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.
Staging Spread And Survival Rates
As with all cancers, doctors use the term stage to describe the characteristics of the primary tumor itself, such as its size and how far prostate cancer has spread when it is found.
Staging systems are complicated. The staging system for most cancers, including prostate cancer, uses three different aspects of tumor growth and spread. Its called the TNM system, for tumor, nodes, and metastasis:
- T, for tumor describes the size of the main area of prostate cancer.
- N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
- M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.
Using the TNM system, each mans prostate cancer can be described in detail and compared to other mens prostate cancer. Doctors use this information for studies and to decide on treatments.
As far as survival rates for prostate cancer go, however, the staging system is pretty simple. As weve mentioned, in terms of survival rates, men with prostate cancer can be divided into two groups:
Strategies To Improve Treatment
The progress that has been made in the treatment of prostate cancer has resulted from development of better treatments that were evaluated in clinical studies. Future progress in the treatment of prostate cancer will result from patients continued participation in appropriate clinical trials. Developing novel precision cancer medicines and immunotherapies is the main area of active current investigation.
Cabazitaxel : Cabazitaxel is administered intravenously and has been demonstrated to improve time to cancer progression and overall survival in men with HRPC previously treated with docetaxel. Cabazitaxels primary side effect is neutropenia, and it is recommended that patients receive a white blood cell growth factor if they are at high risk of this complication.
Sipuleucel-T: Sipuleucel-T is an immunotherapy that prompts the bodys immune system to respond against the cancer. A Phase III clinical trial that contributed to the FDA approval of sipuleucel-T was a study known as IMPACT which demonstrated an improvement in overall survival for men treated with sipuleucel-T. The main side effects reported were chills, fever, and headache.
References:
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What I Wish People Knew About Metastatic Breast Cancer
Women with metastatic breast cancer think about fighting cancer very differently than women who dont have a stage 4 diagnosis. If you have advanced cancer, these women understand what youre going through.
The term metastatic breast cancer describes breast cancer that has spread beyond the breast to the bones, liver, brain, or another organ. Even if the cancer is found in another organ, its still referred to as breast cancer and is treated as such.
While metastatic breast cancer is terminal and cannot be cured, because of improved treatments more women are living longer than ever with it. Even so, a lack of information and many misconceptions about this diagnosis persist.
Treatment Options For Stage Iv Breast Cancer
For women with stage IV breast cancer, systemic therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help women live longer. These cancers are considered incurable.
The role of radiation treatment in the management of women with stage IV breast cancer has historically been confined to providing relief of painful bony metastases or other symptomatic areas of breast cancer. Unlike treatment of earlier stage breast cancer, radiation therapy has not been routinely used to prevent local cancer recurrence in the breast and axilla or other localized sites of disease. The results of a recent clinical study reported by investigators at Duke University, however, suggests that radiation therapy may reduce cancer recurrences and improve survival when used in women who have achieved a complete remission through conventional chemotherapy treatment.
Journal of Clinical Oncology, Vol 17, No 3, pp 887-893, 1999)
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Support For Living With Secondary Breast Cancer
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatever is on your mind.
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
Can Metastatic Prostate Cancer Go Into Remission
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Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
Infection And The Immune System
Looking at people who have had a spontaneous remission of their cancers, its quickly noted that most of these regressions are associated with an acute infection. Infections often result in a fever and stimulation of the immune system.
We know that our immune systems have the ability to fight off cancer. That is, in fact, the logic behind immunotherapy. Immunotherapy medications, while still in their infancy, have resulted in dramatic remissions of cancer for some people, even in the advanced stages of cancer. These drugs work in different ways, but a common theme is that they essentially enhance the ability of our own immune systems to fight cancer.
Infections which have been associated with spontaneous remission include diphtheria, measles, hepatitis, gonorrhea, malaria, smallpox, syphilis, and tuberculosis.
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Understanding Statistics About Survival
Doctors estimate prognosis by using statistics that researchers have collected over many years about people with the same type of cancer. Several types of statistics may be used to estimate prognosis. The most commonly used statistics include:
- Cancer-specific survivalThis is the percentage of patients with a specific type and stage of cancer who have not died from their cancer during a certain period of time after diagnosis. The period of time may be 1 year, 2 years, 5 years, etc., with 5 years being the time period most often used. Cancer-specific survival is also called disease-specific survival. In most cases, cancer-specific survival is based on causes of death listed in medical records.
- Relative survivalThis statistic is another method used to estimate cancer-specific survival that does not use information about the cause of death. It is the percentage of cancer patients who have survived for a certain period of time after diagnosis compared to people who do not have cancer.
- Disease-free survivalThis statistic is the percentage of patients who have no signs of cancer during a certain period of time after treatment. Other names for this statistic are recurrence-free or progression-free survival.
Survival Rates For Prostate Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Ask your doctor, who is familiar with your situation, how these numbers may apply to you.
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Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment
If your prostate-specific antigen blood level shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment youve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.
Stage 2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still .
The PSA score for stage 2 is less than 20 ng/mL.
Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:
- Grade group: 1
- Gleason score: 6 or less
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What Is Bone Metastasis
The bone is a common site for metastasis. Bone metastasis or bone mets occurs when cancer cells from the primary tumor relocate to the bone. Prostate, breast, and lung cancers are most likely to spread to the bone. However, other cancers are not excluded. Bone metastases do not begin from the bones but move there from the primary tumor site. On the other hand, primary bone cancers are rare cancers where the primary tumor actually starts in the bone. Therefore, bone cancer and bone metastases are not the same.
As an example, consider a patient with prostate cancer. Prostate cancer cells from the primary tumor can break away and get into the bloodstream. Once in the blood, the cancer cell can travel to the bone and form a new tumor. It is important to remember that this secondary tumor is made up of abnormal prostate cancer cells, not abnormal bone cells. The result of this process is referred to as prostate cancer that has metastasized to the bone or metastatic prostate cancer. This is otherwise known as bone metastasis.
When cancer cells metastasize to the bone, they can cause changes to the bone. The process by which portions of the bone are damaged is called osteolysis. Oftentimes, small holes result from osteolysis. These holes in the bone are referred to as osteolytic lesions or lytic lesions. Lytic lesions can weaken the bones and increase the risk of breakage or other problems. It is also common for bone metastasis patients to experience pain with lesions.
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
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Is Metastatic Cancer A Terminal
Most cancers of metastatic cancers do not have a good prognosis and are often labeled terminal. Metastatic breast cancer cannot be cured but can be managed with treatment. According to the American Cancer Society, the 5-year survival rate after diagnosis for people with stage 4 breast cancer is 27%.
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
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What Affects Survival
Your outlook depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread.
The type of prostate cancer and grade of the cancer also affects your survival. Grade means how abnormal the cells look under the microscope. The most common system used to grade prostate cancer is the Gleason score. Men with a higher Gleason score have a poorer outlook.
Your outlook also depends on your PSA level. A high PSA level may mean your cancer grows more quickly.
Your general health and fitness also affect survival. The fitter you are, the better you are able to cope with your cancer and treatment.
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.
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How Is A Recurrence Detected
After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.
When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.
Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.
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How Do I Know If Treatment Worked
If treatment is successful, levels of PSA in the blood will decrease. PSA levels can rise substantially when an individual is battling prostate cancer, and these levels are used as an early indicator of potential cancer.
When prostate cancer is successfully treated using radiation therapies, PSA levels will drop to lower levels and stabilize. When prostate cancer is successfully treated by surgically removing the prostate, PSA levels will decrease to the point of being virtually undetectable. When monitoring for recurrence of prostate cancer, one common method is to monitor PSA levels in the blood. If the prostate cancer returns, it is likely that PSA levels will rise again.
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