Can I Survive Stage 4 Prostate Cancer?

The Prostate Cancer Paradigm 

Prostate Cancer is the most common cancer in men. Prostate cancer screening remains very important. There is a myth, that prostate cancer is “not that bad” because a treatment option is to do nothing at all. That is a myth and an interpretation that is causing needless pain, suffering and death for some men. I will blog later on the risks and benefits of Active Surveillance (which is different from “doing nothing” / aka Watchful Waiting; that was common decades ago). The stage at which Prostate cancer is diagnosed is usually early stage, but unfortunately, when prostate cancer evaluation is neglected for a long period of time it may present at a later stage, and a higher risk of dying from the disease. See earlier blog on prostate cancer diagnosis HERE, or search “prostate” on the blog site.  

To learn more about the basics of prostate cancer sign up for the video courses and review short reads about prostate cancer, types of surgery for prostate cancer, staging of prostate cancer, radiation treatment for prostate cancer, hormone therapy for prostate cancer, sexual side effects from treatments and more – visit the Prostate Cancer Courses by clicking HERE. If you do not have a basic understanding of prostate cancer, then continuing beyond this point may not be very beneficial.

How Do I Know If I Have Stage 4 Prostate Cancer? … 

Now that you have a basic understanding of prostate cancer work-up, treatments, and especially the six (6) Risk Groups that drives treatment recommendations, let’s take a look at the components of Very High Risk Prostate cancer and Stage 4 Prostate Cancer.

The components that are considered in staging prostate cancer, assist your team in making the best recommendation that is unique to the characteristics of the prostate cancer with which you are initially diagnosed. They will consider:

• TNM (Tumor, Node, Metastases)
• Gleason’s Score
• PSA
• Risk Group

In previous blog we spoke about TNM, which describes the Tumor (T) in the prostate, if the cancer spread to the Lymph Nodes close by (N), or elsewhere in the body (M = metastases). The course clearly outlines these definition with videos and notes. The Gleason Score tells us how “aggressive” the cancer appears under the microscope. The PSA can be used as an indicator of the burden of disease (sometimes, this may be skewed if you have a large prostate. Talk to your doctor/urologist about this if concerned. Also, some medications can cause your PSA to be 50% lower, and a prostate cancer diagnosis may be missed).   

Treatment for Stage 4 Cancer

It used to be, that a stage 4 cancer diagnosis required an end-of-life discussion … people would call it a “death sentence”.  This is not the routine case anymore. Yes, it is true that some are diagnosed with far advance cancer and nothing can be done, but many men are living with stage 4 prostate cancer for many, many years as well. See previous blog on surviving stage 4 cancer HERE. Thanks to the advancement in medicine, we are now able to treat patients with the intent of eradicating most of the cancer, especially if there are less than 4-5 sites of metastases.  Low tumor burden may equal longer years. Of course, with every treatment, side effects must be discussed. There are risk and benefits to everything in life – even driving a car. 

Common Treatments:

• Radiation therapy – Did you know that radiation therapy to the prostate is an option with “low-volume” stage 4 metastatic prostate cancer? Also, if there are only a few brain lesions and disease elsewhere in the body is being treated and/or controlled, then Stereotactic RadioSurgery (SRS) is very successful at treating small brain metastases. We have even done SRS/SBRT to lung lesions, adrenal gland (above the kidney), vertebral body (spine)/Bone, etc., We can spot treat these areas to slow down the cancer/decrease the cancer burden, decrease painful metastases and more. The recent SABR-COMET trial showed overall survival and progression free survival benefits from some of these treatments
• Hormone Therapy/Chemotherapy/Immunotherapy – ADT (androgen deprivation therapy = hormone shots (Gisereline, Flutamide, Degarellix, etc.,) is a mainstay of prostate cancer treatments. In stage 4 prostate cancer, treatment recommendations depends on the burden of disease. There are novel treatment that we can use that have proven helpful.  Talk to your urologist/oncologists about medications such as Apalutamide, Aberaterone, Docetaxel, etc., Medication to strengthen the bone may also be given
• Surgery – in some cases, surgery may be an option for areas that may be the only area of metastases (liver, lung, etc.,), with low volume disease. Each patient’s case will be different, but those who are otherwise in good health and not a high surgical risk (high risk of dying from the surgery), may ask if they are a candidate

How Do I Talk To My Cancer Team?

I could write on and on about this topic for a very long time, taking each of the above and breaking it down even further. However, the goal here is to provide you with enough information to supplement the Prostate Cancer Courses and Books on Amazon, so that you may have a good conversation with your Cancer Team.  Look, let’s be realistic. Would you buy a computer, or phone, or car without doing research on the best product for you? Why should taking care of yourself be any different? Arm yourself with knowledge and advocate for yourself the best you know how!  Your cancer team will fill in the blanks. It is my prayer that these blogs will help you on your journey …

We have peeled away many layers in discussing stage 4 cancer and have addressed some of the main points.  We will shift gears to a new topic next blog

You may register for the FREE course HERE and test your cancer knowledge HERE 

Until next time know that,

Life is beautiful and God is awesome. And know, you are pure awesomeness!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

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Queen, Your Family Friendly Cancer Doc!