Prostate cancer occurs when a tumor develops in the prostate gland, which makes the liquid portion of semen. Cancer that spreads outside the prostate gland to the lymph nodes, bones, or other areas is called metastatic prostate cancer. Currently, no treatments can cure advanced prostate cancer. However, there are ways to help control its spread and related symptoms.
Treatments that slow the spread of advanced prostate cancer and relieve symptoms often cause side effects. Some patients, often those who are older, decide that the risk of side effects outweighs the benefits of treatment. These patients may choose not to treat their advanced prostate cancer.
It’s important to remember that researchers are always searching for new and better treatments that will cause fewer side effects, better disease control, and longer survival rates.
What Are the Symptoms of Prostate Cancer?
There are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen:
- A frequent need to urinate, especially at night
- Difficulty starting or stopping a stream of urine
- A weak or interrupted urinary stream
- Leaking of urine when laughing or coughing
- Inability to urinate standing up
- A painful or burning sensation during urination or ejaculation
- Blood in urine or semen
These are not symptoms of the cancer itself; instead, they are caused by the blockage from the cancer growth in the prostate. They can also be caused by an enlarged, noncancerous prostate or by a urinary tract infection.
Symptoms of advanced prostate cancer include:
- Dull, deep pain or stiffness in the pelvis, lower back, ribs, or upper thighs; pain in the bones of those areas
- Loss of weight and appetite, fatigue, nausea, or vomiting
- Swelling of the lower extremities
- Weakness or paralysis in the lower limbs, often with constipation.
Prostate Cancer Treatments By Stage
- Once your doctor determines the stage of your prostate cancer, he can start mapping out a treatment plan. The stage is based on:
- The size of your tumor
- How far it has spread
- The chances of it coming back
Matching the right treatment with your stage isn’t always cut and dry. You might benefit from a combo of a few different approaches. Together, you and your doctor will decide on the best treatment.
There are three different doctors who might be involved in your care:
- A medical oncologist, who treats cancer
- A radiation oncologist, who also treats cancer
- A urologist, who specializes in problems with the urinary tract and male reproductive organs
Here are the stages of prostate cancer along with common treatment options.
The cancer is small, and it hasn’t grown outside your prostate. Slow-growing cancers might never cause symptoms or other health problems.
In this stage, your PSA levels and Gleason scores are low, and that’s good. When they’re higher, your cancer is more aggressive. It’s also more likely to come back and require more intensive treatment.
The PSA (prostate-specific antigen) test measures levels of this protein in your blood. Your doctor then determines your Gleason score by looking at prostate tissue cells under a microscope.
With stage I, you should consider the following treatment approaches:
- Active surveillance. Your doctor tracks your PSA levels. If those levels rise, it might mean your cancer is growing or spreading. Your doctor can then change your treatment. He might also do tests like rectal exams and ultrasounds.
- Watchful waiting. This involves fewer tests than active surveillance. Your doctor keeps a close watch on your symptoms. If you’re an older man, or you have other serious health problems, your doctor might opt for this method.
- Radiation therapy. This kills prostate cancer cells or keeps them from growing and dividing. There are two types of this treatment. The “external” kind uses a machine to aim a beam of radiation at your tumor. With “internal radiation,” a doctor places radioactive pellets or seeds in or next to the tumor — this procedure is also known as brachytherapy.
- Radical prostatectomy. This is a surgery to remove your prostate and some of the surrounding tissue.
- Ablation therapy. This treatment uses freezing or high-intensity ultrasound to kill cancer cells.
The cancer is much larger, but it hasn’t spread outside your prostate. Your PSA levels and Gleason scores are also higher. Surgery or radiation is often needed to keep it from spreading.
With stage II, you should consider the following treatments:
- Active surveillance. In this stage, it’s typically used if you’re a much older man or you have other serious health problems.
- Radiation therapy, possibly combined with hormone therapy. Those are drugs that stop testosterone from helping your cancer cells grow.
- Radical prostatectomy
The cancer has spread beyond your prostate, but it hasn’t reached your bladder, rectum, lymph nodes, or nearby organs.
With stage III, you should consider the following treatments:
- External radiation plus hormone therapy
- External radiation plus brachytherapy and possibly hormone therapy
- Radical prostatectomy, often combined with removal of your pelvic lymph nodes. Your doctor might recommend radiation after surgery.
This happens when your cancer has spread to the bladder, rectum, lymph nodes, organs, or bones. Cases of stage IV are rarely cured. Still, treatments can extend your life and ease your pain.
In this stage, you should consider the following treatments:
- Hormone therapy, which is often combined with surgery, radiation, or chemotherapy
- Surgery to relieve symptoms such as bleeding or urinary obstruction and to remove cancerous lymph nodes
- External radiation with or without hormone therapy
- Chemotherapy, if standard treatments don’t relieve symptoms and cancer continues to grow. The drugs will shrink cancer cells and slow their growth.
- Bisphosphonate drugs, which can help slow the growth of cancer in the bone and help prevent fractures
- The vaccine sipuleucel-T (Provenge), which boosts your immune system so it will attack the cancer cells. This might be used when hormone therapy doesn’t work.
- Palliative care, which offers you relief from symptoms like pain and trouble peeing
Clinical trials are testing new treatments. They can give you state-of-the-art cancer treatments or newer ones that aren’t available yet. Ask your doctor if a clinical trial might be right for you.
If Your Prostate Cancer Comes Back
If your cancer goes into remission but later returns, follow-up treatments will depend on where the cancer is located and which treatments you’ve already tried.
- If the cancer is contained in your prostate, surgery or a second attempt at radiation is suggested. If you’ve had a radical prostatectomy, radiation therapy is a good option. If you had radiation, radical prostatectomy might be the best approach. Cryosurgery might also be an option.
- If the cancer has spread to other parts of your body, hormone therapy might be the most effective treatment. External or IV radiation therapy or bisphosphonate drugs can relieve your bone pain.
Diagnosis & Tests
How Is Prostate Cancer Diagnosed?
Two initial tests are commonly used to look for prostate cancer in the absence of any symptoms. One is the digital rectal exam, in which a doctor feels the prostate through the rectum to find hard or lumpy areas known as nodules. The other is a blood test used to detect a substance made by the prostate called “prostate-specific antigen” (PSA). When used together, these tests can detect abnormalities that might suggest prostate cancer.
Neither of these initial tests for prostate cancer is perfect. Many men with a mildly elevated PSA do not have prostate cancer, and men with prostate cancer may have normal levels of PSA. Also, the digital rectal exam does not detect all prostate cancers, as it can only assess the back portion of the prostate gland.
The diagnosis can only be confirmed by examining prostate cells under a microscope. This is done by performing a biopsy in a urologist’s office. A small sample of tissue is taken from the prostate for testing and evaluation under a microscope.
Your doctor is likely to discuss your medical history with you. Answering questions about any history of genital or urinary disease in your family can help your doctor make an accurate diagnosis. Your doctor may also ask about any changes in your pattern of urinating.
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