Four Categories of Advanced Prostate Cancer [AIPC]
The four most commonly encountered disease categories of prostate cancer are summarized below. They range from prostate cancer confined to the prostate glad to prostate cancer that has spread to lymph node and bone.
1. Locally Advanced Prostate Cancer
Cancer that has grown to fill the prostate or has grown through the prostate and may extend into the glands that help produce semen (seminal vesicles), or the lymph nodes.
Occurs in men who have been treated for early prostate cancer, but their PSA is rising. A bone scan and cat scan in these patients is usually shows no evidence of cancer.
2. Biochemically Recurrent Prostate Cancer (Rising PSA)
Patients who have a rising PSA after treatment, but do not have any evidence of disease spread to bone or other organs. This can occur after local treatment, or after hormone therapy. The management of such patients is controversial, and may include investigational treatments, radiation therapy, or chemotherapy.
3. Metastatic Prostate Cancer (Hormone Sensitive)
Cancer that has spread (metastasized) to the bone, lymph nodes or other parts of the body. Depletion of the male sex hormone, testosterone, results in improvement of tumor related symptoms such as bone pain or inability to urinate. This can be achieved by either surgical removal of the testosterone, as well as with medications such as lupron and zoladex.
4. Hormone Refractory Prostate Cancer
Prostate cancer that continues to grow despite the suppression of male hormones that fuel the growth of prostate cancer cells.
A team approach to prostate cancer is very important. Your prostate cancer treatment team may include a urologist, a radiation oncologist, a medical oncologist, your family and nurses, patient navigators and others.
Before a diagnosis of advanced androgen-independent prostate cancer
- Your doctor will ensure your testosterone level is zero.
- Ensure that there’s a consistent rise in PSA, tested several times over several months.
- Perhaps offer a secondary hormonal therapy in addition to the hormone suppression therapy you may already be taking to possibly control you PSA for an additional amount of time
Secondary hormonal therapies could include
- Antiandrogen withdrawl (AAW)
- Antiandrogen addition (Low vs. High)
- Estrogens (I.V., oral, transdermal…)
- Ketoconazole (Nizoral)
- Aminoglutethimide (Cytadren)