Understanding Advanced Prostate Cancer

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What does it mean when prostate cancer is advanced? Patient Power Founder and Host, Andrew Schorr, sits down with experts Dr. William Catalona and Dr. Russell Szmulewitz to better understand advanced prostate cancer.  Listen as Drs. Catalona and Szmulewitz discuss metastases, speed of progression and advancement prevention. 

Sponsored by the Patient Empowerment Network through educational grants from Astellas, Medivation, Inc. and Sanofi. Produced by Patient Power in partnership with the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and Us TOO International.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Dr. Catalona, so men are familiar with if they’re diagnosed with prostate cancer. I’m 65. I worry about that. I have the doctor check me, and I always wonder is that going to come up. My father had prostate cancer and lived with it to age 92. But what do we mean when we say it’s advanced?

Dr. Catalona:      

So by saying it’s advanced, it means it has spread beyond the prostate gland itself. Prostate cancer can spread in three different ways. 1) Is it can just locally move outside the prostate gland into the surrounding tissues.

2) It can go to lymph nodes. And 3) it can go to bone or to any other organ in the body. And the further it has spread, the more advanced and the more challenge it is to treat. 

Andrew Schorr:                  

Now, do we know—why does it progress? And it seems to progress sometimes in different rates for different men. 

Dr. Catalona:      

Yes. Prostate cancers are not just one single disease. There are many different types of prostate cancer. And the mechanisms that cause them to spread are different for different tumors. So some of them can be highly aggressive and can progress very rapidly and can cause pain and suffering and death in a very quick time. And others can be very, very slowly progressive. And so the treatments, obviously, should be different for those different types of tumors. 

Andrew Schorr:                  

I have a question you’ve probably been asked like 10,000 times.

Is there anything a man has done, something he’s eaten, something he’s had to drink, anything, activity that led to fueling the spread of this cancer? 

Dr. Catalona:      

That’s a difficult question. But studies in twins have shown that prostate cancer is the most heritable, solid tumor. And they believe that up to 58 percent of the cause of prostate cancer is due to inherited factors. So the fact that a man has a positive family history is certainly a significant thing to take into consideration. The other 50 percent or so may be due to undiscovered genetic causes. But some of them, surely, are probably due to environmental causes. 

And just as an example, there has been an association with Agent Orange and the veterans who were in Vietnam that they believe that that made them more predisposed to prostate cancer and possibly more predisposed to having the more aggressive types of prostate cancer.

So it’s probably genetics, environment and an interaction between those two.

Andrew Schorr:                  

Dr. Szmulewitz, though, if I were to be diagnosed with prostate cancer, and I worry about it because my dad was diagnosed with it, is there anything that you would tell me to do or not to do that would affect the rate of change and whether it spreads?

Dr. Szmulewitz:

So if you’re diagnosed, the first thing to do is to figure out to what extent has it progressed already? So get a thorough examination. Get a thorough set of imaging tests and see the appropriate experts to define where it is the best we can first. And then, what I would say the most important thing, if it is localized, is to seek expertise in treating aggressively in the appropriate circumstances. 

So I think what Dr. Catalona mentioned is it’s a very heterogeneous disease. And so my recommendations on what a patient should do to prevent the advancement of the disease really depends on how aggressive it seems to be at the time of diagnosis. And so it’s quite nuanced. And I think getting an appropriate expert opinion and some guidance for each specific case is crucial. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on May 24, 2016