Questions and More Questions

Questions often come up in our prostate cancer (PCa) support groups, and I thought it might be helpful to review some of the ways we answer a few of these.

The questions we hear

What are the warning signs of advanced prostate cancer?

We point out that the signs of advancing PCa even after surgery or radiation can include:^1,2,3

• Changes in urination flow or pattern
• Blood in the urine or semen
• Erectile dysfunction
• Pain in the hips, back (spine), ribs
• Weakness or numbness in legs/feet
• Loss of bowel or bladder control
• None – at all

The last item (None) on the above list generally gets the most follow-up questions. And yes, it is possible that you may show no warning signs of advancing prostate cancer. It is the reason we encourage men to go in for routine follow-up appointments and physicals.

Just as important is that men understand the need to be honest and speak up when in the doctor’s office when something does not feel right. Male silence when it comes to personal health can be deadly.

What do I need to know beyond my Gleason score?

Following a PCa diagnosis, most men are aware of their Gleason score. At the same time many are unaware of their TNM staging number. Loosely defined staging is a diagnosis/classification of a particular point in time that is reached by a progressive disease.

Staging was first defined by the American Joint Committee on Cancer (AJCC). The organization was created in 1959 to formulate a system of classifications of various cancers.

TNM prostate cancer stages
T1: not visible on imaging screens
T2: evident and confined to prostate
T3: outside prostate, but may or may not have reached the seminal vesicles
T4: outside prostate and into other tissues (besides the seminal vesicles)

N category
N0: no involvement in regional nodes
N1: spread observed in regional node(s)

M category
M0:cancer has not spread beyond the local lymph nodes
M1: cancer has spread beyond the local lymph nodes
M1a: it has spread to lymph nodes outside of the pelvis
M1b: it has spread to bones
M1c: it has spread to other organs

I think it's important for patients to understand the level of cancer they are facing so that they and their physician can evaluate the next steps.

What can you tell us about different clinical trials and what to know?

Critical trials can be broken down into four different phases.

Phase One: typically involves a small group of people. In this phase, the researchers are evaluating side effects and patient safety.

Phase Two: at this level the group size becomes larger and generally can include up to 200 individuals. In this part of a clinical trial, the researchers are looking at the effectiveness of a treatment and continue to look at patient safety.

Phase Three: the patient pool becomes larger and involves thousands of individuals. At this point the researchers are confirming the effectiveness of what is being tested. They are also comparing their findings with similar or standard treatments. Throughout phase 3 they continue to collect safety information.

Licensing and Approval: The drug receives FDA approval, however at the same time, safety tracking continues as it is made available to the general population. Many experimental drugs do not make it to this stage, however.

If you are looking for clinical trials, you can go to the National Cancer Institute (nci) Clinical Trial search site; you will find various supported clinical trials. You can also check with your local hospital or with a major medical center near you to learn more about the availability of other trials in or out of your immediate area.