Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA and radiologic studies. The American Joint Commission on Cancer (AJCC) TNM system for prostate cancer staging is as follows:
Prostate cancers cannot be seen on imaging tests or felt on examination.
Prostate cancers can be felt on examination and can be visualized with on imaging studies.
Prostate cancers have extended beyond the prostate gland to possibly involve the seminal vesicle or bladder neck.
Prostate cancers have invaded adjacent tissues or organs.
Means that there is no prostate cancer evident in the nearby nodes.
Means that there is evidence of prostate cancer in the nearby nodes.
Means that there is no evidence of spread of prostate cancer into distant tissues or organs.
Means that there is spread of prostate cancer into distant lymph nodes or organs.
The PSA and Gleason score at presentation as well as the final cancer stage designation determine the prognosis of the affected individuals.
Talk to our prostate cancer oncologists at Onco Life Centre about your treatment options. The main treatments for prostate cancer are surgery, hormonal therapy, chemotherapy and radiation therapy. Often the best approach uses 2 or more of these treatment methods. It is important that you understand the goal of your treatment. If a cure is not possible, treatment is aimed at relieving symptoms such as pain.
The removal of the entire prostate gland and the urethra that runs through the prostate and the attached seminal vesicles is referred to as a radical prostatectomy. Radical prostatectomy is an appropriate treatment option for men with clinically localized prostate cancer with a life expectancy of 10 or more years. Pelvic lymph node dissection may be recommended depending on the Gleason score, PSA, and radiologic findings.
Prostate cancer is highly sensitive to and dependent on the level of the male hormone testosterone, which drives the growth of prostate cancer cells, except in poorly differentiated forms of prostate cancer.
Front-line hormonal therapy for advanced and metastatic prostate cancer is called androgen deprivation therapy (ADT).
While it is not a curative treatment in that setting, it can both reduce symptoms and slow down the growth of the prostate cancer to prolong life.
Medications that block testosterone production by the testes include LH-RH agonists, LH-RH antagonists. Medications that block the action of testosterone include the androgen receptor blockers and are usually considered in individuals who have failed first-line ADT.
Adrenal androgen synthesis inhibitors block testosterone production from the adrenal glands. More recently, new agents in this class of drugs have been developed and are also considered in individuals who have failed first-line ADT.
The use of chemotherapy in metastatic prostate cancer (Stage 4 prostate cancer) is able to relieve symptoms of prostate cancer, and can prolong life. It is usually used in the setting of castration-resistant prostate cancer.
Chemotherapy drugs may damage the DNA of the cancer cells or disrupt the cells ability to divide. These effects can cause cells to die. Active chemotherapy drugs for the treatment of prostate cancer today include taxane drugs. Although traditionally recommended for men with castrate-resistant prostate cancer, the NCCN has also recommended the combination usage of chemotherapy and hormone therapy (use of taxane in combination with ADT) and EBRT in men with high- and very-high-risk localized prostate cancer.
There have been advances in the development of targeted therapy drugs for prostate cancer. If there is a BRCA mutation in the patient, then a PARP Inhibitor drug can be used to block PARP proteins, and make it very hard for the tumor cells with an abnrmal BRCA gene to repair damaged DNA, leading to the death of these cells. Our oncologist specialising in prostate cancer treatment prescribes this PARP inhibitor targeted therapy as an oral drug taken as a pill by mouth. It can be used in combination with hormonal therapy.
Targeted therapy are also used to treat metastatic, castration-resistant prostate cancer that have homologous recombination repair (HRR) gene mutations.
In immunoterapy for localized or metastatic prostate cancer, immune checkpoint inhibitors are used for patients whose prostate cancer cells have tested positive for specific gene changes. PD-1 inhibitor targets PD-1, a checkpoint protein on immune system cells called T cells, that normally helps keep these cells from attacking normal cells in the body. By blocking PD-1, this drug boosts the immune response against prostate cancer cells. It has shown promising results in prostate cancer treatment.
Radiation therapy is a potentially curative treatment that uses radiation to kill cancer cells. External beam therapy (EBRT) is appropriate for men who are candidates for radical prostatectomy but do not wish to undergo the surgery or who are not ideal surgical candidates.
The NCCN guidelines recommend that patients with high-risk and very-high-risk prostate cancer receive neoadjuvant/concomitant/adjuvant hormone therapy (androgen deprivation therapy [ADT]) for a total of two to three years.
Several bone-targeted therapies have been approved for use by the US FDA, as both prostate cancer as well ADT can have a significant impact on bone health.
These drugs encourage the death of the osteoclasts. In prostate cancer they impact the course of skeletal-related events including reducing pain in the bones, and delaying the progression of bone metastases associated problems including the appearance of fractures.
2) Monoclonal antibody therapy
This class of bone-targeted therapy inhibits a protein that tells the osteoclasts to remove bone. It does not require dose adjustments if kidney function deteriorates. In some studies, this agent appears to be more effective than bisphosphonates in delaying the initial onset of skeletal-related events in patients with bone metastases.
Onco Life Centre combines key elements of prostate cancer care and prostate cancer treatment under one roof, with convenience and speed. At Onco Life Centre, we have the necessary medical disciplines to achieve this. Our board certified highly experienced consultant oncologists have earned recognition for excellence in the field of prostate cancer treatment, providing our patients with the most advanced prostate cancer treatment options.
Treatment cost for prostate cancer depends on several factors, such as the staging of the prostate cancer. Generally, using only chemotherapy is cheaper compared to using targeted therapy or immunotherapy. The more advanced the cancer stage, the more expensive it becomes to treat the cancer. At Onco Life Centre, the cost for treating prostate cancer using chemotherapy for most of our patients is around MYR4,000 per cycle. Adding in Targeted Therapy can go up from MYR8,000, depending on the specific type of targeted therapy drug used. Immunotherapy can range from MYR10,000 and above depending on the specific type and dosage of immunotherapy drug used.
Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.