What is the terminal stage of prostate cancer?

introduction

Prostate cancer is called prostate cancer in medical terminology. This is a collective term for various, common types of cancer that originate from stem cells in certain parts of the gland in the prostate. Often these are so-called adenocarcinomas.

The types of prostate cancer are malignant in different ways. In addition, the individual stages have a different prognosis. In technical jargon, one speaks of different degrees of malignancy, which are decisive for prognosis and treatment. The prognosis is poor in end-stage prostate cancer. The focus is on palliative treatment, including caring for relatives.

Symptoms in the end-stage prostate cancer

Prostate cancer develops in two-thirds of cases in the external prostate gland area. As a result, the urethra, which lies inside, is only narrowed at an advanced stage. As a result, those affected do not notice prostate cancer for a long time. Since those affected often do not suffer from any symptoms in the early stages of prostate cancer, the mere presence of symptoms usually indicates an advanced stage of the disease.

Certain laboratory tests in the blood, semen, or urine may indicate end-stage prostate cancer. Rarely does blood appear in the urine or semen. If the tumor has grown excessively, it can press on the urethra, causing problems with urination. Consequences can be a weakened or interrupted urine stream, a reduced amount of urine, difficult urination and increased urge to urinate, especially at night. Urinating can also be painful. If there are no other symptoms besides the urination disorders, these problems more often indicate a benign enlarged prostate or an inflammation of the urethra. But only a doctor can differentiate this.

Erectile dysfunction, erectile pain, and decreased ejaculation can all indicate advanced prostate cancer. Some people may localize pain in the prostate. There may also be pain and swelling in the pelvis and legs. In addition, compression of the spine can cause pain and sensitivity disorders in the back area. Permanent bone pain and broken bones can also be triggered. The symptoms can vary greatly in severity.

In order to be able to assess the actual spread of the prostate cancer, an ultrasound image is required. Furthermore, a biopsy is necessary to take several tissue samples. In some cases it is only possible to assess how far the disease has progressed during a surgical procedure.

Also read: What are the stages in prostate cancer?

End-stage prostate cancer pain

Various and extremely severe pains can occur in the context of end-stage prostate cancer. A very important part of treatment is adequate pain management. Patients should speak to their treating physician directly when pain occurs and not only when the pain is unbearable. Due to medical advances, pain can now be minimized in 8-9 out of 10 cancer patients. Both medicinal and non-medicinal measures are used for this. The treating doctor, pain therapists and other specialists draw up the treatment plan. Pain medication is used for mild pain. Opioids can be effective for more severe pain.

Read on below: Pain in the prostate.

If the pain comes directly from a nerve, it has certain characteristics and usually cannot be reduced with conventional painkillers. This pain is called in medical terminology more neuropathic Pain described. Various other medications can relieve neuropathic pain. These can also be drugs that are not actually painkillers, but which, in addition to their main effect, can relieve pain. These drugs include certain antidepressants, for example. This means that the active ingredient is then used not because of depression, but because of the pain. Accordingly, a different, lower dosage is selected than if the drug were used to treat depression.

In addition, chemotherapy, radiation, hormone and antibody therapies can relieve pain. In some cases, the nerve lines that cause the pain are blocked. This is done by injecting a pain-numbing medication into the vicinity of the spinal cord. In addition, non-drug therapies can also have a soothing effect. This includes certain physiotherapy and occupational therapy measures, acupuncture or nerve stimulation methods.

End-stage prostate cancer metastases

Liver metastases

Cells from prostate cancer can peel off and spread and settle in other parts of the body. The cancer cells can reach the well-perfused liver via the bloodstream and form tumor foci, liver metastases. Doctors speak of one hematogenous spread. Prostate cancer is not one of the classic tumors that originate from liver metastases, which usually occur in esophageal, stomach or colon cancer, but it can certainly spread to the liver.

There are different types of liver metastases: Synchronous Liver metastases are detected simultaneously with the prostate tumor. Metachrones In prostate cancer that has already been treated, metastases develop only as the disease progresses. Under singular Liver metastases are understood as single tumor settlements, whereby there is multiple Metastasis comes to multiple settlements. The size, location, appearance and number of liver metastases are decisive for treatment options and prognosis. Liver metastases can vary in appearance. A distinction is made between sharply delimited liver metastases, which can be easily distinguished from the rest of the liver tissue, from extensive metastases that grow without sharp delimitation.

Read more on the subject at: Metastases in prostate cancer

Spinal metastases

Also in the spinal area, cells of the prostate tumor can settle via the bloodstream. The resulting spinal metastases can constrict nerves, muscles and vertebrae, which can trigger various complaints. Pain, abnormal sensations and movement disorders can occur if the nerve cords in the spinal column branching off the spinal cord are affected. The body regions affected by this depend on the exact location (height and lateral orientation) of the spinal metastasis.

Please also read our article on this Symptoms of spinal disease

Bone metastases

In turn, bone metastases arise via the bloodstream. Bone metastases are often associated with severe pain and fractures. But you can also remain completely symptom-free. If bone metastases are suspected, a special examination called a bone scintigraphy is performed. It is possible to irradiate the bone metastases in a relatively targeted manner in order to stabilize the bones and reduce pain. There are several ways to have the bone metastases irradiated:

In addition to class irradiation, radionuclides can also be used. Radionucides are radiating particles that the body builds into the bones, where they ultimately take effect. In addition, in the case of bone metastases, so-called Bisphosphonates used. These are drugs that affect the metabolism of the bone. In addition, specially produced antibodies are increasingly used to minimize damage to the bones.

For more information, see Scintigraphy

Lymph node metastases

Migratory prostate cancer cells can spread not only through the bloodstream but also through the lymphatic system. Lymph node metastases can occur primarily in the lymph nodes in the pelvic area, but also outside the pelvis. The lymph nodes are usually the first to be affected by metastases, as the lymphatic system is reached earlier by cancer cells than the bloodstream.
However, lymph node metastases do not necessarily cause noticeable symptoms in those affected. The examination measures and the search for lymph node metastases are based on the treatment plan. An ultrasound, a magnetic resonance tomography (MRT) and / or an operation are carried out accordingly. The safest way to identify the lymph node metastases is during a surgical procedure and in case of doubt they can be removed directly. The operation is usually minimally invasive using a laparoscopy (Laproscopy) carried out. In the case of a large number of affected lymph nodes, it must be weighed whether it is still useful to remove them in the final stage.

Metastases in the brain

If prostate cancer cells reach the brain via the blood, they can multiply and via the nerve fluid (Liquor) to distribute. Metastases in the brain not only compress brain tissue as they grow, they also cause fluid accumulation and swelling of brain structures, thereby increasing the pressure on healthy tissue in the brain. Accordingly, brain metastases can trigger various and serious complaints.

Depending on which area is affected and how severe the damage to the nerve and brain tissue is, the symptoms of failure and complaints can vary. For example, the metastases in the brain can lead to headaches, nausea, circulatory problems with dizziness, visual disturbances, seizures, language disorders, cognitive impairments, psychological disorders or paralysis. When the cancer cells migrate along the nerve water spaces and the meninges to the spinal cord, in technical jargon one Meningiosis carcinomatosa spoken. Those affected often suffer from headaches, nausea, vomiting and personality disorders. In addition, the so-called cranial nerves can be damaged, which can lead to swallowing disorders, among other things. The voice can also be impaired.

For more information, read our article Brain metastases

PSA value

PSA stands "Prostate specific antigen". It is a protein which is formed by prostate cells and which, among other things, serves to liquefy the sperm. If there is a malignant change in the prostate area, the PSA value usually increases. However, the value is not specific for the presence of a malignant disease, it can also indicate other age-related or acute disorders, inflammations and diseases of the prostate.

For details, see PSA level in prostate cancer or generally under PSA value

What can be done therapeutically in the terminal stage?

In the end-stage prostate cancer, curative treatment is no longer possible. Often a (further) operation is not necessary. There is one palliative Treatment in the foreground. This includes adequate and sufficient pain therapy, which is composed of various medicinal and non-medicinal components. In addition to pain medication, massages, acupuncture, relaxation methods and other physiotherapy and occupational therapy measures can help relieve pain. The aim is to relieve the patient of suffering and pain and to create the best possible quality of life. If desired, the person concerned should have the opportunity to talk to a clergyman, a psychotherapist or other suitable specialist. In addition, empathic and competent care and support for the person concerned and their relatives is essential. Many of those affected wish to spend as little time as possible in hospital. With the help of social services, home nursing and other institutions and persons, the wishes of the person concerned and their relatives should be pursued as far as possible.

Please also read our article on this Palliative therapy

Disease course and life expectancy in the terminal stage

Once the disease has progressed, no cure is possible. The symptoms can temporarily decrease, but the damage is no longer diminishing and tumor growth can only be delayed to a limited extent. The course can differ individually in terms of time and content and cannot generally be predicted. In the final stage, the time that remains should be designed in a way that is individually coherent for the person concerned.

Life expectancy depends on the extent of the metastases and on individual factors. If left untreated, there are usually only a few weeks to live. With therapy, life expectancy can be increased from a few months to a year. In some cases life expectancy is higher. In other cases it can also be lower. It is very difficult to give an exact, general time specification.

Read more about this: Prostate Cancer Cure Chances