason score of 6 10, or you would like a second opinion, request an appointment for a consultation.
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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.
Types Of Cancers That Are More Likely To Go Undetected
Some cancers are more easily detected than others. For example, certain types of skin cancer can be diagnosed initially just by visual inspection though a biopsy is necessary to confirm the diagnosis.
But other cancers can form and grow undetected for 10 years or more, as one study found, making diagnosis and treatment that much more difficult.
This table provides an overview of common cancers that often display little or no symptoms early on, and how theyre typically detected and diagnosed:
|Type of cancer
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How Do Health Care Professionals Determine Bladder Cancer Staging
Bladder cancer is staged using the tumor node metastases system developed by the International Union Against Cancer in 1997 and updated and used by the American Joint Committee on Cancer . In addition, the American Urologic Association has a similar staging system that varies slightly from that used by the AJCC. The combination of both staging systems appears below. This staging gives your physician a complete picture of the extent of the persons bladder cancer.
The T stage refers to the depth of penetration of the tumor from the innermost lining to the deeper layers of the bladder. The T stages are as follows:
- Ta Noninvasive papillary carcinoma
The presence and extent of involvement of the lymph nodes in the pelvic region of the body near the urinary bladder determines the N stage. The N stages are as follows:
The metastases or the M stage signifies the presence or absence of the spread of bladder cancer to other organs of the body.
- Mx Distant metastasis cannot be evaluated
- M0 No distant metastasis
A health care professional then assigns a stage:
What Medications Can Cause Night Sweats
Night sweats are frequently caused by medications. Sweating at night is a side effect of many kinds of drugs including those that affect the sweat glands, the nervous system, or the regulation of body temperature.
- Antidepressants: Antidepressants are often linked to night sweats. Nearly all types of antidepressants have been associated with increased sweating, which usually begins within a few weeks of starting a new antidepressant drug.
- Methadone: Methadone, as well as several other prescription and illicit opioids, can cause a general increase in sweating.
- Hormonal medications: Medications that affects certain sex hormones, like estrogen and testosterone, may cause hot flashes and an overall increase sweating.
Other drugs associated with increased sweating include nonsteroidal anti-inflammatory drugs , corticosteroids, beta blockers, antihistamines, and cough suppressants.
If you are concerned that a prescribed medication may be causing your night sweats, please be sure to speak with a doctor before stopping the drug or changing your dose.
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What Are The Side Effects Of External Beam Radiation Therapy
As with most prostate cancer treatments, external beam radiation therapy can also cause side effects. The severity can depend on the type of radiation, dose size, length of treatment and area of treatments. These frequently include:
- Skin irritation
- Erectile dysfunction
- Secondary malignancy
If you are considering prostate cancer treatment with a form of EBRT, talk with your radiation oncologist to discuss options, potential side effects, and how those side effects will be managed.
Recently, the FDA approved the use of Space OAR, a hydrogel product for men choosing radiation therapy that can reduce the radiation received by the rectum during treatment. This can help decrease the chances of developing rectal complications such as the inability to control your bowels. The hydrogel is injected between the prostate and rectum where the gel solidifies and creates a space before radiation begins. To learn more about this product, visit the manufacturers site here.
Which Prostate Cancers Really Need Treatment
July 9, 2013 by Bert Vorstman
> some 75% of all prostate cancers diagnosed are classed as favorable-risk Gleason 6 > GENERALLY, MOST of these favorable-risk Gleason 6 stage T1c prostate cancers need NO treatment whether through focal therapy or whole gland treatment> GENERALLY, MOST favorable-risk Gleason 6 cancers do NOT PROGRESS while being monitored on ACTIVE SURVEILLANCE> 25% or less of prostate cancers detected are the high-risk significant prostate cancers and it is these cancers which demand treatment> NOT ALL PROSTATE CANCERS ARE EQUAL> more people die from drug resistant infections every year than from breast cancer and prostate cancer combined> the importance of prostate cancer is greatly overemphasized> the preoccupation with PSA prostate cancer screening and detection, particularly for the insignificant Gleason 6 prostate cancer, is disingenuous
THEREFORE, on both MOLECULAR and CLINICAL fronts, it is ABUNDANTLY CLEAR thatthe Gleason 6 prostate cancer is essentially,> INSIGNIFICANT> a MISNOMER and should NOT be called a cancer> grossly MISMANAGED and MISTREATED as if a significant high-risk cancer
Which prostate cancers really need treatment?> only some 25% of prostate cancers diagnosed are classified as high-risk> significant or high-risk prostate cancers needing treatment are: * men with Gleason 4+3, 4+4 and above * men with significant volume of 4s in a Gleason 3+4
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Gleason Score For Grading Prostate Cancer
Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.
The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.
Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
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Radical Prostatectomy Versus Radiation Therapy
The natural history of the disease, life expectancy of the patient, and potential for cure provide compelling reasons to treat the patient presented in this point-counterpoint discussion aggressively, with the intent to cure the prostate cancer. The next question, and the primary subject of this point-counterpoint discussion, is whether to offer radical prostatectomy or radiation therapy. The decision to offer one treatment or the other must reflect a critical analysis of benefits and risks.
As cancer diagnoses go, prostate cancer is often a less serious one. Prostate cancer is frequently slow-growing and slow to spread. For many men, prostate cancer is less serious than their other medical conditions.
For these reasons, and possibly because of earlier detection of low-grade prostate cancers, prostate cancer has one of the highest survival rates of any type of cancer. WebMD takes a look at prostate cancer survival rates and what they mean to you.
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Survival Rates In Prostate Cancer: The Facts
For you as a patient, the disease-specific survival rate is the decisive aspect: what are the chances of surviving prostate cancer? 98 % of our patients who underwent radical prostatectomy, and in whom the tumor was confined to the prostate gland , were still alive 10 years after their operation. Even in patients with an advanced stage tumor , the survival rates are between 72 and 95 %.
Disease-speciic survival rates of our patients after 10 years in percent
The table on the page Results shows the disease-specific survival rate of our patients following surgery, according to the stage of the tumor.
- If the tumor was confined to the protstate or had only spread to the periphery of the prostate, the 10-year survival rate was more than 98%.
- If cancer cells had already spread to the seminal vesicle or to the area surrounding the prostate, the rate was between 87% and 77% respectively.
- If the lymph nodes were affected , 81% of our patients survived.
- If the preoperative PSA value was > 20 ng/mL , the disease-specific survival rate was 93%.
- If the preoperative Gleason Score was 8 or higher, 70% of the patients survived.
Chemo Drugs Used To Treat Prostate Cancer
For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer include:
In most cases, the first chemo drug given is docetaxel, combined with the steroid drug prednisone. If this does not work , cabazitaxel is often the next chemo drug tried .
Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They may slow the cancers growth and also reduce symptoms, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.
Other chemo drugs being studied for use in prostate cancer include carboplatin, oxaliplatin, and cisplatin.
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How Is Prostate Cancer Diagnosed
Doctors describe the growth and spread of prostate cancer in stages. Doctors use these stages as guides when choosing treatment options or offering prognoses to their patients.
Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests such as a digital rectal exam or prostate-specific antigen test and imaging studies like bones scans, MRIs, CT scans, and trans-rectal ultrasounds.
Towards A Meaningful Definition Of High
In the United States, approximately 238,590 men were expected to be diagnosed with prostate cancer in 2013, and 29,720 prostate cancer patients were anticipated to die of their disease in 2013.2 Many of the patients who die of prostate cancer present initially with tumours seemingly confined to the gland this arguably represents true high-risk disease and new approaches are needed for these patients. By current estimates, high-risk disease accounts for 15% of all prostate cancer diagnoses3. The limitations of determining risk based on the T, N, M classification, which does not include Gleason score or PSA, have long been recognized. An important first step toward a more reliable schema was first proposed by DAmico et al.,4 using an endpoint of PSA failure and defining high-risk as a clinical T stage cT2c, a Gleason score 8, or a PSA > 20 ng/mL this definition has been adopted by the American Urological Association .5 The Radiation Therapy Oncology Group developed the first classification which associated specific baseline factors with overall survival and cause-specific survival, arguably more relevant measures. High risk in the RTOG classification includes 1) Gleason 8, or 2) Gleason =7 plus either cT3 or node-positive PSA adds little to this model for the prediction of cause-specific survival or overall survival.6 When combining the RTOG model with the Kattan nomogram, the ability to predict prostate cancerspecific survival is improved.7
Myth : It Is Futile To Treat Advanced Cancers As Most Men Die Soon Regardless Of Treatment
Unlike other cancers, prostate cancer, even in advanced stages, respond well to several modalities of treatment, with significant survival rates. With recent advances in hormonal therapy, the quality of life even in advanced prostate cancer can be good. Hence, treatment should be offered even in advanced prostate cancer.
Does Overdiagnosis Lead To Overtreatment Of Older Men
The widespread use of PSA screening has led to an increase in the diagnosis and treatment of early localized prostate cancer. Data from the US Cancer of the Prostate Strategic Urological Research Endeavor database suggest a significant decrease in risk in the last 2 decades in the United States, with more patients being identified with low-risk disease at diagnosis,29 but the role of active treatment of low- and intermediate-risk disease in elderly men remains controversial.
The median time from diagnosis to death from prostate cancer for men with nonpalpable disease is approximately 17 years.30,31 Considering that the US male life expectancy at the age of 65 years is 16 years, aggressive therapy will hardly extend life expectancy of older men with no palpable prostate cancer at the time of diagnosis.32 Twenty to 30% of prostate cancers detected by PSA screening programs show Gleason scores of 6 or lower and, thus, are not poorly differentiated and have volumes smaller than 0.5 cm3.3335
Histologic evaluation of radical prostatectomy specimens demonstrated that about 20% to 30% of cancers are small volume, show low Gleason scores, and are consequently clinically harmless.35,36 Many of these cancers pose little threat to life, especially for older men. Has PSA screening resulted in prostate cancer overdiagnosis?
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Side Effects Of Prostate Cancer Radiotherapy
Radiotherapy to the prostate can cause some side effects, such as loose or watery poo and passing urine more often.
Side effects tend to start a week or 2 after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so after treatment finishes
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned.
Multiple Imputation And Missing Data
We used multiple imputation to impute missing data taking the variables of T-stage and histopathologic grading, age, and treatment into account. Missing data were mostly confined to the grading parameter in the German data . For propensity score matched analyses and year-specific Cox regression analyses, we used PROC MI in SAS. In piecewise proportional hazard models, we applied the mice package in R. Matching results for the complete data are shown in Table S2, which indicate equal mean values and proportions between treatment groups.
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