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Stage 4 Prostate Cancer

Introduction

Prostate cancer is known as the uncontrolled (malignant) increase of cells in the prostate gland. The prostate gland is positioned beneath the bladder and in front of the rectum, surrounding the urethra. This walnut-sized gland in men produces fluid that helps to make semen.

According to research, 1 out of 5 men in the United States are diagnosed with prostate cancer throughout their lifetime. Prostate Cancer is one of the two leading causes of death in the United States. The incidence of this disease is also increasing outside the western world and is becoming a global problem. The American Cancer Society estimated that in the year 2021, 248,530 men will get diagnosed with prostate cancer, and 34,130 will die from it.

Prostate cancer starts in the prostate gland and advances when it spreads from the prostate to other parts of the body.

Cancer starts spreading when the cells break away from the primary tumor and enter different body sites. The phenomenon is known as metastasis.

Most commonly, prostate cancer spreads to the following organs:

  • liver

  • lungs

  • bones

  • adrenal glands

Stage 4 Prostate Cancer

At the time of diagnosis, if the prostate cancer has spread to nearby or distant organs, it is said to be stage 4 prostate cancer. Even with appropriate therapies, prostate cancer can recur due to being a slow-growing malignancy.

Stage 4 prostate cancer is divided into two sub-groups:

Stage 4A

The tumor spreads to nearby lymph nodes only.

Stage 4B

The tumor spreads to distant parts of the body, such as organs or bones.

Symptoms

If cancer has not spread outside of the prostate, many men do not experience any symptoms. Some might feel trouble while urinating or notice blood in their urine. In metastatic prostate cancer following symptoms can be experienced:

  • fatigue

  • weight loss

  • weakness

Other symptoms may include:

  • bone pain and fractures

  • swelling in the abdomen

  • jaundice

  • shortness of breath

  • seizures.

Risk Factors

Every man is at risk of having prostate cancer. Approximately one man in nine will be diagnosed with it during their lifespan. In addition to being male, other things contribute to the risk, including:

Age

Prostate cancer is uncommon in men of the age 40 or below, but the chances of having prostate cancer rise rapidly after a man reaches 50. About 60% of cases of prostate cancer are reported in men above the age of 65.

Race/Ethnicity

Prostate cancer is more common in African American and Caribbean men of African ancestry than in other groups. When prostate cancer develops in these men, they are likely to be younger. The occurrence of prostate cancer has less probability in Hispanic/Latino and Asian American men, whereas in non-Hispanic whites, it is usual.

Geography

Prostate cancer is increasingly common in North America, northwestern Europe, Australia, and Caribbean islands. Whereas, in Asia, Africa, Central America, and South America, it is not prevalent.

The reasons for geography differences are not clear. However, in developed countries, higher intensity screening for prostate cancer is one of the reasons for this difference. Other aspects such as lifestyle changes and diet also have an impact. For instance, Asian American men are at a relatively lower risk of developing prostate cancer than white Americans. But, the risk is comparatively higher than the men of the same ethnic backgrounds who live in Asia.

Family History

In some cases, inherited or genetic factors could also contribute. However, the risk of developing prostate cancer is still high in men without a family history of it. Men who have a father or brother with prostate cancer are more likely to get the disease. The risk increases if several relatives are affected with prostate cancer, specifically at younger ages.

Gene Changes

Mutations in genes are likely to increase the risk of developing prostate cancer in men. Following are some examples:

  • Mutations in the BRCA1 and BRCA2 genes, which are related to greater risk of ovarian and breast cancers in women, also increase the chances of prostate cancer in men (particularly mutations in BRCA2)

  • DNA mismatch repair genes (including MSH2, MSH6, MLH1, and PMS2): These genes fix mismatches in DNA that can be made when a cell is getting ready to divide into two new cells. Men with inherited mutations in any of these genes have a disorder known as Lynch syndrome (also known as hereditary non-polyposis colorectal cancer, or HNPCC). They have an increased risk for many cancers, including prostate cancer.

Factors with Less Clear Effects on Prostate Cancer

Diet

Men who eat dairy products in a large amount seem to have a slightly higher probability of getting prostate cancer. That is because of an increased amount of calcium present in the body.

Obesity

A few investigations have shown that men with higher weights are at a lower risk of developing an aggressive form of prostate cancer.

Diagnosis Of Stage 4 Prostate Cancer

Tests and procedures for diagnosis may include:

Screening

Doctors perform the following tests to screen for prostate cancer:

  • The Prostate-specific Antigen (PSA) Blood Test: Measures the level of PSA (a protein made by prostate cancer) in the blood.

  • The Digital Rectal Examination (DRE): The doctor examines the patient for an abnormal prostate by placing his lubricated, gloved finger into the rectum.

Biopsy

The biopsy process involves removing a sample of cells from the prostate using a biopsy device. These cells are then observed under a microscope. The pathologist will look for cancer cells in the tissue sample.

Treatment for Stage 4 Cancer

With early detection of prostate cancer, immediate treatment could be possible. Standard treatment for stage 4 cancer includes both targeted and systemic therapies. Most of the men might need a combination of therapies. The goal of the treatment regimens is to shrink the tumors and suppress the symptoms.

Standard treatment options comprise the following:

  • Hormone Therapy

  • Radiation

  • Chemotherapy

  • Immunotherapy

  • Surgery

1. Hormone Therapy

Hormone therapy is the first approach in the treatment regimen. It is also known as androgen deprivation therapy (ADT). If there are no androgens in the body, prostate cancer can not grow. Androgens include testosterone and other hormones. Hormone therapy controls the male hormones that cause the prostate cancer cells to metastasize. If the androgens are reduced to a small number in the body, it can slow the growth and shrink the tumor.

2. Radiation Therapy

Another treatment option for stage 4 prostate cancer is radiation. Rays of radiation target the prostate gland—radiation therapy comes into use when prostate cancer has spread to the bone.

Internal radiation therapy, also known as seed implantation or brachytherapy, is another type of radiation cancer treatment. In this process, tiny radioactive seeds are inserted into the prostate of the patient. The implanted seeds will release permanent low dose or temporary high doses of radiation.

3. Chemotherapy

The process of chemotherapy is applied to kill cancer cells throughout the body. This treatment includes shrinking existing tumors and slowly preventing the growth of new cells.

4. Immunotherapy

If a patient is not responding to hormonal therapy, then immunotherapy comes into consideration. Sipuleucel-T (Provenge) is a vaccine that is used in the treatment of stage 4 prostate cancer. This vaccine is produced from the patient's white blood cells. The patient will receive Sip-T intravenously in three doses.

The production of this vaccine is done by using the patient's white blood cells. The patient will receive this vaccine intravenously in three doses.

5. Surgery

Surgery is not often considered to treat stage 4 cancer but is recommended in some situations. Men who experience symptoms like difficulty in passing urine might need surgery.

There are two types of surgery for stage 4 cancer:

  • Radical Prostatectomy
    This type of surgery is applied to remove the prostate and any cells grown locally near the prostate.

  • Lymph Node Removal
    The lymph node surgical method tests cancer cells by removing several lymph nodes near the prostate.

Personalized Treatments At Silver Cancer Institute and Center for Chronic Disease

Silver Cancer Institute and Center for Chronic Disease is known best for the therapy plans it offers. Dean R. Silver produces a personalized treatment strategy for every stage 4 prostate cancer patient, which also includes special testing.

Genomic Personalized Molecular Testing

  • Evaluating the patient's genetic biomarkers allows the inhibition of pathways that cause tumors.

  • Chemosensitivity testing is another way of determining which chemotherapy is most effective in a patient with prostate cancer.

  • Natural testing helps in deciding which natural substance will work best for prostate cancer.

  • Every patient with prostate cancer must get his circulating cancer cells evaluated both pre and post-treatment. This testing will help in predicting the patient's remission prognosis and future outcomes.

Combination Therapy Gives Best Results

By molecularly characterizing tumors, Silver Cancer Institute and Center for Chronic Disease can use the information on the DNA and RNA to improve treatment for everyone.

The treatment plan includes the following:

  • Low-dose Chemotherapy and Natural Synergistic Substance
    Low-dose chemotherapy is utilized to avoid chemotherapy resistance and adverse effects related to high-dose chemotherapy. Natural substances are also used in combination to increase the efficacy of treatment.

  • Immunotherapy w/ Checkpoint inhibitors
    Checkpoint inhibitor therapy, when combined with chemotherapy and vaccines, produces great responses in patients.

  • Immunotherapy w/ Autologous Whole Tumor Vaccine
    Provenge (sipuleucel-T) Immunotherapy with cellular immunotherapy is planned to stimulate the patient's immune system against prostate cancer.

  • Dendritic Cell Vaccine and Supportive Oligonucleotides (SOT)
    Vaccines used in combination to provide synergistic effects include autologous whole cancer vaccines, dendritic cell vaccines, and supportive oligonucleotide (SOT).

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