(1)Howard University College of Pharmacy, Nursing and Allied Health knowledge, attitudes and perceptions of prostate cancer and early detection methods. of advanced prostate cancer and thoughts on the role of old and new therapies . . There was no Level 1 evidence to support any pharmaceutical therapy at. When you're diagnosed with prostate cancer at an early stage, usually It's important to pick one that's right for your condition and one that will.
“Prostate on Cancer” thought 1
Abiraterone acetate is characterized as an androgen synthesis blocker as it interferes with the C hydroxylase, C20, 21 lyase enzymes on the pathways converting precursor steroid molecules to androgens. Enzalutamide is characterized as an androgen receptor blocker as it displaces androgens from binding to the AR by preferentially occupying the receptor niche. With different mechanisms of action to interfere with androgen receptor activity, there was the potential for inducing as complete an androgen blockade environment — as with all trials LHRH agonist therapy continued — as was currently possible.
Furthermore there appeared to be no indication for overlapping toxicity other than that associated with further depletion of testosterone activity. The trial protocol required pre-entry bone biopsy which was accomplished under CT guidance without difficulty.
The vertebral biopsy analysis seemed ideal for this drug combination. The specimen stained strongly positive for the androgen receptor. There was no evidence of neuroendocrine de-differentiation, no androgen receptor splice variant AR-V7 detectable and steroid receptor co-activator SRC , a proliferation driver, was negative.
All factors lined up for an excellent response. There was no good explanation. It was time for a new start. Our department at Eastern Virginia Medical School had been involved with the earliest sipuleucel-T trials. The IMPACT trial had randomized men with asymptomatic or mildly symptomatic metastatic castration resistant prostate cancer to a cellular based immunotherapy treatment arm versus a control arm and demonstrated a statistically significant survival benefit for the patient receiving immunotherapy.
FDA approval was a breakthrough decision which brought the first immunotherapy for any cancer to the clinic. Since then there has been an explosion of interest in immunotherapy with a number of dramatic successes in its use in the treatment for other malignancies. Immunotherapy can be characterized with attributes that are admirably suited for addressing the same characteristics associated with tumor cell survival as flexible, durable, targeted, and adaptable, there was no hesitation on my part to move forward with Sipuleucel-T Provenge immunotherapy.
There was also developing evidence that radiotherapy might potentiate immunotherapy. Some of the beneficial effects of radiotherapy might be attributed to the abscopal effect. Cellular death caused by radiation, specifically high dose radiation producing double-strand breaks and mitotic death, releases a host of antigens which provide a broad repertoire of targets for immunotherapeutic activity.
My PSA gradually fell. Obviously I am very much appreciative of this good fortune and it has influenced my thinking and management of patients with good performance status and oligometastatic disease. The future is bright with a wealth of developing treatment possibilities on the horizon. Radium xofigo [ 32 ] will be an option for control of osseous metastases with a survival benefit. Immunotherapies with checkpoint inhibitors are promising. However, if high dose testosterone does enter into the clinic, it perhaps will be the only treatment for an advanced cancer that both controls disease while simultaneously allowing the patient to feel stronger and better!
Against the background, I will make some personal observations pertinent to the care and disposition of men diagnosed with prostate cancer. The emotional impact of a cancer diagnosis is quite profound regardless of how well educated or well informed the patient. I will describe my mindset with a cardiovascular event which I experienced 2 years before the diagnosis of prostate cancer — a mindset that I have discussed and confirmed as similar to the experience of others in the same situation.
Certainly the coronary occlusion, which fortunately was promptly treated with two stents with good results was sobering. Nevertheless, there was optimism. Plans for better diet, more exercise, and healthier lifestyle would allow me to partner with my heart with anticipation of a productive future. The emotional impact of the cancer diagnosis was quite different - a visceral reaction, almost a sense of betrayal and fear - a desire to rid myself of the alien invader by whatever means was my primary thought and plan of action.
This, despite the fact that I knew very well that the greatest risk for future morbidity and mortality rested with cardiac disease - I have had six additional stents placed as a reminder of this - and that any prostate cancer morbidity and mortality were certainly many years into the future. With the encouraging recent advances in knowledge about treatments for advanced prostate cancer, morbidity and mortality will decline even farther.
I will paraphrase here an observation made by Wendy Harpham, a physician and medical writer, who was faced with one of many recurrences of a hematologic malignancy. She observed that cancer did not make her life uncertain but exposed her to the uncertainties of life. When she put aside her fears, apprehensions, and concerns about tomorrow and appreciated what she now had, in a way never before possible.
Intertwined with the disappointment of PSA recurrences, is the hope that rests with new effective and approved therapies and the promise of new therapies that are in the process of clinical trial testing and that might be even more effective. The promise of investigative therapies certainly provides hope. However, the time, testing, and travel that clinical trials often demand are daunting and often frustrating.
Patients are prepared to participate in and take risks that trials may present in hopes of deriving benefit. They are essential partners in the team moving cancer therapy forward. The time has arrived to fulfill the promise that trials must be more patient-friendly.
I have entered many patients into clinical trials, and have personally participated in 2 trials one after PSA failure following salvage radiation plus androgen deprivation therapy, and one upon developing castration-resistant metastatic disease and can attest to the difficult regulatory gauntlet they present.
I believe the global effect of androgen deprivation is underappreciated and that the debilitating effects of impaired sexual health are often inadequately addressed.
The long-term strain placed on relationships can be as significant as the strain of the initial prostate cancer diagnosis. It deals with problems and possible solutions. Even with my real life experience with androgen deprivation therapy ADT accumulated over decades, I know I cannot, within the limits of one or even several office visits, begin to prepare and educate patients for their new reality.
I could not even do that for myself! If only a complete user-friendly manual existed. The world of cancer has developed its own vocabulary. When used in certain contexts they deliver a specific message. Three of these words are survivor, cure, and war.
Soldiers, persevering through battle, just as cancer patients enduring chemotherapy or a surgical procedure, consider themselves as a survivor. One of the major differences, of course, is that in medicine survivorship is a time-limited event usually measured by 3, 5, or year survival curves. Survivorship is not a one-time event as there is always the possibility of subsequent cancer recurrences and further treatment.
I am certainly thankful and delighted to be surviving at the present, but I consider my pathway better described by the word participant. I say this because I have, with my physicians, partnered and participated in a number of decisions and then participated in the treatment process whether standard of care or clinical trial based. Another gold standard word is cure. Certainly every cancer patient looks for a procedure or pharmacologic agent that will rid him of disease and restore life, and hopefully quality of life, as experienced prior to the diagnosis.
Cure promises to relegate the cancer experience to the past tense. However, cure is often evanescent. Dormancy may be recognized in the future as an accepted temporary pattern of cancer behavior.
Lastly the word war. The war metaphor has entered almost all aspects of our lives. It is commonly used in competitive sports, business, and politics. War became closely associated with cancer when, in , President Nixon, as part of the National Cancer Act, officially declared war on cancer and aimed to defeat cancer in what is now recognized as a very unrealistic timeline.
War is energy depleting, resource consuming, and long wars all the more so. Prostate cancer is a disease of long natural history. Patients who enter into a daily battle with the disease forfeit the state of living well with their cancer.
Mukherjee, in his biography of cancer, the Emperor of all Maladies, discussed his concern with the cancer war metaphor. He suggested that the war on cancer may have to be won by redefining the meaning of victory. For prostate cancer patients this may involve a state of negotiation whereby they learn to live well and hopefully long with their disease. The emphasis is on thrival as well as survival.
This mindset has been described by others as when there are clouds on the horizon one learns to dance in the rain, or those patients do best who learn to dance with their disease. It has been my privilege to share my story with men receiving the unwelcome news of a prostate cancer diagnosis and also my privilege to witness the courage and strength they demonstrate as they face a future with this disease.
I appreciate the opportunity to share my story with you. This manuscript was prepared by the invitation of the Editorial Board and its scientific evaluation was carried out by the Editorial Board. No conflict of interest was declared by the author. The author declared that this study has received no financial support. National Center for Biotechnology Information , U. Journal List Turk J Urol v. Author information Article notes Copyright and License information Disclaimer.
Received Jul 1; Accepted Jul Copyright by Turkish Association of Urology. Emotions The emotional impact of a cancer diagnosis is quite profound regardless of how well educated or well informed the patient. Clinical Trials and Hope Intertwined with the disappointment of PSA recurrences, is the hope that rests with new effective and approved therapies and the promise of new therapies that are in the process of clinical trial testing and that might be even more effective.
The Lexicon of Cancer The world of cancer has developed its own vocabulary. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. Around 1 in 10 New Zealand men will develop prostate cancer at some stage in their lifetime. Prostate cancer that is found early has a better chance of successful treatment. The incidence of prostate cancer in New Zealand appears to be increasing. Its main function is to produce semen, a fluid that protects and enriches sperm.
Prostate cancer occurs when cells within the prostate gland become cancerous malignant forming a tumour. When the cancer is contained within the prostate gland, this is referred to as "localised" prostate cancer.
When the cancer has spread to the tissues surrounding the prostate gland, this is referred to as "extracapsular" prostate cancer. If the cancer cells spread to other parts of the body, this is referred to as "metastatic" prostate cancer. The causes of prostate cancer are not fully understood. However, it is known that the chances of developing the condition increase with age.
It is also known that prostate cancer is more common in men who have a history of prostate cancer in their family. Other factors, such as smoking and dietary, hormonal and environmental influences such as exposure to certain chemicals may also increase the chances of developing the condition. It is possible for the cancer cells to spread from the prostate gland to other areas of the body metastasise where further tumours can develop.
The most common places for prostate cancer to spread to are the lymph nodes of the pelvis and the bones of the spine. Spread of the cancer can produce symptoms such as lower back pain. Common diagnostic tests for prostate cancer include: Levels rise with age and when the prostate is enlarged.
Significantly increased levels of PSA in the blood can indicate prostate cancer. PSA levels are also known to rise in other prostate conditions such as prostatitis inflammation of the prostate.
PSA is not a test for cancer in itself. Up to 70 years: Digital Rectal Examination A digital rectal examination involves the doctor placing a gloved finger into the rectum. Through the wall of the rectum the doctor can feel the prostate gland and check for signs of enlargement or irregularity. If any irregularity is found the doctor may recommend a biopsy. A biopsy tissue sample is taken by inserting a needle into the prostate gland and withdrawing a small sample of tissue.
The needle is inserted via the rectum and the ultrasound is used to guide the needle to the correct biopsy location in the prostate gland. It is usual for several biopsies to be taken from various locations in the prostate gland. The biopsies are sent to a laboratory where they are examined under a microscope, making it possible to see if cancer cells are present. As there is a risk of infection following prostate biopsy, it is usual for antibiotics to be given prior to the procedure.
Small amounts of blood may be present in the urine, semen or faeces following the biopsy. Heavy bleeding is rare. In this technique, the biopsy samples are obtained by inserting a needle into the prostate gland via the perineum the area between the base of the penis and the anus. MRI magnetic resonance imaging and CT computerised tomography are specialised scans that produce detailed cross-sectional images of the body, allowing bones and internal organs to be assessed for cancer spread.
The type of scan used will be determined by the treating doctor. A bone scan scintigraphy involves injecting a radioisotope a dye that emits a small amount of radiation into the bloodstream through a drip in the hand or arm. The dye travels around the body and will accumulate in any bony areas affected by the cancer. Any deposits can then be detected with a specialised scanning machine. Once a diagnosis of prostate cancer has been made it is important to determine the extent of the cancer. Grading indicates the rate of growth aggressiveness of the tumour and staging indicates the spread and distribution of the cancer in the body.
The grade and stage of the tumour will determine what sort of treatment will be recommended. The system used to grade prostate cancer is known as the Gleason Score.
The higher the score, the more aggressive the tumour is likely to be, and the greater the chance that it has spread within the body. The system used to stage prostate cancer is the TNM system. The "T" refers to the extent of the tumour, the "N" refers to whether the lymph nodes are involved, and the "M" refers to whether cancer cells have spread metastasised.
T1 - The tumour is confined to the prostate and is unable to be felt or seen on an ultrasound scan. T2 - The tumour is confined to the prostate but can be felt and is able to be seen on an ultrasound scan. T3 - The tumour has spread beyond the prostate. T4 - The tumour has spread to the rectum, bladder or pelvic wall.
N0 - Cancer cells have not spread to nearby lymph nodes. N1 - Cancer cells have spread to nearby lymph nodes. M0 - There are no distant metastases. M1 - Distant metastases are present. The choice of treatment will differ for each individual. It is important that time is taken to consider the treatment options available.
Watchful waiting Prostate cancer is usually slow growing. If no symptoms are present the doctor may recommend no treatment apart from regular PSA blood tests and monitoring.
Surgery for Prostate Cancer
Prostate cancer is the second most common cancer diagnosed in men in Australia and the third most common cause of cancer death. One in 7. There is no single cause of prostate cancer. Fats stimulate hormone production , and the one lifestyle-related cause that most researchers agree Naturally high testosterone levels are also thought to trigger prostate cancer. In most cases, prostate cancer symptoms are not apparent in the early stages The symptoms of prostate cancer may be different for each man and any one of.