Your type of cancer
Localized prostate cancer
Localized prostate cancer is contained within the prostate, in other words, it has not spread outside of the prostate. Many localized cancers are often not very aggressive and tend to grow slowly. Because of this, chances are high that this type of cancer will not cause you any problems in your lifetime. However, some localized cancers grow more quickly than others and can spread to other parts of your body.
There is no perfect treatment for localized cancer; each treatment has its strengths and weaknesses. A radical prostatectomy (the complete removal of the prostate) or a radiation therapy treatment can be done, but simply keeping a close watch can be enough to find any cancerous growths in time. Discuss the possible courses of treatment with your urologist.
Locally advanced prostate cancer
Locally advanced prostate cancer is cancer that has begun to break out of the prostate, but not too far. It may have spread beyond the boundaries of the prostate (capsule) into the neighbouring regions of the seminal vesicles, pelvic nodes, bladder, rectum, or pelvic lining.
Selecting the best treatment depends on the extent of the cancer’s spread.
- Hormone therapy
- Radiotherapy with hormone therapy with or without brachytherapy
- Radical prostatectomy, the complete removal of the prostate (in rare cases)
Metastatic prostate cancer
Metastatic prostate cancer, is cancer that has spread to other parts of your body — far from your prostate. Metastases originating from the prostate most often develop in the bones and lymph nodes. Bone pain, fatigue, and weight loss are all symptoms associated of advanced cancer. Advanced prostate cancer cannot be cured. There are, however, many treatments that can help to reduce symptoms and keep your cancer under control for several years. The preferred treatment for metastatic prostate cancer is hormone therapy. Hormone therapy reduces the level of testosterone (castration). It can be done surgically by removing the testicles or medically with injections or drugs.
In recent years, several treatments (chemotherapy and new generation hormone therapy) initially used after conventional hormone therapy has failed – meaning castrate-resistant prostate cancer – are now sometimes used when a new metastatic prostate cancer diagnosis is made.
Other types of prostate cancer
The recurrence of cancer can happen when some cancer cells survive after your initial treatment. Cancer can recur in the same place or it can be detected in another part of your body. The latter is also known as a metastatic recurrence. The next treatment step depends on the location of the recurrence.
Castrate resistant prostate cancer (CRPC)
Hormone therapy can keep the spread of cancer under control for a number of years. However, with time, the cancer may become castrate resistant and start to grow again. That is to say, cancer is able to replicate despite castration (the low level of testosterone). Treatments for cancers that no longer respond to hormone therapy exist, but are dependent on whether or not metastases are present.
Rare types of prostate cancer
The majority of men who have prostate cancer are diagnosed with adenocarcinoma, a malignant tumour in the glandular cells lining an organ. However, rare forms of prostate cancer also exist; the following are examples of such:
Leiomyosarcoma and rhabdomyosarcoma affect, respectively, smooth and striated prostatic muscle cells. These cancers don’t usually affect PSA levels, but often cause urinary problems. Sarcoma is found during biopsy, imaging or following a transurethral resection of the prostate used to treat urinary problems.
This cancer develops from neuroendocrine prostate cells. There are “small cell” neuroendocrine cancers and “large cell” neuroendocrine cancers that are much rarer and much less studied. Small cell carcinoma does not usually affect PSA levels and is often found following a biopsy or transurethral resection of the prostate that is used to treat urinary problems. This form of cancer tends to be aggressive, spreading to other parts of the body (metastases).
Transitional cell carcinoma
This cancer can start in the prostate, but more often than not, it starts in cancerous cells lining the urinary system (bladder, urethra, ureter, and kidney) and spreads to the prostate. This cancer is often diagnosed following a transurethral resection of the prostate.
Whether you are diagnosed with a rare form of prostate cancer or another less common type, such as ductal carcinoma, mucinous carcinoma, or signet ring carcinoma, ask your doctor to give you a detailed explanation of the cancer that you are affected by and its possible treatments.