Best Treatment For Prostate Cancer In Early Stages
Best Treatment For Prostate Cancer In Early Stages
A malignancy of the prostate gland, is prostate cancer. Near the urethra’s link to the bladder, the prostate is an organ that forms a ring around the urethra. The tube that transfers urine from the bladder to the outside of the body is called the urethra.
In the last 20 years, more men have received an early prostate cancer diagnosis, when the disease is most treatable. A high prostate-specific antigen (PSA) test is often used to make the diagnosis. In certain cases, a blood test is used to determine the PSA level in order to screen for prostate cancer.
The symptoms, diagnosis, and therapy for prostate cancer in stages I through III are covered in this article Best Treatment For Prostate Cancer In Early Stages. Prostate cancer that has spread to its fourth stage is treated differently.
THE COVID-19 PANDEMIC AND CANCER CARE
“Coronavirus disease 2019” is known as COVID-19. It is an infection brought on by the SARS-CoV-2 virus. In late 2019, the virus initially surfaced, and it has since expanded globally. People in many localities were advised to remain at home as much as possible in order to restrict the spread of the virus, particularly during the start of the pandemic and while the virus was spreading swiftly in many locations.
This has proved crucial for cancer patients in particular since many of them have a higher chance of developing a serious disease if they get COVID-19. The need of continuing to get routine medical treatment to monitor and treat their disease must be weighed against this danger, however.
Your oncologist may discuss with you whether you should alter your regular regimen or timetable if you reside in an area where there are still many instances of COVID-19 and are receiving cancer treatment.
Reducing the amount of appointments you have to attend in person could be a possibility in certain circumstances. This will rely on a number of factors, such as your location, the rate of viral transmission in your neighbourhood, the kind and stage of your cancer, the available treatment choices, and your general health.
Symptoms of prostate cancer
Usually, prostate cancer is discovered before any symptoms appear. However, frequent toilet trips or a sluggish stream of urine may be early signs of prostate cancer. Typically, a big prostate gland is the cause of these symptoms (called benign prostatic hyperplasia [BPH]). Erectile dysfunction and blood in the urine or semen are two additional, considerably less typical symptoms. Benign prostatic hyperplasia (BPH) Patient Education: Beyond the Basics
If you have an abnormal blood test (prostate-specific antigen [PSA]) or an abnormal rectal examination, your doctor or nurse may often assume that you have prostate cancer. You must get a prostate biopsy in order to be assured of the diagnosis.
A prostate biopsy, which is often performed at a doctor’s office or the radiology department, is used to confirm the diagnosis of prostate cancer. A sample of the prostate is taken using a needle for testing. To lower the chance of infection from the operation, you could be prescribed a course of antibiotics to take before and after the biopsy.
There are two methods for doing a prostate biopsy: utilising magnetic resonance imaging (MRI) or transrectal ultrasonography (TRUS) to guide the needle through the rectum.
TRUS-guided biopsy – You will get local anaesthetic for this sort of biopsy (a shot or gel in the rectum to numb the area). During the surgery, most men experience mild to moderate discomfort. It typically takes 15 minutes to complete the process.
You may have discomfort after the treatment in your rectum or the region surrounding your rectum (called the perineum). You could have minor bleeding in your rectum, urine (for many days), or sperm (for up to several months). Additionally, there is a slight possibility that an infection in the bloodstream or the prostate may develop and call for the use of medicines.
MRI-guided biopsy — This kind of biopsy may be carried out through the rectum or perineum. A perineal biopsy often has a decreased risk of infection after the surgery.
No matter how the biopsy is carried out, the tissue sample will be inspected under a microscope by a pathologist. Typically, the findings are ready in a week. The sample may also be subjected to molecular analyses in addition to the tissue analysis; this might provide extra information that may be helpful in deciding on a treatment strategy.
If cancer is discovered during the prostate biopsy, the Gleason grade group will be used to identify the extent of the cancer and the tumor’s aggressiveness. The Gleason grade is determined by the tumor’s microscopic appearance. The likelihood of an aggressive tumour behaviour increases with Gleason grade (grow faster). The Gleason grade group is created by combining the Gleason grades from several prostate gland regions (grade group 1 to 5). Other biopsy findings, in addition to the Gleason grade group, may affect the prognosis and course of therapy.
Once prostate cancer has been identified, the following step is to categorise it according to its risk group and establish its stage. The following are some of the categories:
Very little risk
Risk level: intermediate (this group is further divided into “favorable” and “unfavorable” depending on how much cancer was found in the biopsy result)
Very Highly dangerous
A technique called staging is used to categorise a cancer’s size, aggressiveness, and spread. The stage of a cancer influences therapy and may aid in estimating the likelihood that the illness will be cured.
The following factors determine the stage of prostate cancer:
How much of the prostate and nearby tissue the tumour has affected
Evidence of lymph nodes nearby being affected by malignancy.
Other organ cancer warning signs (liver, bone)
A prognosis stage group is established using these three factors, the prostate-specific antigen (PSA) level, and the grade group (see “Gleason grade group” above). Stage groups I through IV are available. In comparison to higher stage tumours, lower stage tumours are often less aggressive and less likely to recur following therapy. Prostate cancers in stages I and II are described as “localised” malignancies, stage III cancer is described as “locally progressed” cancer, and stage IV cancer is described as “advanced” or “metastatic” cancer.
“Risk stratification” is the procedure by which the stage, PSA level, grade group, and biopsy findings are evaluated in conjunction to determine the tumor’s aggressiveness and the range of treatment choices. Although there is not always complete overlap, extremely low-risk tumours generally correlate to stage I prostate cancer and very high-risk tumours generally correspond to stage III tumours when the disease is restricted to the prostate.
The degree of aggressiveness of the tumour may also be influenced by other characteristics of the tumour (such as molecular or genetic variables) that are not accounted for in these categories. However, these risk groups are now crucial in guiding men’s therapy selections, especially active monitoring. (See “Active surveillance” further below.)
Before starting therapy, further imaging tests like an MRI, an ultrasound, or a bone scan may be performed to see whether the cancer has progressed outside of the prostate. In the future, newer diagnostics, such a scan based on the prostate-specific membrane antigen (PSMA), may play a role in figuring out if the disease has spread.
II STAGES (LOCALIZED) Treatment for prostate cancer
Cancer that has not migrated to the lymph nodes or other distant organs is referred to as localised prostate cancer. There are three common methods for treating locally advanced prostate cancer:
Prostate gland removal surgery, sometimes known as a radical prostatectomy
Androgen deprivation treatment (ADT) is sometimes used in conjunction with radiation therapy (RT; external beam or brachytherapy.
Cryotherapy and high-intensity focused ultrasound are two other therapies that are currently being explored. These methods may specifically target the prostate gland’s tumor-bearing region (this is called focal therapy). These procedures lack long-term data and have not been thoroughly compared to conventional treatment methods, but given all the possible dangers and rewards, they could be appropriate for certain men.
The ideal course of action is determined by your age, general health, personal preferences, and cancer stage. (See below, “Which therapy is best for me?”)
A radical prostatectomy, also known as a prostatectomy, is a procedure that disconnects the bladder and urethra after removing the prostate gland (figure 1).
The following are the most typical side effects of prostatectomy:
Continence issues (leakage of urine)
Erection problems (difficulty having an erection)
Open and robotic prostatectomy procedures are also available.
A three to four-inch (7.5 to 10 cm) long up-and-down incision (cut), starting from the top of the pubic bone, is necessary for an open prostatectomy.
Robotic prostatectomy is performed by a series of tiny incisions, which are typically 5 to 6 cm long in total. Through the incisions, small tools and a camera are inserted. The monitor that shows what is viewed via the camera is what the surgeon uses to work.
Whether the operation is performed open-heart or using a robot has little bearing on the chances of successfully treating your malignancy and reducing postoperative problems. In the hands of a skilled practitioner, complications including the necessity for a blood transfusion, discomfort, length of stay in the hospital, and recovery time (about three weeks) are comparable between the two methods. To have a decent outcome, it’s crucial to inquire about the expertise of your surgeon.
To decide which form of prostatectomy is best for you, discuss the possible risks and advantages with your physician.
External beam radiation treatment and brachytherapy are the two types of radiation therapy that are used to treat prostate cancer. Particularly for males with intermediate- and high-risk malignancies, they are sometimes combined.
External beam radiation treatment (also known as intensity-modulated radiation therapy) employs a machine that travels around you to aim X-rays to the pelvis. Depending on the exact method used, external beam RT is often performed in a series of daily sessions spread over a number of weeks. Each treatment only lasts a few minutes, and you may often go about your daily business while receiving therapy. For males with intermediate- and high-risk diseases, external beam RT is often combined with short-term hormone treatment (ADT). (See the section below on “Androgen deprivation treatment.”)
External beam RT may cause the need to often use the restroom, bladder discomfort, erectile dysfunction, as well as swelling and soreness in the rectum (called proctitis). Although long-term problems (such rectal bleeding and blood in the urine) may develop several years following external beam RT, these symptoms are often transient.
Radioactive sources are injected directly into the prostate gland during brachytherapy. There are two forms of brachytherapy, both of which are carried out while the patient is sedated:
Low dose rate brachytherapy is a kind of brachytherapy that includes implanting rice-sized seeds within the prostate. The seeds are left in place and progressively lose their radioactivity over time. This is performed as an outpatient operation, therefore a hospital stay is not necessary.
A radioactive source is briefly implanted into the prostate gland during the less common high dosage rate brachytherapy procedure, and it is removed after one or two days. This procedure requires a one- to two-day hospital stay and is often paired with external beam RT.
Men who get brachytherapy often have enlargement and inflammation of the prostate gland, which may cause frequent urination, burning while urinating, and infrequently, urine retention (being unable to empty the bladder completely, which requires temporary use of a catheter). Brachytherapy does the greatest job of maintaining erectile function in the short term when compared to other therapies, but it also has comparable rates of erectile dysfunction over the long run. Bowel urgency and frequency, rectal bleeding, and rectal ulcers are less prevalent in males. In a few weeks to months, these issues normally get better.
Androgen deprivation treatment – Prostate cancer is fueled by male hormones, or androgens, of which testosterone is the most prevalent. Prostate cancer shrinks in size and grows more slowly in response to therapies such as androgen deprivation treatment (ADT), which lowers the body’s testosterone levels. ADT is often administered to men with locally advanced prostate cancer rather than removing the testicles surgically by taking androgen-blocking medicines (called orchiectomy).
Regular injections that distribute medicine over time are a common component of pharmaceutical treatment.
For men with intermediate- and high-risk prostate cancer, a brief course of ADT (range from four to six months for intermediate-risk illness to 18 to 24 months for high-risk disease) could be suggested in conjunction to external beam RT.
Androgen deprivation treatment (ADT) adverse effects include the following and are caused by the decreased levels of male hormones:
decreased libido (sex desire) and erection problems (erectile dysfunction)
Gynecomastia, often known as breast enlargement in males, is described in “Patient Education: Gynecomastia (Breast Enlargement in Men) (Beyond the Basics)”
A rise in body fat and a loss of muscle
“Patient education: Osteoporosis prevention and treatment (Beyond the Basics)” discusses how osteoporosis, which causes the bones to thin and weaken, may raise the risk of bone fractures.
An increased chance of getting type 2 diabetes
Decrease in muscle mass
A large number of these adverse effects are severe. Not all males, nevertheless, experience these negative impacts. The danger of side effects must be weighed against the risk of not utilising ADT, which might cause your cancer to advance or spread. In addition, many of these adverse effects may be avoided or treated.
The individual will still need long-term, cautious monitoring under active surveillance even if initial treatment is deferred or delayed (which may include additional examinations, prostate biopsies, blood tests, and imaging tests). The individual might decide to have permanent therapy if there is evidence of an elevated risk for illness development (surgery or RT). Active surveillance is distinct from “watchful waiting,” in which it is decided up front to forgo decisive treatment and only provide care to alleviate symptoms if the cancer spreads or progresses. Men with a short lifespan or some significant medical condition may choose for watchful waiting.
For men with extremely low- and low-risk malignancies, active monitoring is generally seen as a suitable alternative, and it may even be recommended in these circumstances for men who are at ease with this strategy. Active surveillance has a larger chance of developing into metastatic (stage IV) illness than definitive treatment with surgery or radiation therapy in this circumstance, while it may also be taken into account for a man with a “favourable” intermediate-risk tumour. If men choose rapid treatment over observation, they should consider surgery or radiation therapy (RT). This is true for men in all risk groups, including those with extremely low risk.
PROSTATE CANCER TREATMENT IN STAGE III (LOCALLY ADVANCED)
Prostate cancer that is locally advanced has spread to organs like the seminal vesicles (figure 1). For locally advanced prostate cancer, there is no one “best” therapy. Treatment often combines the following two philosophies:
combined with androgen deprivation treatment (ADT) (ADT)
X-rays are used in radiation treatment (RT) to kill cancer cells. External beam radiation treatment (see “External beam radiation therapy” above) and brachytherapy (see “Brachytherapy” above) are the two types of RT used to treat prostate cancer.
ADT is often administered to most men who get RT for locally advanced prostate cancer (see “Androgen deprivation treatment” below). Using both therapies increases the likelihood of survival and aids in cancer management. The majority of doctors advise ADT use for 18 to 24 months of therapy.
Surgery — Radical prostatectomy, which totally eliminates the prostate gland (see “Radical prostatectomy” above), is a procedure that has grown in popularity for the treatment of stage III prostate cancer. Based on studies indicating better long-term results, RT is often advised after surgery for men with high-risk illness who receive radical prostatectomy. While treatment may be done right after (referred to as “adjuvant” RT), most men can postpone RT until there are symptoms of the cancer returning (called “early salvage” RT).
This is based on monitoring procedures that may identify an increase in prostate-specific antigen (PSA) (see the section below on monitoring for a recurrence of the tumour for further information). Radiation should be postponed until the PSA is increasing in order to avoid unneeded therapy and its negative effects. Studies are being conducted to see whether genetic markers may identify a subgroup of males who will benefit the most from using RT early (ie, when the PSA is undetectable).
Androgen deprivation therapy (ADT) – As previously mentioned, therapies that lower the body’s levels of androgens reduce the size and halt the progression of prostate cancer. ADT is often administered together with RT to men who have locally advanced prostate cancer. (See the section above on androgen deprivation treatment.)
Keeping an eye out for the tumor’s recurrence
Follow-up testing to look for symptoms of a cancer recurrence is advised by specialists after treatment for localised prostate cancer. Prostate-specific antigen testing is often part of this follow-up evaluation (PSA). Because the PSA test is so sensitive, it may start to increase long before you can see or feel a recurrence of the disease. Many individuals with increased PSA levels will go years without exhibiting any symptoms of recurrence of the malignancy (even 15 or more). So, not all men with increasing PSA levels need prompt medical attention.
To lessen the likelihood that the disease may spread or develop further, therapy is advised for certain men with increasing PSA levels. To discuss your alternatives, speak with your doctor or nurse.
The most effective course of action for a rising PSA depends on the prior course of action and whether the recurrence is restricted to the prostate area or has migrated to other places, particularly the bone:
Men who first received radiation treatment (RT) are often recommended to have a prostate biopsy and imaging tests. The “salvage” therapies of surgery (called salvage prostatectomy) or cryotherapy may be an option with a chance of cure if those tests reveal residual cancer and if the disease has not spread beyond the prostate.
RT combined with a brief course of androgen restriction treatment is often used to treat men who first had prostate surgery and whose tumour recurrence is confined to the area of the prostate (ADT).
ADT is used to treat men who are ineligible for radiation therapy (RT) or surgery or whose malignancies have metastasized (spread to other locations, such the bone).
WHAT FORM OF TREATMENT IS BEST FOR ME?
The choice between radiation treatment (RT) and surgery for men with early stage (localised) prostate cancer mostly comes down to personal taste. According to the facts at hand, cancer treatment results are consistent irrespective of the chosen therapy. The likelihood that the cancer may spread fast or recur after therapy will also influence the decision. Men with favourable intermediate-risk tumours may elect for active monitoring, although this is often only an option for men with extremely low- and low-risk tumours.
Surgery, RT, and active surveillance each have their own special risks and problems.
Men with localised (stage I to II) prostate cancer have the choice of treatment (with surgery or radiation therapy) or monitoring (active surveillance), with treatment being postponed until there is indication that the disease may be evolving into an aggressive form. Men who are older or who have other significant conditions may choose active monitoring or careful waiting over surgery or RT.
Men with aggressive, high-risk malignancies that might be difficult to treat later on are often advised to seek therapy very away (surgery or RT). Short-term androgen deprivation treatment is often advised for males with RT (ADT).
Men with locally advanced prostate cancer (stage III) are not eligible for any one particular therapy that is shown to be effective. The majority of doctors advise a combination of either surgery with adjuvant RT with or without ADT, or ADT plus RT.
Prostate cancer that has progressed (stage IV) — The treatment for advanced prostate cancer is covered separately. (Read more about this in “Patient Education: Treatment for Advanced Prostate Cancer (Beyond the Basics)”).
Better therapies must be found via clinical trials, which are carried out all around the globe, in order to advance the treatment of prostate cancer. A clinical trial is a meticulously planned method for examining the efficacy of novel medicines or novel amalgamations of existing ones.
SUGGESTIONS FOR FURTHER INFORMATION
The finest source of information for queries and worries pertaining to your medical issue is your health care practitioner.
The Basics — The Basics patient education materials address the four to five most important questions a patient can have about a certain ailment. Patients who like brief, simple reading materials and who want a general overview might choose these articles.
Prostate cancer patient education (The Basics)
Patient education: PSA testing for prostate cancer screening (The Basics)
Patient education: adult hydronephrosis (The Basics)
Patient education: selecting a low-risk localised prostate cancer therapy (The Basics)
Beyond the Basics – The patient education materials in the Beyond the Basics series are longer, more complex, and more thorough. Patients who seek in-depth knowledge and don’t mind some medical language should read these articles.
Patient education: Tests for prostate cancer (Beyond the Basics)
Patient education: Advanced prostate cancer treatment (Beyond the Basics)
Benign prostatic hyperplasia (BPH) patient education (Beyond the Basics)
Patient education: Male sexual issues (Beyond the Basics)
Gynecomastia (male breast enlargement) patient education (Beyond the Basics)
Osteoporosis prevention and treatment: patient education (Beyond the Basics)
Information written for professionals — Professional level articles are intended to keep physicians and other health professionals informed on the most recent scientific discoveries. These articles are comprehensive, lengthy, and intricate, and they include several references to the research that they are founded on. For those who are familiar with a lot of medical jargon and wish to read the same books their physicians do, professional level articles are preferable.