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How Long Can You Live With Gleason 6 Prostate Cancer

Survival For All Stages Of Prostate Cancer

Gleason 4+4=8 Prostate Cancer Treatments | Ask a Prostate Expert, Mark Scholz, MD

Generally for men with prostate cancer in England:

  • more than 95 out of 100 will survive their cancer for 1 year or more
  • more than 85 out of 100 will survive their cancer for 5 years or more
  • almost 80 out of 100 will survive their cancer for 10 years or more

Survival of prostate cancer is also reported in Scotland and Northern Ireland. But it is difficult to compare survival between these countries because of differences in the way the information is collected.

Cancer survival by stage at diagnosis for England, 2019Office for National Statistics

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account the background mortality that they would have experienced if they had not had cancer.

What Happens When Prostate Cancer Is Left Untreated

While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their healthcare providers monitor their cancer.

Known as active surveillance, it is common when the cancer is expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. In active surveillance, healthcare providers will initiate cancer treatment only if cancer starts growing.

Others men may choose to not undergo cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits.

This option is certainly OK and reasonable in the right circumstancesrequiring a careful and thoughtful discussion with your healthcare provider and family.

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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Does Untreated Clinical Gleason 6 Disease Cause Symptoms Or Death

Several studies that examined the natural history of untreated prostate cancer diagnosed in the prePSA screening era have suggested that men with Gleason 6 cancers are at risk for prostate cancerspecific mortality beyond 10 years of follow-up. The majority of the Gleason 6 disease was T1a/b disease, which was identified at the time of transurethral resection of the prostate for benign disease. Today, it is extremely rare to diagnose T1a/b disease because fewer TURPs are performed and those undergoing TURP have been prescreened with PSA testing. The results of the natural history studies in the PSA screening era are also problematic because many of the cases were likely misclassified at the outset because of the aforementioned limitations attributable to the random-systematic tissue sampling guided by TRUS.

With reported median follow-up ranging from 22 to 82 months, current active surveillance cohorts remain immature at this time, and longer follow-up will be necessary to draw definitive conclusions. Thus far, cancer-specific survival among these cohorts has been > 97%, and there are no data to suggest inferior outcomes after delayed radical therapy, as compared with immediate therapy.

Stage Iv Prostate Cancer Prognosis

How is the life expectancy of a patient with prostate cancer?

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.

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Risk Of Progression Of Prostate Cancer

Prostate cancer can also be classified based on the risk of recurrence . For this assessment, that can impact your choice of therapeutic approach, we take into account your clinical stage, PSA level, and Gleason score.

Low risk

Your cancer may be at low risk of spreading if:

  • Your PSA level is less than 10 ng/mL
  • You Gleason score is 6 or less
  • Your cancer is stage T1 or T2a

Medium risk

Your cancer may be at medium risk of spreading if:

  • Your PSA level is between 10 and 20 ng/mL
  • Your Gleason score is 7
  • Your cancer is stage T2b

High risk

Your cancer may be at high risk of spreading if:

  • Your PSA level is higher than 20 ng/mL
  • Your Gleason score is 8, 9 or 10
  • Your cancer is stage T2c, T3 or T4

New Diagnosis: Where Do I Start

You are not alone. The good news is that most prostate cancers are slow-growing and that with early detection and treatment, it can be cured. Increasing your knowledge by reviewing sections such as Coping with cancer, Choosing your treatment as well as other areas of the web site helps relieve the stress and helps make decisions clearer.

Over the last 12 months, approximately 4,600 Quebecers were diagnosed with prostate cancer. This represents an average of 12 men per day. You are definitely not alone in your fight against prostate cancer. The good news is that we know most prostate cancers are slow-growing, which means that with early detection and treatment, it can even be cured.

Once diagnosed, men will go through understandable and normal reactions, such as fear, denial, anger, helplessness and feeling of loss of control over their life. Once reality sets in, a constructive way to deal with the disease is to learn as much as you can about it. Increasing your knowledge about prostate cancer helps relieve the natural fear of the unknown, and makes the decision-making process easier.

Frequently Asked Questions

Click here for the full list of prostate cancer-related FAQs.

Questions about survival

Talk to your doctor about your prognosis. A prognosis depends on many factors, including:

  • your age
  • certain characteristics of the cancer
  • the treatments chosen
  • how the cancer responds to treatment

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What Does It Mean If My Biopsy Mentions That There Is Perineural Invasion

Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber with the prostate. When this is found on a biopsy, it means there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion does not mean that the cancer has spread, and other factors, such as the Gleason Score and amount of cancer in the cores are more important. In some cases, findings perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.

Where Prostate Cancer Spreads

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If left untreated, diagnosed prostate cancer can grow and possibly spread outside of the prostate to local tissues or distantly to other sites in the body. The first sites of spread are typically to the nearby tissues.

The cancer can spread down the blood vessels, lymphatic channels, or nerves that enter and exit the prostate, or cancer could erode directly through the capsule that surrounds the prostate.

The seminal vesicles are a site of particularly common early spread. More extensive local spread can occur with cancer invading the nearby bladder or rectum.

Further advancement of cancer can occur when cancer cells enter the blood vessels and lymphatic channels. Once cancer has entered into these vessels, prostate cancer cells can seed into virtually any other part of the body.

Prostate cancer is known to have a particular affinity for spreading or metastasizing to the bones especially the lower spine, pelvis, and femur. Other organs such as the liver, brain, or lungs can also be the sites of spread, but these are much rarer.

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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.

Treatments May Have Side Effects

The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.

Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.

If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.

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Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

The Bogus Gleason 6 Prostate Cancer

Prostate Cancer Spread To Liver â Cancer News Update

The very common Gleason 6 type of prostate cancer href=http://www.ascopost.com/issues/june-10-2016/prostate-cancer-opinions-vary-on-gleason-scores-and-surgery/ rel=noopener> fails to behave as a cancer and should NOT be called a cancer. The all-inclusive prostate cancer label is deceitful by implying that all prostate cancers are equal and have the power to kill rapidly. It has been well established fact that the common Gleason 6 type of prostate cancer should not be called a cancer at all.

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Figure 2 Why Understaging May Occur

When the prostate is removed, a pathologist examines slices of the gland for evidence of cancer. A. Under a microscope, the pathologist can distinguish tiny tumors, consisting of clumps of visibly abnormal cells. B. With current imaging technology, it is not yet possible for a pathologist to identify micrometastases individual cancer cells shed from the primary tumor that have gone on to seed adjacent tissue. In this image, for example, cancer cells have already penetrated the capsule and migrated to adjacent tissue, even beyond the margin of tissue removed during surgery.

Individual prostate cancer cells can spread to more remote areas of the body in three ways . Whats more, they can do so without being detected with our current technology, essentially escaping under the radar. So its always possible even if you are diagnosed with early-stage prostate cancer that the cancer has already spread and will manifest in the coming years. How likely is it that an early-stage prostate cancer will become active without treatment? A small study provides some clues .

Where Do These Numbers Come From

The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.

  • Localized: There is no sign that the cancer has spread outside the prostate.
  • Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
  • Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.

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Can The Gleason Score On My Biopsy Really Tell What The Cancer Grade Is In The Entire Prostate

Prostate biopsies are tissue samples from different areas of the prostate. The Gleason Score on a biopsy usually reflects the cancer’s true grade. However, it is possible that the Gleason Score from your biopsy is lower or higher than the true grade. To reduce the risk of over-or-under scoring, multiple biopsies are usually taken from different areas within the prostate.

Prognostic Grouping Of Prostate Cancer

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TNM prognostic grouping for prostate cancer is based on the stage, PSA level and Gleason score. This grouping is more accurate in predicting a prognosis than TNM staging alone. It goes without saying that the lower the scores, the best outlook and chance that your cancer can be successfully treated without the cancer coming back .

In contrast, if the prognosis is darker for men with higher scores, there may still be treatment options to control your cancer, improve your quality of life and prolong your survival.

Doctors also use nomograms to predict a prostate cancer prognosis. Nomograms are predictive tools.

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What Does It Mean If In Addition To Cancer My Biopsy Report Also Says Acute Inflammation Or Chronic Inflammation

Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on a biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase you PSA level, but it is not linked to prostate cancer. The finding of prostatitis on a biopsy of someone with cancer does not affect their prognosis or the way the cancer is treated.

Study Population And Data Collection

This was a population-based study in which potential cases were identified from six cancer registries in Great Britain. Within each region, collaborating hospitals were sought and cases from these hospitals were reviewed. National approval was obtained from the Northern Multi-Research Ethics Committee, followed by local ethics committee approval at each of the collaborating hospital trusts .

Men were included in this study if they were under age 76 years at the date of diagnosis and had clinically localised prostate cancer diagnosed by transurethral resection of the prostate or needle biopsy. Diagnosis between 1990 and 1996 and a baseline PSA were required.

Patients treated by radical prostatectomy or radiation therapy within 6 months of diagnosis were excluded. In addition, those with objective evidence of metastatic disease or clinical indications of metastatic disease , or a PSA measurement over 100ngml1 at or within 6 months of diagnosis were also excluded. These exclusions were a pragmatic method of focusing the study on patients who were very likely to have truly localised disease at presentation. Men who had hormone therapy prior to diagnostic biopsy were also excluded, because of the influence of hormone treatment on interpreting Gleason grade. We also excluded men who died within 6 months of diagnosis, or had less than 6 months of follow-up.

Figure 1

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How Prostate Cancer Spreads

  • The cells escape into the bloodstream, initially by invading small blood vessels around the tumor, then traveling to larger blood vessels that enable the cells to circulate around the body .
  • The cells are filtered through the bodys lymph system although some are captured in lymph nodes, others may travel elsewhere in the body.
  • The cells migrate along the length of a nerve, escaping from the prostate into adjacent soft tissue .

How Reliable Is Our Detection Of Gleason 6 Disease

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Before the PSA screening era began in the late 1980s, prostate cancer was usually diagnosed by directing a biopsy needle into a nodule detected at the time of a digital rectal examination. In most cases, the nodule occupied a significant proportion of the gland. Often, gross extracapsular disease was evident at the time of diagnosis. Low-grade cancers were rarely diagnosed unless they were incidental findings at the time of transurethral prostatectomy for benign disease.

The detection of prostate cancer in the PSA era requires a random biopsy technique because transrectal ultrasonography does not reliably identify the site of clinically significant disease. Therefore, many Gleason 6 cancers identified on biopsy coexist with higher-grade disease missed by random biopsy. Mufarrij et al examined the prostates of 205 and 771 men who met the Epstein or Klotz criteria, respectively, for active surveillance and who underwent radical prostatectomy. By definition, all of these men had Gleason 6 cancers on prostate biopsy. Between 45.9% and 47.2% had Gleason grade 4/5 disease, and 7.8% to 10.9% had evidence of extracapsular extension. The 5-year biochemical-diseasefree survival was estimated to be 83.2% to 92.9% despite curative intervention. Others have confirmed the unreliability of Gleason grading attributable to random biopsy, which remains an essential limitation in assigning men to active surveillance.

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