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Prostate Cancer: Latest Treatments and Emerging Therapies

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What are the options for locally advanced, recurrent, or metastatic prostate cancer?

Locally advanced cancer is called stage III cancer. It refers to cancer that has spread beyond the margins of the prostate gland into the seminal vesicles and/or nearby lymph nodes. Recurrent cancer refers to a previously treated cancer that has returned in the previously treated area. The return is usually signaled by a rise in prostate-specific antigen in the bloodstream after radical prostatectomy or radiation therapy. Metastatic or stage IV cancer refers to the spread of prostate cancer cells through the lymphatic system or bloodstream to other parts of the body. For instance, it might spread through the bloodstream into the bones.

Neither locally advanced, recurrent, nor metastatic prostate cancer can generally be cured with current treatments. But there are several treatments that provide long-term control of the cancer. Many men live for years or even decades with a good quality of life on these therapies. In addition, there are several promising therapies for advanced-stage prostate cancer that are now being studied.

Men with more advanced cancers are often treated with a combination of therapies. This includes surgery, radiation, hormone therapy, and chemotherapy. For instance, some studies show that men with locally advanced prostate cancer have better overall survival with radiation therapy combined with hormone therapy. They also have longer survival free of disease progression when compared to men with radiation therapy alone.

The man's age and his general overall health will be taken into consideration when planning a treatment strategy. For instance, for older men and those with other illnesses, the risks of surgery for advanced prostate cancer may outweigh the benefits.

Can surgery help with advanced prostate cancer?

In general, surgery cannot completely remove cancerous tissue in men with stage III prostate cancer. Instead, the role of surgery is to remove as much tissue from the tumor as possible. Such treatment is considered if the tumor is not fixed to adjacent tissues. Surgery may also be used to remove cancerous lymph nodes or to relieve symptoms such as urine retention. Often, surgery is used in combination with radiation therapy and/or hormonal therapy. Men with urinary symptoms such as painful or difficult urination caused by an enlarged prostate or large tumor may benefit from surgery to open a constricted urethra.


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