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Why
Prostate Cancer Spreads
WebMD Medical Reference
Reviewed by Nazia
Q Bandukwala, DO
Prostate cancer
starts when cells in the prostate gland grow out of control. Those cells can
spread to other parts of the body and affect healthy tissue.
This can happen for
several reasons.
Early Treatment Failure
When prostate
cancer is discovered early, treatment usually works. Most men are able to live
cancer-free for many years.
But sometimes,
treatment doesn't work and prostate cancer can slowly grow. This can
happen after surgery (called a radical prostatectomy) or radiation therapy.
Sometimes called a
chemical recurrence, it's when the cancer survives inside the prostate or
reappears and spreads to other tissues and organs.
The cancer is
usually microscopic and grows very slowly.
You and your doctor
will work together to keep an eye on the cancer as it grows. You may come up
with a new treatment plan.
Active Surveillance
Because prostate
cancer cells usually grow very slowly, some men might not need treatment right
away.
Your doctor might
suggest something called active surveillance. That means instead of having
surgery or radiation right away, you and your doctor will track your cancer for
a while to see if it gets more serious.
You'll have regular
tests, like PSA levels, and possibly biopsies and MRI. And if your cancer gets
more aggressive, you and your doctor will figure out the next steps.
This plan is
usually for men who don't have symptoms and whose cancer is expected to grow
slowly. It's also an option when surgery or radiation could be harmful.
Watchful Waiting
Another potential
plan is watchful waiting. Like active surveillance, this avoids surgery and
radiation, and you and your doctor watch the progress of your cancer.
But with watchful
waiting, you don't have regular testing.
Most often, this is
the best option for people who don't want or can't have other cancer
treatments, or those who have another serious medical condition.
The risk with this
approach is that the cancer might grow and spread between checkups. If it does,
this could limit which treatment you could take and if your cancer can be
cured.
Treatment Issues
When you're
diagnosed with cancer, as with any medical issue, it's important that you
follow your treatment plan.
That can mean
scheduling regular checkups or, if radiation therapy is part of your treatment,
being sure to go to all scheduled radiation visits.
If you miss some of
them, you may have a greater chance that your cancer will spread.
In one study, for
example, men who missed two or more sessions during their treatment had a
greater chance that their cancer would come back.
That was even
though they eventually finished their course of radiation.
Late Diagnosis
Experts disagree on
whether all men should get tested for prostate cancer and at what age screenings
and the discussions about them should take place.
Exams such as a
prostate-specific antigen (PSA) test can help find cancer early. But there are
questions about if the benefits of screening tests always outweigh the risks.
Some groups suggest
that men at a normal risk for prostate cancer should have prostate screening
tests when they turn 50.
Some men might want
to get tests earlier if they have risk factors that make them more likely to
get prostate cancer.
The U.S. Preventive
Services Task Force says that testing may be right for some men ages 55 to 69.
They recommend that
men talk to their doctor to discuss the potential risks and benefits of being
tested.
The American Cancer
Society recommends starting screenings at age 50, possibly earlier for men at a
high risk.
But first, men
should discuss the pros and cons of the PSA test with their doctor to decide if
it's right for them.
The American
Urological Association says men ages 55 to 69 should talk to their doctor about
the benefits and risks of a PSA test. The group also says:
· PSA screening in men under age 40 is not recommended.
· Routine screening in men between ages 40 and 54 at average risk
is not recommended.
· To reduce the harms of screening, a routine screening interval
of 2 years or more may be preferred over annual screening in men who have
decided on screening after a discussion with their doctor. As compared to
annual screening, it is expected that screening intervals of 2 years preserve
the majority of the benefits and reduce over-diagnosis and false positives.
· Routine PSA screening is not recommended for most men over 70 or
any man with less than a 10- to 15-year life expectancy.
· There are some men ages 70 and older who are in excellent health
who may benefit from prostate cancer screening.
Early prostate
cancer usually has no symptoms. You may go to see the doctor when you have
trouble urinating or pain in your hips and back.
That's when
prostate cancer may be discovered.
After that, your
doctor may find out that your cancer has already spread beyond your prostate.
If that's possible, you may be asked to take a test like a:
· Bone scan
· MRI
· Ultrasound
· CT scan
· PET scan
Knowing if your
cancer has spread will help your doctor work with you to choose your best
treatment.
WebMD Medical Reference
Reviewed by Nazia Q Bandukwala, DO
Nazia
Bandukwala,
DO, graduated magna cum laude with a bachelor's degree in microbiology from the
University of Georgia. She earned her medical degree from the Philadelphia
College of Osteopathic Medicine and completed her internship and residency in
urology at Detroit Medical Center. And as she completed her fellowship in
female pelvic medicine, urologic reconstruction, and urodynamics in Miami, she
published articles on urinary incontinence and pelvic organ prolapse. She also
was a clinical instructor in the urology department at Michigan State
University.
Bandukwala
enjoys serving the community -- she received the American College of
Osteopathic Surgeons Humanitarian Scholarship. She is also an active member in
the Society of Urodynamics, Female Pelvic Medicine & Urogenital
Reconstruction; Society of Women in Urology; American Urological Association;
Society of International Urology; and American Osteopathic Association.
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