When is prostate cancer considered cured

Prostate cancer can recur locally in the pelvis or elsewhere in the body. The location of the recurrence is determined by these radiographic scans. Stage IV Prostate Cancer Prognosis Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate.

How We Treat Prostate Cancer The prognosis for metastatic prostate cancer can be discouraging, but some treatment centers—like the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer—specialize in innovative, individualized therapy with the potential to improve outcomes. Learn more about the Precision Medicine Center of Excellence. Long-Term Prognosis Because most prostate cancers are diagnosed with early screening measures and are curable, the average long-term prognosis for prostate cancer is quite encouraging.

Recurrence Even if your cancer was treated with an initial primary therapy surgery or radiation , there is always a possibility that the cancer will reoccur. Use the following guide to gauge recurrence: Clinicians use the change in PSA over time as a marker for the aggressiveness of the recurrence. Prostate cancer, therefore, has one of the highest curability rates of all types of cancer, thanks in large part to early detection standards and advances in treatment, such as the stereotactic body radiation therapy SBRT offered by Pasadena CyberKnife.

When the cancer is detected in the early local or regional stages — that is, before the cancer has spread or when it has only spread to limited areas in the pelvic regions — the five-year survival rate is nearly percent. Survival rates decline significantly when cancer is detected at later stages; however, the good news is that only about five percent of men are diagnosed after the cancer has become widespread throughout the body.

In short, more than 90 percent of men who are diagnosed with prostate cancer live for five years or longer after treatment, making it one of the most curable forms of cancer. This system evaluates the local extent of the cancer the T level , as well as the extent of spread to regional lymph nodes N and how the cancer has metastasized — or spread — to the rest of the body M. Each category has its own levels and subcategories, and the combination of factors specifies the extent of the disease.

More specifically:. T Stages : Rated on a scale of 1 to 4. In this way, it can be like living with a chronic disease like heart disease or diabetes, requiring ongoing treatment to minimize symptoms and maintain well-being. Supportive, or palliative, care to help relieve symptoms and side effects is an important part of the care of advanced prostate cancer. Supportive care options include:. Bone-modifying drugs may be used to strengthen bones, reduce the risk of bone fractures, and reduce the risk of skeletal-related events for prostate cancer that has spread to the bone see "Bone-modifying drugs".

Intravenous radiation therapy with radium, strontium, and samarium can also help relieve bone pain see "Radiation therapy". Palliative radiation therapy to specific bone areas can also be used to reduce bone pain when medications do not help.

Researchers are using other methods to better understand metastatic prostate cancer and identify new treatment approaches. For example, the Metastatic Prostate Cancer Project allows people with metastatic prostate cancer to enroll themselves. Please note that the link above takes you to another, independent website.

Many people treated with surgery or radiation therapy are cured. However, some will develop a biochemical recurrence BCR.

Radiation therapy may be a treatment option for certain patients with BCR after surgery. For people who received radiation therapy as the main treatment for prostate cancer, BCR is defined as a normal testosterone level and a PSA value more than 2. Treating BCR after radiation therapy is more difficult. You are encouraged to discuss the treatment options with the health care team.

Hormonal therapy may be recommended, especially if other local treatments are not possible. Prostate cancer that has spread to other parts of the body and still responds to treatment that suppresses testosterone is called metastatic castration-sensitive prostate cancer. The best treatment option depends on the patient's health and the extent of the cancer. It is important to talk with the health care team about the risks and benefits of each option. The following treatment options can be used to treat people who are newly diagnosed and those who have received previous treatments, including radical prostatectomy or radiation therapy.

Docetaxel plus hormonal therapy. In those with very widespread disease who are able to receive chemotherapy, docetaxel combined with hormonal therapy may be recommended.

Docetaxel with or without prednisolone is given by IV every 3 weeks for a total of 6 doses. The side effects of docetaxel may include low levels of blood cells, infection, nausea and vomiting, muscle aches, and hair and nail changes.

Abiraterone with prednisone or prednisolone plus hormonal therapy. This treatment is recommended for newly diagnosed, high-risk metastatic castration-sensitive prostate cancer, but it can also be offered to people with low-risk disease. Apalutamide plus hormonal therapy. This combination was approved in It offers a treatment plan that does not need long-term treatment with steroids and frequent monitoring with laboratory tests.

This treatment is recommended as an option for those with metastatic castration-sensitive prostate cancer regardless of the risk or volume of the disease. Enzalutamide plus hormonal therapy. This combination was approved in late It does not need treatment with steroids and frequent monitoring with laboratory tests.

In addition to the above treatment options, treatment to relieve symptoms and side effects continues to be an important part of the overall treatment plan.

ASCO recommends that treatment for non-metastatic castration-resistant prostate cancer should continue to focus on lowering testosterone levels. This may include a permanent treatment, such as orchiectomy, or it may include continuing treatment with medications that lower hormone levels, such as apalutamide, darolutamide, or enzalutamide.

For those who have not had chemotherapy, additional hormonal therapy may be an option if there is a high risk that the disease will spread. Talk with your doctor about your personal risk level. Imaging tests, such as a bone scan, CT scan, or MRI, may be done if there are symptoms or signs that the cancer is worsening.

Imaging tests may also be done. Metastatic castration-resistant prostate cancer can be difficult to treat. ASCO recommends continuing treatment that lowers hormone levels for metastatic castration-resistant prostate cancer.

ASCO has treatment recommendations for hormone therapy for advanced cancer and for systemic treatment of metastatic castration-resistant prostate cancer. Treatment options for metastatic castration-resistant prostate cancer are listed below.

Treatment in a clinical trial may also be an option. A remission is when cancer cannot be detected in the body and there are no symptoms. A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back.

Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning.

There are tools your doctor can use, called nomograms, to estimate someone's risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence. In general, following surgery or radiation therapy, the PSA level in the blood usually drops.

If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer. When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate called a local recurrence , in the tissues or lymph nodes near the prostate a regional recurrence , or in another part of the body, such as the bones, lungs, or liver a distant or metastatic recurrence.

Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.

After this testing is done, you and your doctor will talk about the treatment options. The choice of treatment plan is based on the type of recurrence and the treatment s you have already received and may include the treatments described above, such as radiation therapy, prostatectomy for people first treated with radiation therapy, or hormonal therapy. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

Palliative care usually includes pain medication, external-beam radiation therapy, brachytherapy with radium, strontium, or samarium, or other treatments to reduce bone pain.

People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence. Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help.

Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important. People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care.

Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families.

Learn more about advanced cancer care planning. After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss. The next section in this guide is About Clinical Trials.

It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide. Treatment overview In cancer care, different types of doctors—including medical oncologists, surgeons, and radiation oncologists—often work together to create an overall treatment plan that may combine different types of treatments to treat the cancer.

This discussion should also address the current state of the cancer, such as: Whether you have symptoms or PSA levels are rising rapidly Whether the cancer has spread to the bones Your health history Your quality of life Your current urinary and sexual function Any other medical conditions you may have Although your treatment recommendations will depend on these factors, there are some general steps for treating prostate cancer by stage.

Active surveillance and watchful waiting If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting. ASCO encourages the following testing schedule for active surveillance: A PSA test every 3 to 6 months A DRE at least once every year Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Local treatments Local treatments get rid of cancer from a specific, limited area of the body. Surgery Surgery involves the removal of the prostate and some surrounding lymph nodes during an operation. Learn more about the basics of cancer surgery. Radiation therapy Radiation therapy is the use of high-energy rays to destroy cancer cells. According to recommendations from ASCO, the American Society for Radiation Oncology, and the American Urological Association, hypofractionated radiation therapy may be an option for the following people with early-stage prostate cancer that has not spread to other parts of the body: People with low-risk prostate cancer who need or prefer treatment instead of active surveillance.

ASCO recommends the following brachytherapy options: People with low-risk prostate cancer who need or choose an active treatment may consider low-dose-rate brachytherapy. Side effects of radiation therapy Radiation therapy may cause side effects during treatment, including increased urinary urge or frequency; problems with sexual function; problems with bowel function, including diarrhea, rectal discomfort or rectal bleeding; and fatigue. Learn more about the basics of radiation therapy.

Focal therapies Focal therapies are less-invasive treatments that destroy small prostate tumors without treating the rest of the prostate gland. Systemic treatments Systemic therapy is the use of medication to destroy cancer cells.

The types of systemic therapies used for prostate cancer include: Hormonal therapy Targeted therapy Chemotherapy Immunotherapy Radiopharmaceuticals Bone-modifying drugs Each of these types of therapies is discussed below in more detail.

Hormonal therapy Because prostate cancer growth is driven by male sex hormones called androgens, lowering levels of these hormones can help slow the growth of the cancer. Some of the situations in which this therapy may be used include: People with NCCN-based intermediate-risk and high-risk, localized prostate cancer who are having definitive therapy with radiation therapy are candidates for hormonal therapy. Types of hormonal therapy Bilateral orchiectomy. Side effects of hormonal therapy These treatments will cause side effects that generally go away after treatment has finished, except in those who have had an orchiectomy.

General side effects include: Erectile dysfunction Loss of sexual desire Hot flashes with sweating Gynecomastia, which is growth of breast tissue that sometimes can lead to discomfort Depression Cognitive dysfunction and memory loss Heart problems and heart disease Weight gain Loss of muscle mass Osteopenia or osteoporosis, which is thinning of bones Learn more about coping with the sexual side effects of prostate cancer treatment in the Coping With Treatment section.

Targeted therapy for prostate cancer includes: Olaparib Lynparza. One or more tests must be given to determine whether a patient may receive olaparib or rucaparib: Testing for germline mutation after discussion with a genetic counselor Genomic sequencing of tumor tissue Genomic sequencing of the tumor DNA floating in the bloodstream Genomic sequencing may be performed on tissue that was previously collected or on tissue from a new biopsy.

Chemotherapy Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Learn more about the basics of chemotherapy. Immunotherapy Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer.

Radiation therapy by infusion Radium Xofigo is a radioactive substance used to treat castration-resistant prostate cancer that has spread to the bone. Bone-modifying drugs Bone health is an important issue in the lives of people with prostate cancer.

Physical, emotional, and social effects of cancer Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Treatment by stage of prostate cancer Different treatments may be recommended for each stage of prostate cancer. Early-stage prostate cancer stages I and II Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all.

Locally advanced prostate cancer stage III Locally advanced prostate cancer may be treated with external-beam radiation therapy and concurrent hormonal therapy or with surgery alone. Advanced prostate cancer stage IV If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Supportive care options include: TURP to manage symptoms such as bleeding or urinary obstruction see "Surgery".

It is effective right away. Testosterone levels drop dramatically. 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. 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. Candidates for this treatment include men who cannot or do not wish to have surgery to remove their testicles. There are different types of medical hormone therapy your doctor could prescribe to lower your body's production of testosterone.

After your testosterone levels drop to a very low level, you are at "castration level. They may be used for cancer that has come back, whether or not it has spread. When first given, agonists cause the body to produce a burst of testosterone called a "flare". Agonists are longer acting than natural LHRH. As a result, the testicles are not stimulated to produce testosterone. Based on the drug used, they could be given from once every one, three or six months.

These drugs also lower testosterone. Antagonists may be taken by mouth or injected shot under the skin, in the buttocks or abdomen.

The shot is given in the health care provider's office. You will likely stay in the office awhile after the shot to ensure 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. Antiandrogen drugs are taken as a pill by mouth. This therapy depends partly on where the cancer has spread and its effects. This treatment lowers testosterone by inhibiting 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. This method blends castration by surgery or with the drugs described above and antiandrogen drugs.

The treatment reduces production of testosterone and can help stop it from binding to cancer cells. Surgery or taking oral drugs may be ways to lower the testosterone made by your testicles.

The rest of the testosterone is made by the adrenal glands. Antiandrogen therapy blocks testosterone made by the adrenal glands. These drugs help 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.

This drug helps stop 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. 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 possible side effects. Learn what they are. Intermittent not constant hormone therapy may also be a treatment option. Before starting any type of hormone therapy, talk with your health care provider.

There are many benefits and risks to each type of hormone therapy, so ask questions of your doctor so you understand what is best for you. Chemotherapy drugs can slow the growth of cancer. These drugs may reduce symptoms and extend life. Or they 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 may be a treatment option for men whose cancer has spread. Chemotherapy may be given before pain starts as it may prevent pain as cancer spreads to bones and other sites. 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:. If you use chemotherapy, your health care team may watch you closely to manage side effects. There are medicines to help with things like nausea.

Most side effects stop once chemotherapy ends. It may be 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. Side effects are often in the first 24 hours after treatment and may include fever, chills, weakness, headache, nausea, vomiting and diarrhea.

Patients may also have low blood pressure and rashes. 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. Radiopharmaceuticals are drugs with radioactivity. They can be used to help with bone pain from metastatic cancer. Some may also be used for men whose mCRPC has spread to their bones.