Prostate cancer is one of the most common diagnoses you’ll probably see as an OncoPT…
So we’re long overdue for a prostate cancer deep dive.
Today’s episode is the perfect recap on this all too common diagnosis, plus:
- Prostate cancer, by the numbers
- Treatment regimens for patients with prostate cancer
- How prostate cancer & its treatments affect your patients
- Common impairments patients will face
Listen now!
Prostate Cancer by the Numbers
Prostate cancer is the leading cancer diagnosis among men, accounting for a significant 14.7% of all new cancer cases in 2023. This statistic places it at the forefront of men’s health issues, right after skin cancer. To put it in perspective, this means that 1 in every 8 men will receive a prostate cancer diagnosis at some point in their lives. The prevalence of this disease underscores the importance of awareness and regular screenings.
While prostate cancer is the most common cancer diagnosis, it also ranks as the second most common cause of cancer-related deaths among American men, trailing only behind lung cancer. Approximately 5.7% of all cancer deaths in 2023 can be attributed to prostate cancer, equating to about 34,700 deaths each year. This alarming statistic emphasizes the critical need for early detection and advanced treatment options to combat this disease effectively.
Despite the prevalence and impact of prostate cancer, there is a silver lining in the form of a high 5-year survival rate. According to SEER.gov, the 5-year survival rate for prostate cancer stands at an impressive 97.1%. This figure reflects the favorable outcomes that many men experience when diagnosed and treated promptly. It underscores the importance of regular check-ups and early intervention, which significantly improve the chances of a successful recovery.
It’s important to note that most men with prostate cancer do not die because of prostate cancer; instead, they often pass away with prostate cancer. This distinction highlights the relatively slow progression of many prostate cancers. In some cases, men may live for years or even decades after diagnosis, thanks to advancements in treatment and management strategies.
Basics of Prostate Cancer
Almost every prostate cancer will be an adenocarcinoma, meaning these prostate cancers develop from the gland cells.
Other rare types of prostate cancer include small cell carcinomas, neuroendocrine cells, transitional cell carcinomas, & sarcomas.
Common risk factors for prostate cancer include:
- Having a prostate
- Older age
- African American
- Caribbean of African ancestry
- Living in North America, NW Europe, Australia, Caribbean islands
- Family history of prostate cancer*
- Genetic mutations, such as:
- BRCA 1 & 2
- Lynch syndrome
Diagnosing Prostate Cancer
Prostate-specific antigen blood tests & digital rectal exams are common screening tests. Patients may then undergo repeat PSA testing &/or biopsies to confirm suspected prostate cancer.
Once prostate cancer is diagnosed, it will be assigned a Gleason score. The Gleason system is used to grade prostate cancers (how differentiated the cancer cells are). In short, the higher the grade, the more poorly-differentiated the prostate cancer cells are.
Treatment for Prostate Cancer
Unlike some other cancers we commonly encounter in OncoPT, one method of prostate cancer treatment is the wait & see. Active surveillance or observation are methods to monitor patients with less aggressive, slow growing, early stage prostate cancer that is not causing symptoms. This would be our very-low risk patients.
Patients with low risk prostate cancer may choose to pursue radiation therapy. This may include proton beam therapy, external beam radiation therapy or brachytherapy, typically with the seed implantation approach.
Some patients may choose to undergo prostatectomy in lieu of or in addition to radiation therapy. Available options for patients include laparoscopic prostatectomies, radical prostatectomies, & transurethral resections of the prostate (TURP). I am actively working on getting a prostate cancer expert on the podcast to discuss these options further, so stay tuned.
Hormone suppression therapy is another common modality for patients with hormone-sensitive prostate cancer. These can include:
- LHRH agonists (Leuprolide, Goserelin, Triptorelin)
- LHRH antagonists (Degarelix, Relugolix)
- Anti-androgens (Flutamide, Nilutamide)
For patients with advanced prostate cancer, chemotherapy may be used. Keep in mind that chemo for prostate cancer is NOT typical first-line therapy. Common agents include:
- Docetaxel
- Cabazitaxel
- Mitoxantrone
- Estramustine
With the ever-expanding landscape of immunotherapies & targeted therapies, you will definitely see these used for prostate cancer in your practice. Treatments may include cancer vaccines, immune checkpoint inhibitors, PARP inhibitors, & more.
While only 8% of patients are diagnosed with metastatic prostate cancer initially, I previously saw several patients with metastatic prostate cancer. This came with a lot of bone metastases & corresponding considerations. Common treatments for bone metastases include bisphosphonates, denosumab, & corticosteroids.
Additionally, patients with bone metastases may undergo other interventions to manage bone metastases-related issues, such as radiation therapy, surgery, & radiopharmaceuticals.
Potential Rehab Implications for Prostate Cancer Survivors
For this episode, I’m going to break down side effects by treatment approaches. Not that prostate cancer can’t cause side effects on its own, but the patients I’ve seen most commonly have a slew of side effects that stem from their cancer treatments (including after years of treatment for advanced prostate cancer).
So first up, active surveillance/observation: patients could already be experiencing musculoskeletal impairments completely unrelated to their prostate cancer.
Radiation therapy
As you know, radiation therapy is a big ol’ burn to all tissues receiving the doses. Patients who undergo prostate radiation therapy may experience pelvic floor dysfunction (bowel, bladder, & sexual dysfunction), lymphedema, & fatigue.
While you tend to think of brachytherapy having less side effects compared to external beam, sexual function after prostate cancer seems most closely tied to younger age & sexual function prior to treatment (rather than method of prostate cancer treatment).
Hormonal therapy
LHRH agonists (Leuprolide, Goserelin, Triptorelin), as well as LHRH antagonists (Degarelix, Relugolix), can cause bone pain & thinning, sexual dysfunction, anemia, cognitive dysfunction, hot flashes, gynecomastia, loss of muscle mass, weight gain, fatigue, & depression.
Anti-androgens (Flutamide, Nilutamide) can cause muscle wasting, osteoporosis, & erectile dysfunction (may be less severe than when on LHRH agonists/antagonists.
Chemotherapy
Taxane-based chemotherapies commonly cause peripheral neuropathy, cytopenia, & in severe cases, acute myocardial infarction.