About Advanced Disease

Advanced Disease
 
“Advanced prostate cancer” includes cases in which the cancer has:
 
1.  Spread outside of the confines of the prostate to surrounding areas - “locally advanced disease”;
2. Spread to lymph nodes and/or other sites within the body (most commonly, bone) – “metastatic disease”;
3. Recurs (comes back) after initial treatment (which may have been surgery, radiation or hormonal therapy) -“recurrent disease”; and
4. Already been treated with hormonal therapy but has now become resistant to hormone treatment - “castrate-resistant disease”.
 
We will look at each type of advanced cancer in more detail.
 
Locally advanced prostate cancer
 
Locally advanced cancer is cancer that is starting to break out of the prostate, or has spread to the area just outside the prostate.
 
Your treatment will depend on how far the cancer has spread and will either get rid of the cancer or control it over the long-term. If you are given a choice of treatments, you might want to discuss the following with your health care provider:

  • What each treatment involves (the pros and cons and any side effects)
  • Your general health and age (and any other medical conditions you have such as heart disease), and
  • Any clinical trials that might be available).
 
Metastatic Prostate Cancer
 
This refers to prostate cancer that has spread beyond the prostate. Lymph nodes in the pelvic region (then later in other regions) and bones are the most common sites of prostatic metastatic disease. Other organs such as liver, lungs, brain are less commonly affected.
 
Investigations including bone scans and “computerized tomography” or “CT scan”/“CAT scan” help to determine how far along the cancer has spread; i.e., what “stage” the cancer is in.
 
As with advanced disease generally, the type of treatment you receive will depend on the extent of your disease, your age and general health, and how severe your symptoms are (sometimes you may have no symptoms even with metastatic disease).
 
Generally, you will receive “systemic treatment”.  This means that drugs will be given to you by mouth, by needle injection into muscle tissue or under the skin, or by intravenous injection.  These drugs will act against prostate cancer tissue throughout your body, regardless of the location of the cancer. 
 
The most commonly used first-line drugs lower the testosterone levels in the body, thereby “starving” the prostate cancer cells and slowing their growth.   
 
Recurrent Prostate Cancer
 
If you have cancer that has persisted or returns after radiation therapy or surgery, in the same location or elsewhere, your doctor may talk to you about the following treatment approaches:
  • Hormone therapy is the main treatment. It is not a cure, but it can control prostate cancer growth for many years.
  • If you have had radical prostatectomy, radiation therapy, specifically external beam radiation, may be used, unless this treatment has already been tried in the prostate area. (It may still be used for bone metastases.)
  • If you have had radiation as part of your initial treatment, surgery (TURP, “salvage” cryoablation or “salvage” radical prostatectomy or “salvage high intensity focused ultrasound ) may be options when cancer recurs or persists in the prostate area itself (but not when it has spread elsewhere, i.e., “metastasized” (see below).
  • Locally advanced cancer causes blockage of the ureters (tubes draining from the kidneys) and may require tubes to be inserted to improve drainage and preserve kidney function. 
 
Castrate-Resistant Prostate Cancer
 
Some men have tumours that do not respond, or have stopped responding, to testosterone-lowering hormone treatments. If you have this kind of cancer, you have “castrate-resistant prostate cancer”.
 
To treat castrate-resistant prostate cancer, Androgen Deprivation Therapy (ADT) is continued, because without it, the cancer would grow faster.  In addition, the following other therapies may be added:
  • Powerful anti-androgens (abiraterone or enzalutamide) may be the next step, or chemotherapy drugs such as docetaxel (Taxotere) may be used first.  They have been shown to improve survival and quality of life.
  • Radium-223 is a bone-seeking radioactive injection that may be used where bone metastases predominate.
  • Radiation therapy may relieve urinary symptoms or bone pain.
  • Surgery known as transurethral resection of the prostate (TURP) can help relieve urinary symptoms.
  • Bisphosphonate drugs or biological therapy can strengthen bone and prevent osteoporosis due to hormone therapy. It also reduces the risk of bone complications.

 
Several new treatments have recently become available.  You may want to talk to your doctor about the following new drugs which have shown very good response for castrate-resistant prostate cancer: These are: Abiraterone, Enzalutamid, and Cabaxitaxel.

Please refer to our Prostate Cancer Drugs webpage for more information.
  
We know that being told you have advanced prostate cancer can be very difficult.  Please contact the Prostate Cancer Information Service if you have any questions at 1-855-722-4636.  You can also join one of our support groups by finding one close to where you live. 
 
References
Health Canada
Prostate Cancer UK


View and order the our advanced prostate cancer resource here.


 
Have questions about your diagnosis or treatment? Talk with an information specialist, one-on-one for free. Call 1-855-PCC-INFO (1-855-722-4636) or email support@prostatecancer.ca.
 
Watch our Expert Angle Webinars to learn more about advanced disease.




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