Prostate Cancer Spread To Bladder Neck

Treatments To Control Advanced Prostate Cancer

If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

• chemotherapy with hormone therapy
• clinical trials.

Chemotherapy with hormone therapy

Chemotherapy uses anti-cancer drugs to kill cancer cells, wherever they are in the body. It wont get rid of your prostate cancer, but it aims to shrink it and slow down its growth. You might be offered chemotherapy at the same time as, or soon after, you start having hormone therapy. This helps many men to live longer, and may help delay symptoms such as pain.

You need to be quite fit to have chemotherapy. This is because it can cause side effects that are harder to deal with if you have other health problems. Read more about chemotherapy.

Hormone therapy

Hormone therapy will be a life-long treatment for most men with advanced prostate cancer.

Prostate cancer usually needs the hormone testosterone to grow. Hormone therapy works by either stopping your body from making testosterone, or stopping testosterone from reaching the cancer cells. This usually causes the cancer to shrink, wherever it is in the body. Hormone therapy can also help control symptoms of advanced prostate cancer, such as bone pain.

Hormone therapy can cause side effects speak to your doctor or nurse about ways to manage these. Read more about hormone therapy, and its side effects.

Clinical trials

What Is My Outlook

If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.

While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.

No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.

Simple And Endoscopic Intervention

The majority of surgical anastomotic stenoses respond to simple urethral dilatation or visual urethrotomy . This includes office-based techniques such as passage of urethral sounds or filiform followers and is often supplemented with a regime of clean intermittent self-catheterization . This correlates with the SEER data, which suggests that patients with BOO post-treatment for prostate cancer, 44% of patients will require more than one procedure . Park et al. demonstrated post-retropubic radical prostatectomy patients with anastomotic stenoses who underwent dilatation followed by CISC, was successful in 92% at 1 year follow up, although it must be noted 27% required two or more procedures . They suggested that men with hypertrophic scars were at greater risk of anastomotic stricture, suggesting pathological wound healing.

Steroids, with the most described agent triamcinolone , work by enhancing collagenase activity, act to break down peptide bonds in collagen to allow tissue remodeling. Eltahawy et al. evaluated 24 patients with recurrent or resistant bladder neck stenoses post-RRP who underwent Holmium laser BNI with injection of triamcinolone, with a success rate of 83% at 24 months .

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What Is Your Prostate Cancer Stage

Your prostate cancer stage is set after testing. Stage describes if the tumor was detected or felt during the digital rectal exam. The prostate cancer stage also indicates whether or not the cancer may have spread to lymph nodes or other organs. Clinical stage is based on all information available prior to any treatment and designated by the TNM system as shown below.

How Is Prostate Cancer Diagnosed

If you have symptoms of prostate cancer, your provider will perform a digital rectal exam and a PSA blood test. If either of those two tests are abnormal, then most likely your provider will recommend that you have a prostate biopsy. A biopsy is the only way to know for sure if you have cancer, as it allows your providers to get cells that can be examined under a microscope.

The most common way that a biopsy is done is with a trans-rectal ultrasound . A trans-rectal ultrasound is a thin cylinder that puts out sound waves and monitors them when they bounce off of tissue. It is inserted into your rectum, and allows the provider performing the biopsy to view your prostate and choose where to remove the tissue for further evaluation. Any suspicious areas are biopsied. In addition, some tissue will be removed from all of the different parts of the prostate . The procedure is done while you are awake, with the help of some numbing medicine. Unfortunately, a trans-rectal ultrasound isn’t a perfect tool. Even though many samples are taken, it can occasionally miss the area of the cancer. If this happens, and your PSA remains elevated, you may need to have the procedure repeated.

Your provider may order other tests including a bone scan, CT scan or MRI to see if the cancer has spread to the bones, lymph nodes or other organs.

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Chances Of Developing Metastatic Prostate Cancer

About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.

A small percentage of men aren’t diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it’s metastatic cancer when they take a small sample of the tissue and study the cells.

Eating Problems And Weight Loss

Some men with advanced prostate cancer have problems eating, or dont feel very hungry. You might feel or be sick. These problems may be caused by your cancer or by your treatments. Being worried about things can also affect your appetite.

Problems eating or loss of appetite can lead to weight loss and can make you feel very tired and weak. Advanced prostate cancer can also cause weight loss by changing the way your body uses energy.

What can help?

If you feel sick because of your treatment, your doctor can give you anti-sickness drugs. Steroids can also increase your appetite and are sometimes given along with other treatments.

Try to eat small amounts often. If youre struggling to eat because of nausea , try to avoid strong smelling foods. Cold foods tend to smell less, or it may help if someone cooks for you. Try to eat when you feel less sick, even if its not your usual mealtime. Fatty and fried foods can make sickness worse. Drink plenty of water, but drink slowly and try not to drink too much before you eat.

Tell your doctor if you lose weight. They can refer you to a dietitian who can provide advice about high calorie foods and any supplements that might help. It can be upsetting for your family to see you losing weight, and they may also need support. Macmillan Cancer Support and provide support and information about eating problems in advanced cancer.

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The Prognostic Significance Of Bladder Neck Invasion In Prostate Cancer: Is Microscopic Involvement Truly A T4 Disease

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Risk Factors For Formation Of Urethral Stenosis And Stricture

Post-radical prostatectomy

Radiotherapy

Risk factors include age, obesity, hypertension, diabetes, previous TURP , longer follow-up, higher radiation dose, HDR-BT, adjuvant RT and combination with BT . Delaying adjuvant RT for more than 9 months after RP may decrease stricture formation, however this is at the expense of an increase in cancer-specific mortality . Zelefsky found that intensity modulated RT increases the risk of late urinary toxicities including urethral stricture compared to 3-D conformal RT, but with lower rectal toxicity . However, a recent review found no difference in urethral stricture between 3-dimensional conformal radiotherapy and IMRT . Similar to ERBT, BT strictures affect the bulbomembranous urethra in the majority of cases, which could be due to a âhot spotâ in the distal bulbar urethra or due to caudal needle shifting in patients receiving HDR-BT , although Hindson found no relation between needle shifting and stricture incidence . A prospective, matched-pair analysis by Diez found no association between urethral stricture incidence and urethral dosimetry in patients receiving HDR-RT, however the number of events was too small to draw a definitive conclusion .

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How Is Prostate Cancer Staged

With these tests, a stage is assigned to help decide the treatment plan. The stage of cancer, or extent of disease, is based on information gathered through the various tests as the diagnosis and work-up of the cancer is being performed.

Prostate cancer is most commonly staged using the TNM system plus the Gleason score. The TNM system is used to describe many types of cancers. In prostate cancer it has four components:

• T- Describes the extent of the “primary” tumor .
• N- Describes if there is cancer in the lymph nodes.
• M- Describes if there is spread to other organs .
• G- Describes the Gleason score and takes into account the PSA and the histologic grade of the tumor.

The staging system is very complex. The entire staging system is outlined at the end of this article. Though complicated, the staging system helps healthcare providers determine the extent of the cancer, and in turn, make treatment decisions for a patient’s cancer.

Has Your Cancer Spread Beyond The Prostate

Prostate Cancer Stage is the rating system consisting of four stages used to describe the spread of cancer. The different stages of cancer describe cancer confined within the prostate, growth that extends to tissue outside the prostate, to local organs or metastasized to distant parts of the body. Several different tests can be used either alone or in combination to determine the extent of spread of the cancer. Not all of these tests are needed in all men. Staging tests include the DRE, PSA Blood Test, Ultrasound, Biopsy, Bone Scan, Cat Scan, MRI and PET Scan.

Prostate Cancer Stage is the rating system consisting of four stages used to describe the spread of cancer. The different stages of cancer describe cancer confined within the prostate, growth that extends to tissue outside the prostate, to local organs or metastasized to distant parts of the body. Several different tests can be used either alone or in combination to determine the extent of spread of the cancer. Not all of these tests are needed in all men. Staging tests include the DRE, PSA Blood Test, Ultrasound, Biopsy, Bone Scan, Cat Scan, MRI and PET Scan.

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Local Bladder Cancer Metastasis

When bladder cancer spreads, it first invades the bladder wall, which is made up of four distinct layers. It can take some time for cancer to penetrate all of these layers, but once it has, it can then spread into the surrounding fatty tissues and lymph nodes. Once bladder cancer has reached the lymph nodes, it can travel to distant parts of the body through the lymphatic system. Separately, it can also continue to grow into surrounding areas such as the abdominal wall .

Radiotherapy To The Prostate

Some men who have just been diagnosed with advanced prostate cancer may be offered external beam radiotherapy as part of their first treatment. This is where high-energy X-ray beams are directed at the prostate from outside the body. The X-ray beams damage the cancer cells and stop them from dividing and growing. Read more about radiotherapy for advanced prostate cancer.

Radiotherapy to the prostate isnt suitable for all men with advanced prostate cancer. If it isnt suitable for you, you might be offered a type of radiotherapy to help manage symptoms instead.

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Can Colon Cancer Affect The Prostate

colorectal cancerprostate cancerprostate cancer

Are colon cancer and prostate cancer related?

Colon cancer and prostate cancer are two of the most common cancers in males, says Ognian Pomakov, MD, an author on the study. However there are no published clinical studies to date that determined the prevalence of colorectal neoplasms in people with prostate cancer.

Contents

• 10 What problems can enlarged prostate cause?

How To Tell If Your Cancer Has Metastasized

Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.

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How Is Metastatic Bladder Cancer Treated

The way that metastatic bladder cancer is treated depends primarily on where the cancer has spread and the type of cells that make up the primary tumor. Its important to remember that when bladder cancer spreads, the secondary tumors are still considered to be bladder cancer not lung cancer, liver cancer or any other type of malignancy. Potential treatment options may include chemotherapy, radiation therapy and clinical trials.

At Moffitt Cancer Center, weve treated many patients with metastatic bladder cancer, creating tailored treatment plans for every single one. To help ease the burdens of treatment, we also offer comprehensive supportive care services for patients and their caregivers.

Treatments To Help Manage Symptoms

Treatments to help manage symptoms caused by advanced prostate cancer include:

• pain-relieving drugs
• complementary therapies

Pain-relieving drugs

There are lots of different types of pain-relieving drugs, such as tablets, patches and injections. Your doctor or palliative care nurse will help you find whats best for you.

Some men worry about becoming addicted to pain-relieving drugs. But this is uncommon in men with prostate cancer. Read more about managing pain in advanced prostate cancer.

Radiotherapy

Radiotherapy can help control symptoms by slowing down the growth of the cancer. Radiotherapy to help control symptoms is sometimes called palliative radiotherapy.

The most common type of radiotherapy used to reduce symptoms is external beam radiotherapy. This is high-energy X-ray beams targeted at the area being treated from outside the body. It can help to manage symptoms such as pain, blood in your urine or discomfort from swollen lymph nodes. Its also used to treat metastatic spinal cord compression.

You might have slightly more pain during treatment, and for a few days afterwards, but this should soon get better. It can take a few weeks for radiotherapy to have its full effect.

If your prostate cancer is causing bone pain, you may be offered radium-223 to help reduce the pain and delay some other symptoms.

Read more about radiotherapy for advanced prostate cancer.

Bisphosphonates

Complementary therapies

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What Are The Treatments For Prostate Cancer

There are many different ways to treat prostate cancer. For prostate cancer, it is important that you get a second opinion and you will most likely be consulting multiple types of healthcare providers before making a final decision. You should talk to both urologists and radiation oncologists to hear about the benefits and risks of surgery, hormonal therapy and radiation in your particular case. If your prostate cancer has already spread at the time of diagnosis, you will also need a medical oncologist to talk about chemotherapy. The most important thing is to review your options and make a decision that best suits your lifestyle, beliefs and values.

Active Surveillance

Surgery

Surgery is a common form of treatment for men with prostate cancer. Surgery attempts to cure prostate cancer by removing the entire prostate and getting all of the cancer out of the body. An attempt at a surgical cure for prostate cancer is usually done with early stage prostate cancers. However, sometimes surgery will be used to relieve symptoms in advanced stage prostate cancers.

Talk to your surgeon about their complication rates before your operation. With surgery, urinary incontinence and impotence are often most severe right after the operation and generally get better with time. There are things that your providers can recommend to help you with either of these problems. Talk to your urologist about your options.

Radiation

Hormonal Deprivation Therapy

Chemotherapy

What Is Advanced Prostate Cancer

When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.

Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.

• Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
• Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
• Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.

When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.

There are several types of advanced prostate cancer, including:

Biochemical Recurrence

With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.

Castration-Resistant Prostate Cancer

Non-Metastatic Castration-Resistant Prostate Cancer

Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.

Metastatic Prostate Cancer

• Lymph nodes outside the pelvis
• Bones
• Other organs, such as liver or lungs

Metastatic Hormone-Sensitive Prostate Cancer

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