Treatments To Control And Prevent Symptoms Caused By The Spread Of Prostate Cancer To The Bones
Palliative External beam radiotherapy
Radiopharmaceuticals: Strontium-89 , samarium-153
Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment.
Zolidronic acid is a bisphosphonate given by a 15-minute intravenous infusion every 34 weeks. It reduces the risk of bone complications, including pain and fractures.
Xgeva : this is a newly licensed drug available at BPC.
Surgery may be undertaken to treat bone fractures or to relieve the pressure on the spinal cord by bone metastases.
What Is The Life Expectancy Of Someone With Metastatic Prostate Cancer
In the past, the life expectancy of men with metastatic prostate cancer was 2-3 years. But with advancements in medicine and care, the life expectancy of men with metastatic prostate cancer has increased to about 5-6 years.
The 5-year survival rate of metastatic prostate cancer is 28%, which is much lower than local and regional prostate cancers. This refers to the percentage of people diagnosed with a particular cancer who can expect to live for at least 5 years after diagnosis.
Outlook For Men With Localised Prostate Cancer
Most localised prostate cancer is slow-growing and may not need treatment or shorten a mans life. For many men who have treatment for localised prostate cancer, the treatment will get rid of the cancer. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.
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Improved Survival At 4 Years
In the ARASENS trial, nearly 1,300 participants were randomly assigned to receive darolutamide or a placebo . All participants received ADT within 12 weeks before randomization and six cycles of docetaxel starting within 6 weeks after randomization.
After 4 years, about 63% of patients who received darolutamide were still alive compared with about 50% of patients who received placebo. The group that received darolutamide lived longer even though most participants in the placebo group received other commonly used treatments, including abiraterone and enzalutamide, during follow-up.
Darolutamide resulted in other improvements as well. For example, among those treated with darolutamide, the time for their cancers to become resistant to hormone-suppressing therapies was longer, as was the time until the pain caused by their cancer got worse.
The frequency of serious side effectswhich included fatigue, falls, fractures, and cardiac issueswas similar in the two groups. Roughly two-thirds of the patients in both groups experienced serious side effects, most of which occurred when darolutamide were given at the same time as docetaxel.
Most Patients Did Not Progress
With active surveillance, the patients had physical exams and PSA tests every six months, with biopsies recommended every one to two years.
Over an average of two and a half years of follow-up, 43 of the study participants showed evidence of cancer progression and received treatment.
In two patients, cancer spread beyond their prostate.
The study is published in the April issue of the Journal of Urology.
The findings support the idea that some men with prostate cancer may not need treatment, American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, tells WebMD.
He says the addition of a second biopsy should help refine the search for men who are appropriate candidates for active surveillance, but he also agrees that the strategy of watchful waiting is not without its risks.
ÃÂ¢The real advance will be when we have tests that will tell us with a high degree of accuracy when treatment is needed and when it is not,ÃÂ¢ he says.
A great deal of research is being done to identify genetic tests or tumor markers that can do this, but Lichtenfeld says it will be years before these tests are validated.
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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.
Managing Symptoms Of Advanced Prostate Cancer
Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.
You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.
Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
Docetaxel Continues To Show Profound Benefits In Prostate Cancer
Targeted therapies and immunotherapy are revolutionizing oncology, however, chemotherapy retains a key role in the treatment of advanced prostate cancer, with recent data showing profound benefits with docetaxel in newly diagnosed patients.
William Oh, MD
Targeted therapies and immunotherapy are revolutionizing oncology, however, chemotherapy retains a key role in the treatment of advanced prostate cancer, with recent data showing profound benefits with docetaxel in newly diagnosed patients, according to William Oh, MD.
The recent positive findings seen with docetaxel come from 2 randomized trials: CHAARTED and STAMPEDE. In the largerSTAMPEDE trial, adding docetaxel to standard hormonal therapy significantly improved survival among men with newly diagnosed, hormone-naïve advanced prostate cancer. The median overall survival was 81 months with docetaxel plus standard of care versus 71 months with standard of care alone . In the CHAARTED study , the median OS was 57.6 months with the combination of docetaxel and androgen-deprivation therapy versus 44 months with ADT alone .
In an interview withTargeted Oncologyat the 2016 Chemotherapy Foundation Symposium, Oh, chief, Division of Hematology and Medical Oncology, professor of Medicine and Urology, Mount Sinai School of Medicine, discussed the continued significance of docetaxel in advanced prostate cancer.
TARGETED ONCOLOGY:Can you provide an overview of the role of docetaxel in metastatic prostate cancer?
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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.
Signs Of Approaching Death
Death from cancer usually occurs after a person has become weaker and more tired over several weeks or months. It is not always possible to predict how long someone will live. But some common signs and symptoms show that a person is entering the final weeks and days of life. Knowing what to expect helps relieve anxiety and allows better planning.
The following are signs and symptoms that suggest a person with cancer may be entering the final weeks of life:
Worsening weakness and exhaustion.
A need to sleep much of the time, often spending most of the day in bed or resting.
Weight loss and muscle thinning or loss.
Minimal or no appetite and difficulty eating or swallowing fluids.
Little interest in doing things that were previously important.
Loss of interest in the outside world, news, politics, entertainment, and local events.
Wanting to have only a few people nearby and limiting time spent with visitors.
As the last days of life approach, you may see the following signs and symptoms:
Of course, every person is different. The signs and symptoms that people experience vary. And the order in which signs and symptoms occur may differ.
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Death From Other Causes
The mean age at metastatic prostate cancer diagnosis in the study was roughly 71 years. Most of the cohort was White and had a diagnosis of stage M1b metastatic prostate cancer , which means the cancer had spread to the bones.
Among men in the cohort, the rates of death from septicemia, suicide, accidents, COPD, and cerebrovascular diseases were significantly increased compared with the general US male population, the team observes.
Thus, the study authors were concerned with not only with death from metastatic prostate cancer, but death from other causes.
That concern is rooted in the established fact that there is now improved survival among patients with prostate cancer in the US, including among men with advanced disease. âPatients tend to live long enough after a prostate cancer diagnosis for noncancer-related comorbidities to be associated with their overall survival,â they write.
The editorialists agree: prostate cancer âhas a high long-term survival rate compared with almost all other cancer types and signals the need for greater holistic care for patients.â
As noted above, cardiovascular diseases were the most common cause of non-prostate cancer-related deaths in the new study.
As in the management of other cancers, there is concern among clinicians and researchers about the cardiotoxic effects of prostate cancer treatments.
The study had no specific funding. The study authors and editorialists have disclosed no relevant financial relationships.
How Docetaxel Works
Docetaxel is a drug treatment included in the category of taxane type drugs, which means that it was originally developed from yew tree needles. Docetaxel is used as a chemotherapy drug and is prescribed in cases of hormone-refractory metastatic prostate cancer, among many other cancers. It is used with the purpose of blocking the growth of the tumor, as it acts on the cancerous cells, preventing them from separating into two new cells.
The compound is administered as a liquid through a drip intravenously. Depending on the type of cancer, patients are treated weekly or once every three weeks, and each infusion takes about an hour. The injection may enter the vein through a thin and short tube known as cannula placed in the arm or through a central line, a portacath or a PICC line. Docetaxel is currently used in the treatment of numerous types of cancer, including breast, lung, head and neck, prostate, and stomach cancers, and is being studied for the treatment of ovarian and bladder cancers.
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What Are Next Steps
Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But its important to remember that the numbers are only statistics.
The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.
Everyones cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.
Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
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Outlook For Men With Advanced Prostate Cancer
While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.
Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer.
What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.
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Hormone Therapy In Older Patients
The backbone of prostate cancer treatment is hormonal therapy, which aims to limit the activation of the androgen receptor with testosterone. This limitation of AR activation may occur through agents that decrease circulating testosterone, such as gonadotropin-releasing hormone agonists or antagonists. The use of these agents also decreases testosterone precursors and other off-target effects of testosterone. Agents such as nonsteroidal anti-androgens block AR activation and yet preserve circulating testosterone levels.
Providers must carefully consider the toxicities of androgen deprivation therapy in a physiologically older population. These patients have less reserve to absorb additional imbalances or conditions that will impact their current steady state. In general, agents that result in a hypogonadal state can lead to toxicities within the following domains: metabolic and body composition sexual health and mood and central nervous system symptoms .
Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. That’s because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes — not their prostate cancer.
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Know Your Priorities When Deciding On Prostate Cancer Treatment
While this one study showed that people who get a prostatectomy may live longer, its important to understand the risks involved with each and to know your priorities. You may be quick to want to remove your prostate or get radiation treatment to get rid of the cancer right away, however, there are many quality of life issues to take into account:
- With active surveillance, your cancer may grow and spread.
- Choosing not to treat your cancer right away could lead to anxiety.
- Men who undergo radiation are more likely to have bowel problems.
- There is a chance you may lose bladder control after surgery.
- You may lose your ability to have an erection after surgery.
The decision about how you will treat your prostate cancer is not one to be taken likely. Discussing the risks and complications with your physician and your family, and thoroughly considering your priorities, can help you make a decision that feels right for you.
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Castrate Refractory Prostate Cancer: A Wider Range Of Options
In this section, we explain the treatments available at Birmingham Prostate Clinic for patients once their disease becomes resistant to hormone treatment, called castrate refractory prostate cancer. Two types of treatments are needed to:
- Control the cancer and prevent further spread of cancer
- Control or prevent the symptoms caused by the spread of prostate cancer to the bones
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How Third Stage Prostate Cancer Manifests Itself
At this stage the tumour has already grown outside the prostate gland. There are no distant metastases and no pain associated with them yet, but the patient may experience symptoms of obstruction, that is, compression of the urinary tract:
- frequent and difficult urination
- the need to push yourself when you go to the bathroom
- imperative, i.e. very intense, almost unbearable urges
- nighttime urge to pee, or nocturia
- a feeling of incomplete bladder emptying.
If the tumour has grown into the bladder neck, you may develop urinary incontinence or haematuria blood in the urine. Sometimes the patient experiences pain because the tumour is compressing the surrounding tissues. Due to the obstruction, some patients may develop renal failure or hydronephrosis enlargement of the renal pelvis.