End Stages Prostate Cancer

Early prostate cancer usually causes no symptoms. Intermediate stage disease may cause symptoms that are often similar to those of diseases like benign prostatic hypertrophy (BPH) or prostatitis ? symptoms that include frequent urination, increased urination at night, difficulty starting and maintaining a steady stream of urine, blood in the urine, and painful urination. Other symptoms of prostate cancer in the intermediate stages are associated with urinary dysfunction problems with sexual function and performance, e.g., difficulty achieving and erection, painful ejaculation, and blood in ejaculate.

But these are just the disease being nice; advanced prostate cancer typically spreads to other parts of the body and causes additional symptoms. Of these symptoms, the most common symptom is bone pain, which is frequently found in the bones of the spinal columns, the pelvis, or the ribs; it may also spread into other bones, such as the femur, usually to the proximal part of the bone. And in the end stages prostate cancer can metastasize into the spine and begin to compress the spinal cord. This would cause characteristic leg weakness and urinary and fecal incontinence.

Early prostate cancer can be cured; late stage disease (or advanced prostate cancer) cannot. The bone pain is due to metastatic tumors starting to grow on the bones as they are incident from the bloodstream. They cause regions higher bone concentration to develop, resulting in hot spots; and regions of lower bone concentrations causing cold spots. Together they make the bone fragile or brittle, and vulnerable to spontaneous fractures.

Treating the end stages of prostate cancer can be a challenge depending on how aggressive the cancer is. Generally though, since the specialists are by and large not trying to cure the disease, their aim would be merely to provide palliation, a situation in which treatment focuses on extending life and relieving the symptoms of metastatic disease.

In order to reduce PSA levels and tumor size in aggressive advanced-stage prostate cancer, abiraterone acetate may be the best choice to slow disease progression and postpone symptoms, chemotherapy may be offered; and to delay the fractures or the need for radiotherapy, bisphosphonates are the best ports of call. This is especially true for patients with hormone-refractory metastatic prostate cancer.

As for the bone pain, it may get no better than morphine or other opioid pain relievers can provide it; otherwise, radioisotopes can be injected into the patient to aim at bone metastases and help relieve pain. Ultimately, prolonged patient survival times, reduced pain and improved quality of life are the goals.

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