If there is a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.
- Magnetic resonance imaging (MRI) or computerized tomography (CT) scan – these scans build a detailed picture of the inside of your body.
- Isotope bone scan – this can tell if the cancer has spread to your bones. A small amount of radiation dye is injected into the vein and collects in parts of the bone where there are any abnormalities.
While the radioactive material used for the bone scan is attracted to bone, the material for the ProstaScint scan is attracted to prostate cells in the body. This test is often not recommended for men who have just been diagnosed with prostate cancer. But it may be useful after treatment if your blood PSA level begins to rise and other tests can’t find the exact location of your cancer.
- Positron emission tomography (PET) scan.
Once testing is complete, your doctor assigns your cancer a stage. This helps determine your treatment options. The prostate cancer stages are:
- Stage I. This stage signifies very early cancer that's confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren't considered aggressive.
- Stage II. Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
- Stage III. The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
- Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.
The first decision to be made in managing prostate cancer is whether treatment is needed. Prostate cancer, especially low-grade forms found in elderly men, often grows so slowly that no treatment is required. Treatment may also be inappropriate if a person has other serious health problems or is not expected to live long enough for symptoms to appear.
For many men with prostate cancer, no treatment will be necessary. Active surveillance or "watchful waiting" will mean keeping an eye on the cancer and starting treatment only if the cancer shows signs of getting worse or causing symptoms.
When treatment is necessary, the aim is to cure or control the disease so it doesn't shorten life expectancy and affects everyday life as little as possible. Sometimes, if the cancer has already spread, the aim is not to cure it, but to prolong life and delay symptoms.
Watchful waiting may also be recommended for people with a higher risk of prostate cancer if:
- your general health means you are unable to receive any form of treatment
- your life expectancy means you will die with the cancer rather than from it
Aims to avoid unnecessary treatment of harmless cancers, while still providing timely treatment for men who need it.
When they are diagnosed, it is known that around half to two-thirds of men with low-risk prostate cancer do not need treatment. Surveillance is a safe strategy that provides a period of observation to gather extra information over time to see whether the disease is changing.
Active surveillance involves you having regular PSA tests and often several biopsies to ensure any signs of progression are found as early as possible. Sometimes, MRI scans may also be carried out. If these tests reveal the cancer is changing or progressing, you can then make a decision about further treatment.
About one in three men who undergo surveillance will later have treatment. This does not mean they made the wrong initial decision. Good evidence shows that active surveillance is safe over an average of six years. Men undergoing active surveillance will have delayed any treatment-related side effects, and those who eventually need treatment will be reassured that it was necessary.
Usually involves removing all or part of the prostate, depends on the size and location of the tumor. Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the gland (stage T1 or T2 cancers).
Like any operation, this surgery carries some risks, and there may be some side effects. These are outlined below.
- Some men have problems with urinaryincontinence. This can range from leaking small drips of urine, to leaking larger amounts. However, for most men, this usually clears up within three to six months of the operation. About two in every 10 men have long-term problems requiring the use of pads.
- Some men have problems getting an erection (erectile dysfunction). For some men, this improves with time, but around half of men will have long-term problems.
- In extremely rare cases, problems arising after surgery can be fatal. For example, one in 1,000 men under 65 years old and one in 200 men over 65 will die following a radical prostatectomy.
After a radical prostatectomy, you will no longer ejaculate during sex. This means that you will not be able to have a child through sexual intercourse.
This treatment uses high-energy waves or particles to kill cancer cells and shrink tumors. Radiation may be used:
- As the first treatment for low-grade cancer that is still just in the prostate gland. Cure rates for men with these types of cancers are about the same as those for men getting radical prostatectomy.
- As part of the first treatment (along with hormone therapy) for cancers that have grown outside of the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back (recurs) in the area of the prostate after surgery.
- If the cancer is advanced, to reduce the size of the tumor and to provide relief from present and possible future symptoms.
- discomfort around the rectum and anus (the opening through which stools pass out of your body)
- loss of pubic hair
- cystitis – an inflammation of the bladder lining, which can cause you to urinate frequently; urination may be painful.
- an inability to obtain an erection – this affects about one- to two-thirds of men
- urinary incontinence – this affects about one or two in every 10 men
- back passage problems (diarrhea, bleeding, discomfort) – these affect between five and 20 in every 100 men
This involves placing many rice-sized radioactive seeds in the prostate tissue using a needle guided by ultrasound images. The radioactive seeds deliver a low dose of radiation over a long period of time. This is called low dose-rate brachytherapy. The implanted seeds eventually stop giving off radiation and don't need to be removed. The radiation can also be delivered through hollow, thin needles placed inside the prostate (high dose-rate brachytherapy).
This method has the advantage of delivering a high dose of radiation to the prostate, while minimizing damage to other tissues. However, the risk of sexual dysfunction and urinary problems is the same as with radiotherapy, although the risk of bowel problems is slightly lower.
Also called cryotherapy or cryoablatio it is sometimes used to treat early-stage prostate cancer by freezing it. It’s often not used as the first treatment for prostate cancer, but it is sometimes an option if the cancer has come back after other treatments. As with brachytherapy, this may not be a good option for men with large prostate glands.
In this approach, the doctor uses transrectal ultrasound (TRUS) to guide several hollow probes (needles) through the skin between the anus and scrotum and into the prostate. Very cold gases are then passed through the needles, creating ice balls that destroy the prostate. To be sure the prostate is destroyed without too much damage to nearby tissues, the doctor carefully watches the ultrasound images during the procedure. Warm saltwater is circulated through a catheter in the urethra during the procedure to keep it from freezing. The catheter is kept in place for about 3 weeks afterward to allow the bladder to empty while you recover.
The aim is to kill cancer cells while causing as little damage as possible to healthy cells. The side effects of cryotherapy can include:
- erectile dysfunction – this can affect between two and nine in every 10 men
- incontinence – this affects less than one in 20 men
· soreness in the area where the needles were placed.
· Swelling of the penis or scrotum is also common.
· The freezing might also affect the bladder and intestines, which can lead to pain, burning sensations, and the need to empty the bladder and bowels often. Most men recover normal bowel and bladder function over time.
· Freezing often damages the nerves near the prostate that control erections. Erectile dysfunction is more common after cryosurgery than after radical prostatectomy.
· Urinary incontinence is rare in men who have cryosurgery as their first treatment for prostate cancer, but it is more common in men who have already had radiation therapy.
· After cryosurgery, less than 1% of men develop a fistula (an abnormal connection) between the rectum and bladder. This rare but serious problem can allow urine to leak into the rectum and often requires surgery to repair.
Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow and cutting off the hormonal supply may cause cancer cells to die or to grow more slowly.
Hormone therapy may be used:
- If the cancer has spread too far to be cured by surgery or radiation, or if you can’t have these treatments for some other reason
- If your cancer remains or comes back after treatment with surgery or radiation therapy
- Along with radiation therapy as initial treatment if you are at higher risk of the cancer coming back after treatment
- Before radiation to try to shrink the cancer to make treatment more effective
- Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide , goserelin , triptorelin and histrelin. Other drugs sometimes used include ketoconazole and abiraterone.
- Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells. Examples include bicalutamide, flutamide, and nilutamide. The drug enzalutamide may be an option when other hormone therapies are no longer effective.
- Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body.
Side effects of hormone therapy may include erectile dysfunction, hot flashes, sweating, swelling and tenderness of breasts, loss of bone mass, reduced sex drive and weight gain.
Hormone therapy alone should not normally be used to treat localized prostate cancer in men who are fit and willing to receive surgery or radiotherapy. This is because it does not cure the cancer on its own. Hormone therapy can be used to slow the progression of advanced prostate cancer and relieve symptoms.
Mainly used to treat metastatic prostate cancer and that which is not responding to hormonal therapy, chemotherapy destroys cancer cells by interfering with the way they multiply. Chemotherapy does not cure prostate cancer, but can keep it under control and reduce symptoms (such as pain) so everyday life is less affected.
Some of the drugs used here include: Docetaxel, Cabazitaxel, Mitoxantrone, Estramustine, Doxorubicin, Etoposide, Vinblastine, Paclitaxel, Carboplatin, Vinorelbine.
The main side effects of chemotherapy are caused by their effects on healthy human cells and include infections, tiredness, hair loss, sore mouth, loss of appetite, nausea and vomiting, diarrhea, easy bruising or bleeding, and fatigue. Many of these side effects can be managed with other medicines.
Biological therapy (immunotherapy) uses your body's immune system to fight cancer cells. One type of biological therapy called Sipuleucel-T has been developed to treat advanced, recurrent prostate cancer.
This treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer, then injects the cells back into your body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple treatments. The vaccine hasn’t been shown to stop prostate cancer from growing, but it seems to help men live an average of several months longer.
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