Prognosis And Survival For Prostate Cancer
If you have prostate cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for prostate cancer.
Hormonal Therapy And Its Complications
Several different hormonal approaches are used in the management of various stages of prostate cancer.
These approaches include the following:
- Abiraterone acetate .
- Aminoglutethimide.
Abiraterone acetate
Abiraterone acetate has been shown to improve OS when added to ADT in men with advanced prostate cancer who have castration-sensitive disease. Abiraterone acetate is generally well-tolerated however, it is associated with an increase in the mineralocorticoid effects of grade 3 or 4 hypertension and hypokalemia compared with ADT alone. It may also be associated with a small increase in respiratory disorders.
Bilateral orchiectomy
Benefits of bilateral orchiectomy include the following:
- Ease of the procedure.
- Immediacy in lowering testosterone levels.
- Low cost relative to the other forms of ADT.
Disadvantages of bilateral orchiectomy include the following:
- Psychological effects.
Bilateral orchiectomy has also been associated with an elevated risk of coronary heart disease and myocardial infarction.
Estrogen therapy
Estrogens at a dose of 3 mg qd ofdiethylstilbestrol will achieve castrate levels of testosterone. Likeorchiectomy, estrogens may cause loss of libido and impotence. Estrogens also cause gynecomastia, and prophylactic low-dose radiation therapy to the breasts is given to prevent this complication.
Luteinizing hormone-releasing hormone agonist therapy
Evidence :
Antiandrogen therapy
ADT
Evidence :
Antiadrenal therapy
Prediction Of Al1392871 Slc9a3
Paclitaxel sensitivity demonstrated a significant negative correlation with the mRNA expression of ADORA2A . Erlotinib sensitivity had a significant negative correlation with the mRNA expression of TNFRSF18 and AL139287.1 . Erlotinib and vinorelbine sensitivity showed a significant negative correlation with the mRNA expression of SLC9A3–AS1 . Doxorubicin, erlotinib, gemcitabine, and vinorelbine sensitivity demonstrated a significant negative correlation with the mRNA expression of SNHG12 .
Figure 8ADORA2ATNFRSF18AL139287.1SLC9A3-AS1SNHG12ADORA2A TNFRSF18 AL139287.1 SLC9A3-AS1 SNHG12
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Grading After Radiation And Hormonal Therapy
In general, the Gleason grading system should be applied only to tumor that shows no evidence of treatment effect. For radiation therapy cases, where there is no evidence or minimal evidence of therapy effect, Gleason grading may be utilized. Hormonal therapy can cause pattern alterations resembling high Gleason grades. Overall, the consensus view is that one should not report histologic grade after hormonal therapy.
Watchful Waiting Or Active Surveillance/active Monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrantconsideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Watchful waiting and active surveillance/active monitoring are the most commonly used terms, and the literature does not always clearly distinguish them, making the interpretation of results difficult. The general concept of watchful waiting is patient follow-up with the application of palliative care as needed to alleviate symptoms of tumor progression. There is no planned attempt at curative therapy at any point in follow-up. For example, transurethral resection of the prostate or hormonal therapy may be used to alleviate tumor-related urethral obstruction should there be local tumor growth hormonal therapy or bone radiation might be used to alleviate pain from metastases. Radical prostatectomy has been compared with watchful waiting or active surveillance/active monitoring in men with early-stage disease .
- Regular patient visits.
- Transrectal ultrasound .
- Transrectal needle biopsies .
Patient selection, testing intervals, and specific tests, as well as criteria for intervention, are arbitrary and not established in controlled trials.
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Jatinder Kumar* Muhammad Umar Alam Karthik Tanneru Shiva Gautam Daniel Norez Charu Shastri Joseph Costa Mark Bandyk Hariharan Palayapalayam Ganapathi Shahriar Koochekpour Sanjeev Shukla And Kc Balaji
*Corresponding author:Received:Accepted:
Abstract
Purpose: To provide a comprehensive summary of published literature regarding influence of intraductal carcinoma of prostate on clinical outcomes in men with Prostate Cancer .
Methods: We compared the following clinical endpoints in men with PC with or without IDC-P Castration Resistant Free Survival and Overall Survival for metastatic PC , biochemical recurrence rate and/or cancer specific survival in men undergoing radical prostatectomy or radiotherapy . A meta-analysis was done by fixed effect model using 12 studies reporting Hazard Ratio and meeting the selection criteria.
Results: In Group 1 for men with IDC-P, the pooled HR for CFS and OS were 1.69 and 2.00 , respectively. In group 2a BR and CSS were higher in men with IDC-P with HR 2.63 and 2.87 respectively. Similarly, presence of IDC-P in group 2b demonstrated a HR of 2.04 for BR.
Men with IDC-P demonstrated poorer clinical outcomes including higher rate of BR following radical prostatectomy, radiation therapy either in primary and salvage settings, shorter time to CFS and poorer OS in men with metastatic disease. Our analysis and review of the literature suggest that IDC-P could be used as a novel prognostic and predictive morphological biomarker to influence clinical management in men with PC including pelvic lymph node dissection, pelvic radiotherapy or genetic testing.
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General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
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Stage 4 Prostate Cancer Clinical Trials
Clinical trials provide cancer patients with life-extending and curative new medicines. Clinical drug trials are critical in getting new medicines to patients who need them the most, as well as securing data so that regulatory clearances may be secured, and new drugs can enter broad clinical practice. Patients who take part in clinical trials benefit both treatment science and their fellow patients.
There are currently 100 Phase III drug trials and more than 500 Phase I/II trials related to prostate cancer treatment in progress in the United States alone. Those that are approved will join the 12 new drugs that have been approved for men with advanced/metastatic disease since 2010 and further improve outcomes for patients:
Using our AI-powered approach, Massive Bio leads patients through the most extensive clinical trial matching process available.
We can assist you if you have been diagnosed with any of the following prostate cancer subtypes:
- Transitional Cell Carcinoma
- Small Cell Carcinoma
If you do not know which type of prostate cancer you have, that is okay. Additional testing can help you determine your exact diagnosis.
What Can Affect My Outlook
No one can tell you exactly what will happen. How prostate cancer affects you will depend on many things.
- Your stage Whether your cancer is localised, locally advanced, or advanced.
- Your Gleason score or grade group The higher your Gleason score, the more aggressive the cancer, and the more likely it is to spread.
- Your treatment options You may be able to have treatment aimed at getting rid of the cancer. Or you may be able to have treatment to keep the cancer under control. Read more about choosing your treatment.
- Your health If you have other health problems, you may have fewer treatment options. And you may be more likely to die from another condition, such as heart disease.
- Your PSA level After youve been diagnosed, PSA tests are a good way of monitoring your prostate cancer and seeing how youre responding to treatment.
- How successful your treatment is Your treatment may be successful at getting rid of your cancer or keeping it under control. But for some men, treatment may not work as well as expected.
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What Is Prostate Cancer
Prostate cancer develops when abnormal cells in the prostate gland grow in an uncontrolled way, forming a malignant tumour.
Prostate cancer is the most common cancer diagnosed in Australia. It is estimated that 24,217 new cases of prostate cancer will be diagnosed in Australia in 2022. One in 6 men will be diagnosed with prostate cancer by the age of 85. It is more common in older men, with over 70.1% of cases diagnosed in men over 65 years of age, and the mean age at diagnosis being 69.2 years old.
Early prostate cancer refers to cancer cells that have grown but do not appear to have spread beyond the prostate.
There are two stages of advanced prostate cancer:
- locally advanced prostate cancer where the cancer has spread outside the prostate to nearby parts of the body or glands close to the prostate
- metastatic prostate cancer where the cancer has spread to distant parts of the body.
The five year survival rate for prostate cancer is 95.5%.
Diagnosing Rare Prostate Cancers
Rarer prostate cancers can be harder to diagnose. For example, some dont cause your prostate specific antigen level to rise. This means theyre not always picked up by a PSA test. Because of this, some rare cancers may not be diagnosed until they have already spread outside the prostate. Read more about the PSA test and other tests used to diagnose prostate cancer.
Some rare prostate cancers may only be picked up after having a biopsy to check for prostate cancer, or surgery called transurethral resection of the prostate to treat an enlarged prostate. The tissue removed during the biopsy or TURP is looked under a microscope to see if you have common prostate cancer or a rare type of prostate cancer. Rare cancers arent always given a Gleason score after a biopsy. This is because they can behave differently to common prostate cancer and cant be measured in the same way.
Because rare cancer can be aggressive and spread outside the prostate, you will probably have more tests to see if they have spread. These include:
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Brain Cancer Survival Rate
The average five-year relative survival rate for malignant brain tumors is 35.6 percent, according to the National Brain Tumor Society. This means that 35.6 percent of people who are diagnosed with brain cancer are still alive five years after their tumor is found.
Many factors affect survival following a brain cancer diagnosis, including:
For example, according to the American Cancer Society, the five-year relative survival rate by age bracket for glioblastoma, the most common type of primary malignant brain tumor, is:
- 22 percent for people aged 20 to 44
- 9 percent for people aged 45 to 54
- 6 percent for people aged 55 to 64
This means that the younger you are, the higher the estimate of survival after five years. As a general rule, survival is longer with lower-grade brain tumors, but brain cancer survival data isnt often categorized by grade.
Its also important to keep in mind that survival estimates are just thatestimates. They are based on past data and older treatments. Advances continue to be made in medicine, and you should feel comfortable asking your care team to go over what these estimates mean for you, and what newer treatments may be appropriate for you.
Improvements In Life Expectancy
A decade ago, a man with metastatic prostate cancer would typically have a life expectancy of two to three years. Today, life expectancy for men with the same advanced disease is likely to be five to six years. In the UK the survival rate for men with stage 4 prostate cancer is approximately 50%, meaning that 50 out of every 100 men will survive their cancer for 5 years or more after they are diagnosed with stage 4 prostate cancer*. There is now a much broader range of chemotherapy drugs available for men with advanced disease with greater efficacy . We also have better treatments to control the symptoms of advanced prostate cancer, such as pain from metastases. In this section, we consider in more detail the different treatments that are available and evidence for their effectiveness.
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Citation Doi & Article Data
- Endometrial carcinoma of the prostate
- Endometrioid carcinoma of the prostate
- Prostatic ductal adenocarcinoma
Ductal adenocarcinomas of the prostate or prostatic ductal adenocarcinomas are malignant glandular neoplasms of the prostate and tend to be more aggressive than acinar adenocarcinomas.
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Survival By Disease Progression
The extent prostate cancer has progressed can influence survival rates.
Prostate-specific antigen is a protein produced by cells of the prostate gland by normal and malignant cells. In men with prostate cancer, blood levels of PSA are often elevated.
Doctors can use PSA as a marker to better understand the progression of prostate cancer and the resulting prognosis.
One way doctors assess the progression of the disease is through PSA doubling time. This refers to the number of months it takes for PSA to double.
One study suggests a short doubling time means a poorer prognosis for patients with stage IV prostate cancer. Median survival was 16.5 months for those with a PSA doubling time lower than 45 days compared with 26 months for patients with a longer PSA doubling time.
Whether or not the cancer has metastasized and spread to other areas of the body outside the prostate can also influence survival. In distant or stage IV prostate cancer, when cancer has spread from the prostate to other organs like the liver or lungs, the five-year survival rate is 31% compared with localized cancer, which has a five-year survival rate of nearly 100%.
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What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.
Correlation Between Serum Psa Levels And Pathological Type
Among the 21 patients with pure SmCC, serum PSA levels in 18 cases were normal and only elevated in three cases. For the five mixed cases, three had an elevation, and the other two had serum PSA levels in the normal range. However, the results of the chi-square tests revealed no significant differences .
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Ajcc Stage Groupings And Tnm Definitions
The AJCC has designated staging by TNM classification.
| Grade Group | Gleason Score | Gleason Pattern |
|---|---|---|
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | ||
| 1 | ||
| 4+4, 3+5, or 5+3 | ||
| 5 | 4+5, 5+4, or 5+5 |
| Stage | Gleason Score Gleason Pattern g | Illustration | |
|---|---|---|---|
| T = primary tumor N = regional lymph nodes M = distant metastasis cT = clinical T PSA = prostate-specific antigen pT = pathological T. | |||
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | |||
| The explanations for superscripts b through g are at the end of Table 5. | |||
| I | cT1ac, cT2a, N0, M0 | cT1 = Clinically inapparent tumor that is not palpable. | < 10 |
| cT1a = Tumor incidental histologic finding in 5% of tissue resected. | |||
| cT1b = Tumor incidental histologic finding in > 5% of tissue resected. | |||
| cT1c = Tumor identified by needle biopsy found in one or both sides, but not palpable. | |||
| cT2 = Tumor is palpable and confined within prostate. | |||
| cT2a = Tumor involves ½ of one side or less. | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. | |||
| Gleason Score, 6 Gleason Pattern, 3+3 . | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. |
References
In Addition To Boots On The Ground
I believe there are also provisions beyond âboots on the groundâ for VA benefits for PCa for Vietnam era military service. If you were on certain ships that came into areas designated as âgray waterâ then âboots on the groundâ is not necessary.
Bronx advice was excellent: Contact your VA office ASAP to file your claim. If approved, the date your claim was filed determines when benefits start. There are several other threads discussing this subject. A search using the search box feature should provide more info.
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Is It A Systemic Maybe Not
Hi Lori,
Sorry for the news on the bone lesions. I wonder how extensive the metastasis exist and their location. The typical treatment of choice is ADT which is palliative, but when the lesions are fewer in number and in convenient locations one has the possibility in treating with spot radiation .
Dr. Laccetti is a medical oncologist. He may prefer recommending palliative approach but you can inquire on the possibility of a combination of ADT plus RT, or even request for a second opinion at the MSK radiation department. Many other factors could cause bone lesions.
Another aspect for inquiring is about existing bone loss. I recommend you to discuss on the need of bisphosphonates, if any. Had to the list of questions matters regarding systemic cases.