Prostate Cancer (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
- Prostate cancer facts
- What is prostate cancer?
- What causes prostate cancer?
- What are the risk factors for prostate cancer?
- What are the signs and symptoms of prostate cancer?
- What specialists treat prostate cancer?
- What tests do health-care professionals use to diagnose prostate cancer?
- Prostate cancer biopsy results
- The accuracy of the PSA test
- What are the stages of prostate cancer?
- What are the treatment options for prostate cancer?
- Observation and active surveillance
- Radiation therapy
- Focal therapy
- Hormonal therapy
- Immunotherapy/vaccine therapy
- Bone-targeted therapy
- Monoclonal antibody therapy
- Metastatic-castrate resistant prostate cancer
- Research techniques
- Complementary and alternative care approaches
- What is the prognosis for prostate cancer?
- Is it possible to prevent prostate cancer?
- Find a local Oncologist in your town
What is the prognosis for prostate cancer?
Staging evaluation is essential for the planning of treatment for prostate cancer. A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate. Further testing and calculations may be performed to best estimate a patient's prognosis and help the doctor and patient decide upon treatment options. Prognosis refers to the likelihood that the cancer can be cured by treatment, and what the patient's life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.
If a cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If the cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally (where it started) or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival based again on group statistics for people who have been in the same situation.
Nomograms are charts or computer-based tools that use complex math from analysis of many patients' treatment results. They help to estimate the likelihood of a patient surviving free of recurrence after a treatment. They also can determine the likelihood of a cancer being found confined to the prostate, or spread beyond the prostate, or into the nearby lymph glands. Your doctor will likely input the data from your staging evaluation into a nomogram in order to best counsel you regarding your treatment options.
The prognosis for prostate cancer varies widely, and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and the cancer's responsiveness to treatment, among other factors.
Is it possible to prevent prostate cancer?
For a disease as common as prostate cancer, a condition which one man in six will be diagnosed with in their lifetime, the ideal approach is to prevent men from getting prostate cancer.
Two clinical trials referred to as the Prostate Cancer Prevention Trial (PCPT) and the subsequent Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial were conducted over the past two decades. These studies demonstrated that both finasteride and dutasteride (Propecia and Avodart), when used in men between 50 and 75 years of age, reduced the incidence of prostate cancer by 28% and 23% respectively as compared to similar men taking a placebo.
The reduction in the overall incidence of prostate cancer was significant. The use of these drugs and their FDA-approval for prevention has been slow to come in part because of the lingering concern over the high-grade prostate cancer risk. Men in these trials got less prostate cancer if treated with these drugs, but the prostate cancers that they did get were more often high-grade (had higher Gleason scores) and thus appeared to be at risk for behaving more aggressively. Men with a family history of prostate cancer or other high risk factors, and in fact any man, should discuss the use of these drugs for this purpose.
- Vitamin E and selenium were not effective in the prevention of prostate cancer in the SELECT trial. Vitamin E supplementation may have increased the incidence of prostate cancer.
- Lycopene was also ineffective as a preventive agent.
- Pomegranate juice had no meaningful impact on prostate cancer prevention.
- Green tea had some early results suggestive of a possible protective effect, and a larger trial is under way.
- Vitamin D and its derivatives have been studied in prostate cancer. There is no evidence that vitamin D protects against prostate cancer. The vitamin D derivative, calcitriol, has some therapeutic utility against this disease, and is still under study.
Prostate cancer is the most common cancer in men (after skin cancer), and the second leading cause of death from cancer in men. The biology of prostate cancer is better understood today than it was in the past. The natural history of the disease and its staging have been well defined. There are numerous potentially curative approaches to prostate cancer treatment when the disease is localized. Treatment options also exist for prostate cancer that has spread. Ongoing research continues to search for treatments for metastatic prostate cancer.
Coping with prostate cancer
The diagnosis of cancer can cause great anxiety to the individual and his family and friends. At times, one may have troubles coping with the diagnosis, the disease, and its treatment. Searching online for information may prove overwhelming also and may not be the best resource. Ask your physician or local hospital about local resources. Often, there are local prostate cancer support groups which may help you cope with your feelings and provide local resources for more knowledge. You may consider contacting one or more of the following organizations: US Prostate Cancer Foundation, American Urological Association Foundation, Centers for Disease Control and Prevention, American Cancer Society, and Patient Advocates for Advanced (Prostate) Cancer Treatment.
American Cancer Society (ACS). <http://www.cancer.org/cancer/prostatecancer/index>.
Byrd, E.S., et al. AJCC Cancer Staging Manual, 7th Ed. New York, NY: Springer, 2009.
The James Buchanan Brady Urological Institute. Johns Hopkins Medicine.
National Comprehensive Cancer Network
"Prostate Cancer." Memorial Sloan Kettering Cancer Center.
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