Cancer of the gums: 9 things to know
Overview Of Metastatic Prostate Cancer
When prostate cancer spreads beyond your prostate gland, it's called metastatic prostate cancer. This is considered an advanced form of prostate cancer.
The prostate is a gland in the male reproductive system located beneath your bladder. Prostate cancer is one of the most commonly diagnosed types of cancer worldwide.
When prostate cancer spreads, it metastasizes to your bones from 85–90% of the time. It can also spread to your lungs, liver, or brain, as well as other organs in some cases.
There's no cure for metastatic prostate cancer today, but it's treatable.
When prostate cancer spreads beyond your prostate gland, it often ends up in nearby your lymph nodes.
Your lymphatic system is involved in fighting off diseases, and your lymph nodes act like filters within this system. When cancer cells are filtered by a lymph node, they're usually destroyed. But sometimes they might pass through and travel through your body until they attach somewhere else.
Prostate cancer cells can travel through your lymph fluid or your blood stream in order to spread.
Prostate cancer often doesn't have any obvious symptoms in the early stages. Some of the symptoms you might experience with prostate cancer include:
Because metastatic prostate cancer generally spreads to your bones, you might experience more specific symptoms such as:
Anyone who has a prostate is at risk of having prostate cancer. In the United States, about 13% of people with a prostate develop prostate cancer at some point in their life.
Prostate cancer is uncommon for those younger than 45 years, and the risk continues to increase with age.
People with close relatives who have had prostate, breast, or ovarian cancer have an increased risk of developing prostate cancer.
African Americans are at a higher risk of prostate cancer than other groups and tend to have more advanced prostate cancer at the time of diagnosis and at younger ages.
Metastatic prostate cancer is generally divided into two types.
The first type is metastatic hormone-sensitive prostate cancer. This type responds to hormone therapy treatments. When you first receive a diagnosis of metastatic prostate cancer, this is generally the default diagnosis because, in most cases, you haven't undergone any hormone therapies yet.
The second type is metastatic castration-resistant prostate cancer. This type doesn't respond to hormone therapy, meaning that the cancer continues to grow or spread even after these treatments are used.
Prostate cancer is very common. Close to 13% of all people with a prostate in the United States are expected to have prostate cancer at some point in their lives.
The United States Preventive Services Task Force, a nongovernmental advisory group, recommended against a type of prostate cancer preventive screening called a prostate-specific antigen (PSA) test in 2012, advising that false positives were causing more harm than early diagnoses were preventing.
Since that time, the likelihood that prostate cancer is metastatic at the time of diagnosis has increased significantly.
Because metastatic prostate cancer often interacts with your bones, and especially the bones in your spine, one complication is spinal cord compression. Spinal cord compression, in turn, can sometimes lead to neurological issues.
Other complications may occur as a result of treatments such as surgery, each of which carries its own risks.
The main way a doctor will diagnose metastatic prostate cancer is with a biopsy.
This means that a doctor will take tissue samples from your prostate to be examined under a microscope. A biopsy may be guided by imaging techniques such as MRI scan or ultrasound, but not always. This will show whether you have prostate cancer.
Once it's determined you have prostate cancer, additional tests will be needed to see if it's spread, or metastasized. If it has, you'll receive a diagnosis of metastatic prostate cancer. These tests could include:
A relative survival rate compares how long a group of people with a disease is likely to live as compared with a similar group of people without prostate cancer. It's only an average and doesn't take into account your own unique circumstances.
People who received a diagnosis of metastatic prostate cancer have a 5-year relative survival rate of 32%.
Let's briefly look at some other questions related to metastatic prostate cancer.
What are the TNM stages of metastatic prostate cancer?The TNM method stages cancer by providing three different scores. Lower numbers generally mean less advanced cancer than higher numbers. The three scores relate to:
Metastatic prostate cancer will have any T or N number with an M number of 1.
What are the PSA levels in metastatic prostate cancer?PSA is a protein made by your prostate. Prostate cancer cells can also make PSA.
If a PSA test reveals that you have high PSA levels, it could be a sign of prostate cancer. There are other conditions that can also raise your PSA, though. So elevated PSA levels are usually not enough evidence to diagnose prostate cancer on their own.
A PSA level above 4 indicates about a 25% chance of having prostate cancer, and a PSA level above 10 indicates about a 50% chance of having prostate cancer.
Is metastatic prostate cancer terminal?Metastatic prostate cancer isn't necessarily terminal. While there isn't a known cure, it can respond to treatment and be controlled in many cases.
Metastatic prostate cancer is a type of cancer that begins in your prostate and has then spread to other parts of your body. The most common place for prostate cancer to metastasize is your bones.
While metastatic prostate cancer is an advanced stage of cancer, there are also many treatments available.
If you believe you might have a higher risk of prostate cancer, consider talking with a doctor about whether prostate cancer screening might be a good option for you.
Understanding Oligometastatic Prostate Cancer
Prostate cancer is oligometastatic when it has spread to only a few sites beyond your prostate. Doctors consider it stage 4, but oligometastatic prostate cancer usually has a better outlook than cancer that has spread to several places.
The prefix "oligo-" means "few" or "little." "Metastatic" means that cancer has spread from the original tumor to other parts of your body. Oligometastatic prostate cancer means that cancer cells start in your prostate and travel to form new tumors in a few other parts of your body.
Doctors typically diagnose oligometastatic prostate cancer when cancer has spread to up to five other locations outside your prostate. However, there's currently no standardized definition.
Even though doctors consider oligometastatic prostate cancer advanced or stage 4 cancer (the most advanced form), it's typically easier to treat than metastatic cancer that has spread more widely throughout the body.
Improvements in diagnostic imaging have allowed doctors to better see the sites where cancer has spread. This also means they can target these sites with radiation therapy and other treatments.
Prostate cancer typically grows very slowly. So you might not experience any symptoms right away.
In oligometastatic prostate cancer, the cancer travels to a few places outside your prostate gland, such as your lymph nodes, bladder, or bones. Your symptoms will depend on where in your body the tumors have spread.
One common area for prostate cancer to spread is the bladder since it's so close to the prostate. If there is a tumor in your bladder, symptoms may include:
If cancer has spread to your bones, symptoms may include:
Cancer that has spread to the lymph nodes near your groin might cause swelling, pain, or soreness in that area.
Doctors use diagnostic imaging tests, such as a PSMA PET scan, to find out if prostate cancer has spread to other parts of your body.
During a PSMA PET scan, a technician injects a special dye with a radioactive tracer into a vein. The tracer attaches to a protein called prostate-specific membrane antigen (PSMA). PSMA is found in high amounts in prostate cancer cells.
While you lie down in the machine, a special camera creates images of your body. The radioactive tracers make it easier for your doctor to see the location of the prostate cancer cells during the scan.
Your doctor may also order other imaging tests, such as CT, MRI, or bone scan, to help with diagnosis and staging.
The 5-year survival rate for all stage 4 prostate cancers is about 34%. Research suggests that Black men are more than twice as likely to die from prostate cancer as white men at almost every stage.
Research indicates that people with fewer metastases have a better outlook than those with more widespread metastatic disease.
Oligometastatic prostate cancer may even be curable with treatment. Your doctor might use the term "cured" if you show no signs of cancer for several years. But your overall outlook depends on several factors, including the location and the number of metastases and your overall health.
As time goes on, scientists will likely develop better ways to diagnose and treat oligometastatic prostate cancer and improve outcomes.
If you receive a diagnosis of metastatic or stage 4 prostate cancer, ask your doctor if you qualify for oligometastatic treatments. Oligometastatic prostate cancer means the cancer has spread to five or fewer sites in your body. As you work with a doctor to decide on a treatment plan, you may also consider asking about the benefits and risks of participating in a clinical trial.
Prostate Cancer Can Be A Silent Killer, But Early Diagnosis Makes All The Difference
Prostate cancer is thought of as a disease of the elderly, but the age group of patients is dropping worldwide.
By Dr Mohamed Zehran
When a 75-year-old patient relayed his symptoms of difficulty urinating along with drops of blood in the urine, Dr Mohamed Zehran Saipillai, Senior Consultant Medical Oncologist at Apollo Cancer Centre in Chennai, could see some tell-tale signs of prostate cancer. "He had the classic symptoms to indicate that something wasn't right. But he had been reluctant to get tested. So when he finally agreed to get tested, we found late-stage cancer that could not be cured."
Even at that stage, says Dr Zehran, there were several options for treating the cancer and extending the patient's life for some years. "We told him that with hormone treatment and some other gentle medications we could strike a balance between quantity of life and quality of life," says the doctor.
Unfortunately, based on anecdotes he had heard, the patient was convinced that the cancer treatment itself would kill him, and went in search of alternate therapies before passing away a few months later. "There are many patients who go down this alternative therapy route and we never see them again. Sadly, this patient's lack of awareness is not an isolated case, leading to many patients arriving for a diagnosis only when the cancer has reached an advanced stage" says Dr Zehran.
Why men should care about prostate cancerThe prostate is a small walnut-shaped organ that is involved in producing seminal fluid in men. Prostate cancer is one of the most common types of cancers in men. However, there are several myths about the disease that prevent men from going in for screening and early diagnosis, says Dr Zehran.
"Most patients, when they get the diagnosis, say that they have no pain or other symptoms, so they can't be sick," says the doctor. However, prostate cancer may show symptoms only in more advanced stages of the disease. And for many older patients, the symptoms that do show up, such as difficulties in urination or erectile dysfunction seem just the regular effects of growing older, explains Dr Zehran. "By the time you feel pain, the cancer may have progressed a lot," he says.
Prostate cancer is often thought of as a disease of the elderly. "But worldwide the age group of patients with prostate cancer is coming down. Now, we see patients in their 40s and 50s being diagnosed with it." Importantly, not all prostate cancers are the same, and the cancers affecting younger patients tend to also be more aggressive at times. "So, if I have a patient in his 40s, I know that his cancer could behave aggressively and the treatment will have to be modified accordingly," says Dr Zehran.
Many patients also cannot accommodate the possibility of cancer because they have no immediate family members who have had it. However, while family history does indicate an increased risk for prostate cancer, its absence does not mean a patient cannot develop cancer. "While family history is a contributing factor, cancer is not entirely a hereditary disease," the doctor explains.
Diagnosing prostate cancerWhile prostate cancer can develop without symptoms, there are certain symptoms that should not be ignored. These include,
"These symptoms should be investigated, not because they mean one should have cancer, but because we need to rule out the possibility when these symptoms emerge," says Dr Zehran.
An early screening test for prostate cancer is a test to check the levels of PSA (prostate specific antigen) in the blood. "When the PSA is high, it may indicate the presence of prostate cancer, though it can also rise due to trauma to the perineal area, urinary or prostate infections or catheterisation," doctor explains. If PSA levels are high, doctors would then recommend an ultrasound to detect unusual masses. Finally, a biopsy is done to confirm malignancy for a diagnosis of prostate cancer. Additional MRI, CT or PET CT may also be done to confirm the diagnosis.
A highly treatable disease, if caught early"What's different about prostate cancer from other cancers is that many prostate cancers are hormone dependent. So, if we suppress the testosterone levels, a large majority of patients have a good response to start with—the cancer would stop growing or even shrink," says Dr Zehran.
In the early stages, the simplest treatment for prostate cancer is removal of the prostate, which is called a prostatectomy. In order to avoid recurrence of the disease, this typically involves removing the whole prostate. "In centres like ours, this surgery is mostly done robotically, because healing is much quicker, post-op complications are fewer and accuracy is better," says Dr Zehran.
Another alternative is radiation treatment, where targeted radiation is used to destroy the tumour cells. "In terms of radiation therapy, Apollo offers many cutting-edge technologies such as Cyberknife and Proton Therapy," says Dr Mohamed. These technologies help to very accurately target cancerous cells and deliver highly calibrated doses of radiation so that only the cancer cells are affected, while damage to healthy tissue around them is minimised. In many cases, radiation therapy is accompanied by hormone treatment to maximise the impact, says Dr Zehran.
In men with more advanced cancer, where there is spread to other organs, chemotherapy is likely to be necessary.
For more details on Prostate Cancer, please refer https://apollocancercentres.Com/cancers/prostate-cancer/
Dr Mohamed ZehranSenior Consultant – Medical Oncology
This article was published in association with Apollo Cancer Centre.
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