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What is Advanced Prostate Cancer?

When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.

Prostate cancer is often grouped into four stages.

  • Stages I & II: The tumor has not spread beyond the prostate. This is often called “early stage” or “localized” prostate cancer.
  • Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called “locally advanced prostate cancer.”
  • Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called “advanced prostate cancer.”

When an early stage prostate cancer is found, it may be treated or placed on surveillance (watching closely). If prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer. Stage IV prostate cancer is not “curable,” but there are many ways to control it. Treatment can stop advanced prostate cancer from growing and causing symptoms.

There are several types of advanced prostate cancer, to include:

Biochemical Recurrence

If your Prostate Specific Antigen (PSA) level has risen after the first treatment(s) but you have no other signs of cancer, you have "biochemical recurrence."

Castration-Resistant Prostate Cancer (CRPC)

Castration-resistant prostate cancer (CRPC) is a form of advanced prostate cancer. CRPC means the prostate cancer is growing or spreading even though testosterone levels are low from hormone therapy. Hormone therapy is also called testosterone depleting therapy or androgen deprivation treatment (ADT) and lowers your natural testosterone level. It is given through medicine or surgery to most men with prostate cancer to stop the testosterone “fuel” that makes this cancer grow. That fuel includes male hormones or androgens (like testosterone). Typically, prostate cancer stops growing with hormone therapy, at least for some time. If the cancer cells begin to "outsmart" hormone treatment, they can grow even without testosterone. If this happens, the prostate cancer is considered CRPC.

Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC)

This type of prostate cancer is found even after the hormone (testosterone) is blocked in patients who have had biochemical failure. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.

Metastatic Prostate Cancer

Cancer cells have spread beyond the prostate. Cancer spread may be seen on imaging studies. Imaging tests may show the cancer has spread. Prostate cancer is metastatic if it has spread to these areas:

  • Lymph nodes outside the pelvis
  • Bones
  • Other organs

You may be diagnosed with metastatic prostate cancer when you are first diagnosed, after having completed your first treatment or even many years later. It is uncommon to be diagnosed with metastatic prostate cancer on first diagnosis, but it does happen.

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

Metastatic hormone-sensitive prostate cancer (mHSPC) is when cancer has spread past the prostate into the body and the patient has not yet had hormone therapy. This means that male sex hormones, including androgens like testosterone, can be blocked or stopped to slow cancer growth. Un-checked, these male sex hormones “feed” the prostate cancer cells to let them grow. Hormone therapy, like ADT, may be used to stop these hormones.

Metastatic Castration-Resistant Prostate Cancer (mCRPC)

Metastatic prostate cancer has been treated with androgen ablation therapy lowering testosterone levels; but, PSA levels keep rising and metastatic spots are present/growing. This is disease progression despite medical or surgical castration.

Symptoms

Men with advanced prostate cancer may or may not have symptoms. Symptoms depend on the size of new growth and where the cancer has spread in the body. With advanced disease, mainly if you have not had treatment to the prostate itself, you may have problems passing urine or see blood in your urine. Some men may feel tired, weak or lose weight. When prostate cancer spreads to bones, you may have bone pain. Tell your doctor and nurse about any pain or other symptoms you feel. There are treatments that can help.

Causes

Prostate cancer spreads when cancer cells break free from the prostate. These cells enter the blood stream or lymph nodes. Most cancer cells that break free from the prostate die. But sometimes they spread to other organs and start new tumors. Advanced prostate cancer often moves into the lymph nodes or bones before spreading to other organs. Less commonly it spreads to the lungs, liver, or brain.

Diagnosis

Even if you have already been diagnosed with prostate cancer, your health care provider will want to observe changes over time. This information will help direct your treatment options.

The following tests are used to diagnose and track prostate cancer:

Blood Tests

The prostate-specific antigen (PSA) blood test measures a protein in your blood called the prostate-specific antigen (PSA). Only the prostate and prostate cancers make PSA. Results for this test are usually shared as nanograms of PSA per milliliter (ng/mL) of blood. The PSA test is used to look for changes to the way your prostate produces PSA. It is used to stage cancer, plan treatment and track how well treatment is going. A rapid rise in PSA may be a sign something is wrong. In addition, your doctor may want to test the level of testosterone in your blood.

Advanced cancer may be found before, at the same time, or later than the main tumor. Most men diagnosed with advanced prostate cancer have had biopsy and treatment in the past. When a new tumor is found in someone who has been treated for cancer in the past, usually cancer has spread.

Digital Rectal Exam (DRE)

The Digital Rectal Exam (DRE) is a physical exam used to help your doctor feel for changes in your prostate. This test is also used to screen for and stage cancer, or track how well treatment is going. During this test, the doctor feels for an abnormal shape, consistency, nodularity or thickness to the gland. The DRE is often done with the PSA together. For this exam, the health care provider puts a lubricated gloved finger into the rectum.

Imaging and Scans

Imaging helps doctors learn more about your cancer. Some types are:

  • Magnetic resonance imaging (MRI): MRI scans can give a very clear picture of the prostate and show if the cancer has spread into the seminal vesicles or nearby tissue. A contrast dye is often injected into a vein before the scan to see details. MRI scans use radio waves and strong magnets instead of x-rays
  • Computed tomography (CT) scan: The CT scan is used to see cross-sectional slices of tissue and organs. It combines x-rays and computer calculations for detailed images from different angles. It can show solid vs. liquid structures, so it is used to diagnose masses in the urinary tract. CT scans are not as useful as magnetic resonance imaging (MRI) to see the prostate gland itself.
  • Bone scan: A bone scan can help show if cancer has reached the bones. If prostate cancer spreads to distant sites, it often goes to the bones first. In these studies, a radionuclide dye is injected into the body. Over a few hours, images are taken of the bones. The dye helps to make images of cancer show up more clearly.

Biopsy

Men diagnosed with advanced prostate cancer from the beginning may start with a prostate biopsy. It is also used to grade and stage the cancer. Most men diagnosed with advanced prostate cancer have had a prostate biopsy in the past. When a new tumor is found in someone who has been treated before, it is usually cancer that has spread.

A biopsy is a tissue sample taken from your prostate or other organs to look for cancer cells. There are many approaches to prostate biopsies. These can be done through a probe placed in the rectum, through the skin of the perineum (already between the scrotum and rectum) and may use a specialized imaging device, such as MRI. The biopsy removes small pieces of tissue for review under a microscope. The biopsy takes 10 to 20 minutes. A pathologist (a doctor who classifies disease) looks for cancer cells within the samples. If cancer is seen, the pathologist will "grade" the tumor.

Grading and Staging

Prostate cancer is grouped into four stages. The stages are defined by how much and how quickly the cancer cells are growing. The stages are defined by the Gleason Score and the T (tumor), N (node), M (metastasis) Score.

Gleason Score

If a biopsy finds cancer, the pathologist gives it a grade. The most common grading system is called the Gleason grading system. The Gleason score is a measure of how quickly the cancer cells can grow and affect other tissue. Biopsy samples are taken from the prostate and given a Gleason Grade by a pathologist. Lower grades are given to samples with small, closely packed cells. Higher grades are given to samples with more spread out cells. The Gleason Score is set by adding together the two most common grades found in a biopsy sample.

The Gleason score will help your doctor understand if the cancer is as a low-, intermediate- or high-risk disease. The risk assessment is the risk of recurrence after treatment. Generally, Gleason scores of 6 are treated as low risk cancers. Gleason scores of around 7 are treated as intermediate/mid-level cancers. There are two types of these scores. Gleason scores of 8 and above are treated as high-risk cancers. Some of these high-risk tumors may have already spread by the time they are found.

Staging

The Tumor, Nodes and Metastasis (TNM) is the system used for tumor staging. The T, N, M score is a measure of how far the prostate cancer has spread in the body. The T (tumor) score rates the size and extent of the original tumor. The N (nodes) score rates whether the cancer has spread into nearby lymph nodes. The M (metastasis) score rates whether the cancer has spread to distant sites.

Tumors found only in the prostate are more successfully treated than those that have metastasized (spread) outside the prostate. Tumors that have metastasized are incurable and require drug based therapies to treat the whole body.

Prostate Cancer Stage Groupings

Using the "T" part of the system, prostate cancer is staged as:

  • T1: Health care provider cannot feel the tumor
  • T1a: Cancer present in less than 5% of the tissue removed and low grade (Gleason less than 6)
  • T1b: Cancer present in more than 5% of the tissue removed or is of a higher grade (Gleason greater than 6)
  • T1c: Cancer found by needle biopsy done because of a high PSA
  • T2: Health care provider can feel the tumor with a DRE but the tumor is confined to prostate
  • T2a: Cancer found in one half or less of one side (left or right) of the prostate
  • T2b: Cancer found in more than half of one side (left or right) of the prostate
  • T2c: Cancer found in both sides of the prostate
  • T3: Cancer has begun to spread outside the prostate and may involve the seminal vesicles
  • T3a: Cancer extends outside the prostate but not to the seminal vesicles
  • T3b: Cancer has spread to the seminal vesicles
  • T4: Cancer has spread to nearby organs
  • N0: There is no sign of the cancer moving to the lymph nodes in the area of the prostate (becomes N1 if cancer has spread to lymph nodes)
  • M0: There is no sign of tumor metastasis (becomes M1 if cancer has spread to other parts of the body)

Gleason Score

Treatment

What is Hormone Therapy?

Hormone therapy is a treatment that lowers a man's testosterone, or hormone, levels. This therapy is also called ADT: androgen deprivation therapy. Testosterone, an important male sex hormone, is the main fuel for prostate cancer cells, so blocking it may slow the growth of those cells. Hormone therapy slows prostate cancer growth in men when prostate cancer has metastasized (spread) away from the prostate or returned after other treatments. It may also be used to shrink a local tumor that has not spread. There are several types of hormone therapy for prostate cancer treatment, including medications and surgery. Your doctor may prescribe a variety of ADT medication therapies over time.

Hormone Therapy with Surgery

Surgery to remove the testicles for hormone therapy is called orchiectomy or castration. When the testicles are removed, it stops the body from making the hormones that fuel prostate cancer. It is rarely used as a treatment choice in the United States. Men who choose this therapy want a one-time surgical treatment. They must be willing to have their testicles permanently removed and must be healthy enough to have surgery.

This simple surgery allows the patient to go home the same day. The surgeon makes a small cut in the scrotum (sac that holds the testicles). The testicles are detached from blood vessels and removed. The vas deferens (tube that carries sperm to the prostate before ejaculation) is detached. Then the sac is sewn up.

There are multiple benefits to undergoing orchiectomy to treat advanced prostate cancer. It is not expensive. It is simple and has few risks. It only needs to be performed once. It is effective right away. Testosterone levels drop dramatically. There is often fast relief from cancer symptoms.

Side effects to your body include infection and bleeding. Removing the testicles means the body stops making testosterone, so there is also a chance of the side effects listed below for hormone therapy. Other side effects of this surgery may be about body image due to the look of the genital area after surgery. Some men choose to have artificial testicles or saline implants placed in the scrotum to help the scrotum look the same as before surgery. Some men choose another surgery called subcapsular orchiectomy. This removes the glands inside the testicles, but it leaves the testicles themselves, so the scrotum looks normal.

Hormone Therapy with Medications

There are different types of hormone therapy available as injections or as pills that can be taken by mouth. Some of these therapies stop the body from producing luteinizing-hormone-releasing-hormone (LHRH, also called gonadotrophin releasing hormone, or GnRH). LHRH triggers the body to make testosterone. Other therapies stop prostate cells from being affected by testosterone by blocking hormone receptors. Sometimes, after the first shot, a blood test is done. This is done to check testosterone levels. You may also have tests to monitor your bone density during treatment.

With LHRH treatment there is no need for surgery. The main down side to LHRH treatment is the cost. The injections are more expensive than a one-time surgery. Check to see if your health insurance covers this option. Men who cannot or do not wish to have surgery are good candidates for this treatment.

There are different types of medical hormone therapy your doctor could prescribe to lower or stop your body's production of testosterone. After your testosterone levels drop to almost zero, you are at "castration level." It is the same as if your testicles were gone. Once testosterone levels drop, prostate cancer cells decrease in growth and proliferation.

Types of Medications

Agonists (analogs)

LHRH/GnRH agonists are drugs that lower testosterone levels. This hormone therapy is usually the first treatment for localized cancer. It is also used for cancer that has come back, whether or not it has spread. Men who cannot or do not wish to have surgery to remove their testicles are good candidates for these treatments.

When first given, agonists cause the body to produce a burst of testosterone (called a "flare"). Agonists are longer acting than natural LHRH. After the initial flare, the drug tricks your brain into thinking it does not need to produce LHRH/GnRH because it has enough. As a result, the testicles are not stimulated to produce testosterone. Your testosterone levels then drop by 90-95%. This is called the "castrate level." It is the same as if your testicles were gone. Once testosterone levels drop, prostate cells and cancer cells stop growing. This is because testosterone is not fueling their growth.

LHRH or GnRH agonists are given as shots or as small pellets placed under the skin. Based on the drug used, they are given from once every one, three or six months.

Some types of LHRH or GnRH agonist drugs are:

  • Leuprorelin
  • Goserelin
  • Triptorelin
  • Histrelin

Side effects include the "flare up" from the agonist treatment. About 7-10 days later, these hormones stop being produced by your body. Other side effects may include bone pain and possible irreversible loss of the body's ability to make testosterone. The cost may be a burden if health insurance does not cover the treatment because the injections may be more expensive than a one-time surgery.

Antagonists

These drugs also lower testosterone, but more quickly. This is the second line of treatment for localized cancer or cancer that has come back. Men who cannot or do not wish to have surgery to remove their testicles are good candidates for these treatments.

Instead of flooding the pituitary gland with LHRH, they stop LHRH from binding to receptors. There is no testosterone flare with an LHRH/GnRH antagonist because the body does not get the signal to produce testosterone.

Antagonists are injected (shot) under the skin, in the buttocks or abdomen every month. It is done in the health care provider's office. You will stay in the office awhile after the shot. This is to make sure there is no allergic reaction. After the first shot, a blood test makes sure testosterone levels have dropped. You may also have tests to monitor bone density.

The LHRH or GnRH antagonist drug used is:

  • Degarelix

Side effects may include bone pain and possible irreversible loss of the body's ability to make testosterone. Side effects may be reversible, but depends on the length of time you are on treatment. The cost may be a burden if health insurance does not cover the treatment because the injections may be more expensive than a one-time surgery.

Anti-androgen drugs

These drugs block testosterone by preventing the testicles from receiving the message to release testosterone. This therapy depends partly on where the cancer has spread and its effects.

This treatment stops testosterone by blocking the androgen receptors in the prostate cancer cells. Normally, testosterone would bind with these receptors to fuel growth of prostate cancer cells. With the receptors blocked, testosterone cannot "feed" the prostate. Using anti-androgens a few weeks before, or during, LHRH therapy may reduce "flare ups." Anti-androgens are also used after surgery or castration when hormone therapy stops working.

Anti-androgen drugs are taken as a tablet or pill and you should take the drug around the same time every day. This keeps a steady level of the drug in your body. Taking a dose the same time each day also lowers side effects like nausea or vomiting. If you forget to take a dose, you should not take a double dose.

Some types of anti-androgen drugs are:

  • Flutamide
  • Bicalutamide
  • Nilutamide

Side effects may include nausea or vomiting. Anti-androgen therapy does not lower testosterone, so it may have fewer or milder side effects than surgery and medical hormone treatment.

CAB (combined androgen reducing treatment, with anti-androgens)

This method blends castration (by surgery or with the drugs described above) and antiandrogen drugs. The treatment blocks testosterone and stops it from binding to cancer cells. This therapy may be a good choice for you, but depends partly on where the cancer has spread and how you feel.

Normally, testosterone would bind with these receptors to fuels prostate cancer cell growth. With the receptors blocked, testosterone cannot "feed" the cells. The testicles produce almost all of the body's testosterone. To stop your testicles from making testosterone you can have surgery or take oral drugs. The rest of the testosterone is made by the adrenal glands. Antiandrogen therapy blocks testosterone made by the adrenal glands.

Your doctor may choose to use anti-androgens for a short period of time (one to two months). It may be used long term when androgen deprivation therapy (ADT) starts. Or, it may be used when other hormone therapies are no longer effective.

Androgen synthesis inhibitors

These drugs stop other parts of your body (and the cancer itself) from making more testosterone and its metabolites. Men newly diagnosed with metastatic hormone sensitive prostate cancer (mHSPC) or men with metastatic castration-resistant prostate cancer (mCRPC) may be good candidates for this therapy.

Androgen synthesis inhibitors may be taken by mouth as a pill. It stops your body from releasing the enzyme needed to make androgens in the adrenal glands, testicles and prostate tissue, resulting in reduced levels of testosterone and other androgens. Because of the way it works, this drug must be taken with an oral steroid called prednisone.

The androgen synthesis inhibitor drug used is:

  • Abiraterone acetate

Androgen receptor binding inhibitors

These drugs block testosterone from linking to prostate cancer cells (like anti-androgens). These drugs may be used in men with newly diagnosed mHSPC or mCRPC before or after chemotherapy.

Androgen receptor binding inhibitors are taken by mouth as a pill. You do not need to take a steroid with this drug. This drug blocks the androgen receptor at multiple sites to prevent cancer cells from growing. These drugs may slow down the spread of cancer. Some men have done very well with these options, combined with ADT drugs.

The androgen receptor binding inhibitor drugs used are:

  • Apalutamide
  • Enzalutamide

Estrogen therapy

Estrogens are female sex hormones and they can be used to block testosterone production in the testicles. Estrogen hormone therapy has side effects similar to androgen hormone therapy. But the use of estrogens may cause female sex characteristics to develop. This may include breast tenderness and swelling and other changes. Because of the side effects of estrogen hormone therapy, it is not often used today.

Hormone Therapy Side Effects

Unfortunately, hormone therapy may not work forever, and it does not cure the cancer. Over time, the cancer may grow in spite of the low hormone level. Other treatments are also needed to manage the cancer. Hormone therapies have many side effects. Learn what they are. Intermittent (not constant) hormone therapy may also be a good treatment option. Before starting any type of hormone therapy, talk with your health care provider.

Possible hormone therapy side effects include:

  • Lower libido (sexual desire) in most men
  • Erectile dysfunction (inability to have or keep a strong enough erection for sex)
  • Hot flashes or sudden spread of warmth to the face, neck and upper body, heavy sweating
  • Weight gain of 10 to 15 pounds. Dieting, eating fewer processed foods and exercising may reduce weight gain
  • Mood swings
  • Depression to include feeling loss of hope, loss of interest in enjoyable activities, not being able to concentrate or changes in appetite and sleeping
  • Fatigue (feeling tired) that doesn't go away with rest or sleep
  • Anemia (low red blood cell count) due to less oxygen getting to tissues and organs, causing tiredness or weakness
  • Loss of muscle mass causing weakness or low strength
  • Weak bones (loss of bone mineral density) or bones getting thinner, brittle and may break easier.
  • Memory loss
  • High cholesterol, especially LDL ("bad") cholesterol
  • Breast nipple tenderness or increased breast tissue growth
  • Increased risk of diabetes, 40% higher compared to men not on ADT
  • Heart disease with only some studies showing men on ADT at higher risk for heart problems, so the effect of ADT on the heart is still unknown

There are many benefits and risks to each type of hormone therapy so be sure to ask questions to your doctor so you understand what is best for you.

What is Chemotherapy?

Chemotherapy drugs can slow the growth of cancer. These drugs may reduce symptoms and extend life. Or, it may ease pain and symptoms by shrinking tumors. Chemotherapy is useful for men whose cancer has spread to other parts of the body.

Most chemotherapy drugs are given through a vein (intravenous, IV). During chemotherapy, the drugs move throughout the body. They kill quickly growing cancer cells and non-cancer cells. Often, chemotherapy is not the main therapy for prostate cancer. But it is a useful treatment for men whose cancer has spread and are still responding to hormone therapy (hormone sensitive). Chemotherapy may be given before pain starts as it may prevent pain as cancer spreads to bones and other sites.

The main types of chemotherapy drugs are:

  • Docetaxel
  • Cabazitaxel

Side effects may include hair loss, fatigue, nausea and vomiting. There may be changes in your sense of taste and touch. You may be more prone to infections. You may experience neuropathy (tingling or numbness in the hands and feet). Due to the side effects from chemotherapy, the decision to use these drugs may be based on:

  • Your health and how well you can tolerate the drug
  • What other treatments you have tried
  • If radiation is needed to relieve pain quickly
  • What other treatments or clinical trials are available
  • Your treatment goals

If you use chemotherapy, you will be watched closely to manage side effects. There are medicines to help with things like nausea. Most side effects stop once chemotherapy ends.

What is Immunotherapy?

Immunotherapy uses the body’s immune system to fight cancer. It is a choice for men with mCRPC who have no symptoms or only mild symptoms.

If the cancer returns and spreads, your doctor may offer a cancer vaccine to boost your immune system so it can attack the cancer cells. Immunotherapy may be given to mCRPC patients before chemotherapy or it may be used along with chemotherapy.

Prostate cancer immunotherapies are still being studied. The main type of immunotherapy drug is:

  • Sipuleucel-T

Side effects are often in the first 24 hours after treatment and may include fever, chills, weakness, headache, nausea, vomiting and diarrhea. Patient may also have low blood pressure and rashes.

What is Combination Therapy?

There are also many drug combinations for patients with mCRPC. Your doctor may suggest some of the options below based on your symptoms:

  • Minor or no symptoms: Options include Abiraterone + Prednisone, Enzalutamide, Docetaxel, or Sipuleucel-T may be offered.
  • Cancer that has spread to bones: Options include Abiraterone + Prednisone, Enzalutamide, Docetaxel, Radium-223.
  • Other treatments did not work well: Options include Abiraterone + Prednisone, Enzalutamide, Ketoconazole + Steroid, Radionuclide Therapy.
  • Options for men who have taken Docetaxel Options include Abiraterone + Prednisone, Cabazitaxel or Enzalutamide, or often Radium-223 can help with bone pain.

What is Bone-targeted Therapy?

Bone-targeted therapy may help men with prostate cancer that has spread to the bones as they may get “skeletal-related events” (SREs). SREs include fractures, pain and other problems. If you have advanced prostate cancer or are taking hormone therapy, your provider may suggest calcium, Vitamin D or other drugs for your bones. These drugs may stop the cancer, reduce SRE’s and help prevent pain and weakness from cancer growing in your bones.

Radiopharmaceuticals are drugs with radioactivity. They can be used to help with bone pain from metastatic cancer. Some are called Strontium-89 and Samarium-153. Radium-223 may also be used for men whose mCRPC has spread to their bones. It may be offered when ADT is not working. It gives off small amounts of radiation that go to the exact parts where cancer cells are growing.

Drugs used to reduce SREs are Zolendronic Acid and Denosumab. Both help reduce bone turnover. Zolendronic Acid is given by IV every three to four weeks. Side effects include low calcium, worsening kidney function and, rarely, destruction of the jawbone. So, you are monitored closely. You should have a dental exam before starting the drugs. Denosumab is used for men on hormone therapy and men with CRPC. The drug is given under the skin. Side effects are low calcium and rare chance to destroy the jaw, so a dental check before and calcium monitoring after treatment are advised.

Calcium and Vitamin D are also used to help protect your bones. They are often recommended for men on hormone therapy to treat prostate cancer.

What is Radiation Therapy?

Radiation uses high-energy beams to kill tumors. Prostate cancer often spreads to the bones. Radiation can help ease pain or prevent fractures caused by cancer spreading to the bone.

There are many types of radiation treatments. Radiation may be given one time, or over several visits. The treatment is like having an x-ray. It uses high-energy beams to kill tumors. Some radiation techniques focus on saving nearby healthy tissue. Computers and software allows better planning and targeting of radiation doses. They target the radiation to pinpoint where it is needed.

Active Surveillance for Prostate Cancer

Some men choose surveillance. Active surveillance is often used if you have a small, slow growing cancer. It may be good for men who do not have symptoms or want to avoid sexual, urinary or bowel side effects for as long as possible. Others may choose surveillance due to their age or overall health. Active surveillance is mainly used to delay or avoid aggressive therapy.

This method may require you to have many tests over time to track cancer growth. This lets your doctor know how things are going, and prevents treatment-related side effects. This will also help you and your health care team focus on managing cancer-related symptoms. Talk with your care team about whether this is a good choice for you.

Clinical Trials

Clinical trials are research studies that test new treatments or learn how to use existing treatments better. Clinical studies aim to find the treatment strategies that work best for certain illnesses or groups of people. For some patients, taking part in a clinical trial may be the best treatment.

Clinical trials follow strict scientific standards. These standards protect patients and help produce reliable study results. You will be given either a standard treatment or the treatment being tested. All of the approved treatments used to treat or cure cancer began in a clinical trial.

You may qualify for one. Learn about the risks and benefits of the treatment being studied. Talk with your doctor about whether you qualify for a clinical trial.

To search for information on current or recent clinical trials for the treatment of prostate cancer, visit UrologyHealth.org/ClinicalTrials.