How Long To Live With Advanced Prostate Cancer

Understanding Prostate Cancers Progression

To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.

• Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
• Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.

After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.

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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. 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.

Signs Of Approaching Death

Death from cancer usually occurs after a person has become weaker and more tired over several weeks or months. It is not always possible to predict how long someone will live. But some common signs and symptoms show that a person is entering the final weeks and days of life. Knowing what to expect helps relieve anxiety and allows better planning.

The following are signs and symptoms that suggest a person with cancer may be entering the final weeks of life:

• Worsening weakness and exhaustion.

• A need to sleep much of the time, often spending most of the day in bed or resting.

• Weight loss and muscle thinning or loss.

• Minimal or no appetite and difficulty eating or swallowing fluids.

• Little interest in doing things that were previously important.

• Loss of interest in the outside world, news, politics, entertainment, and local events.

• Wanting to have only a few people nearby and limiting time spent with visitors.

As the last days of life approach, you may see the following signs and symptoms:

Of course, every person is different. The signs and symptoms that people experience vary. And the order in which signs and symptoms occur may differ.

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What Is Localized Prostate Cancer

Prostate cancer is the abnormal growth of cells in the prostate gland. Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesn’t cause symptoms.

Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.

Men of African descent have the highest rates of both prostate cancer and deaths from it.

About 21,000 men are diagnosed with prostate cancer in Canada every year.footnote 1 In the United States, about 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime in their lifetime.footnote 2 But most men who are diagnosed with prostate cancer don’t die from prostate cancer.

Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery.

Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.

What Are Next Steps

Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But its important to remember that the numbers are only statistics.

The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.

Everyones cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.

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What Is Advanced Cancer

Advanced cancer is most often used to describe cancers that cannot be cured. This means cancers that wont totally go away and stay away completely with treatment. However, some types of advanced cancer can be controlled over a long period of time and are thought of as an ongoing illness.

Even if advanced cancer cant be cured, treatment can sometimes:

• Shrink the cancer
• Help relieve symptoms
• Help you live longer

For some people, the cancer may already be advanced when they first learn they have the disease. For others, the cancer may not become advanced until years after it was first diagnosed.

Advanced cancers can be locally advanced or metastatic.

Locally advanced means that cancer has grown outside the body part it started in but has not yet spread to other parts of the body. For example, some cancers that start in the brain may be considered advanced because of their large size or closeness to important organs or blood vessels. This can make them life-threatening even though they havent spread to other parts of the body. But other locally advanced cancers, such as some prostate cancers, may be cured.

Metastatic cancers have spread from where they started to other parts of the body. Cancers that have spread are often thought of as advanced when they cant be cured or controlled with treatment. Not all metastatic cancers are advanced cancers. Some cancers, such as testicular cancer, can spread to other parts of the body and still be very curable.

Most Patients Did Not Progress

With active surveillance, the patients had physical exams and PSA tests every six months, with biopsies recommended every one to two years.

Over an average of two and a half years of follow-up, 43 of the study participants showed evidence of cancer progression and received treatment.

In two patients, cancer spread beyond their prostate.

The study is published in the April issue of the Journal of Urology.

The findings support the idea that some men with prostate cancer may not need treatment, American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, tells WebMD.

He says the addition of a second biopsy should help refine the search for men who are appropriate candidates for active surveillance, but he also agrees that the strategy of watchful waiting is not without its risks.

âThe real advance will be when we have tests that will tell us with a high degree of accuracy when treatment is needed and when it is not,â he says.

A great deal of research is being done to identify genetic tests or tumor markers that can do this, but Lichtenfeld says it will be years before these tests are validated.

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Managing Symptoms Of Advanced Prostate Cancer

Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.

You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.

Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.

Life Expectancy And Localized Prostate Cancer

So how do these treatments affect life expectancy? In one study, researchers in Switzerland examined the treatment and outcomes of 844 men diagnosed with localized prostate cancer. They compared men who had been treated with prostatectomy, radiotherapy and watchful waiting and found that at five years from diagnosis, the type of treatment made little difference to survival. When the researchers went to 10 years from diagnosis, they did find a difference in survival based on treatment, but it was fairly small.

After 10 years, 83 percent of the men who had gotten a prostatectomy were still living, compared to 75 percent who had undergone radiotherapy and 72 percent who took a watchful waiting approach.

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Changes To Your Sex Life

Sex will be a little different if you have surgery to remove your prostate gland. It means you wonât ejaculate, though you can still have an orgasm. Trouble getting erections or having orgasms is also a risk after an operation or if you have radiation therapy.

You can work with your doctor to cut those risks. Start by asking about “nerve-sparing” surgery and more precise radiation therapy. You can ask about the success they’ve had in protecting other men from these side effects.

If you do end up having problems after treatment, youâre not out of luck. Keep in mind that for many men, the problems go away on their own once the body has time to heal. Medications, devices, penile implants, and couples counseling also can make your sex life satisfying again. But most of all, be patient with yourself.

What Else Do You Need To Make Your Decision

Check the facts

• Sorry, that’s not right. One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
• You’re right. One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
• It may help to go back and read “Get the Facts.” One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.

• That’s right. The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
• That’s not right. The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
• It may help to go back and read “Get the Facts.” The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.

How sure do you feel right now about your decision?

Use the following space to list questions, concerns, and next steps.

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Managing Bone Pain And Weakness

Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.

Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.

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What Happens Without Treatment

Physicians will sometimes talk about a particular diseases natural history or typical progression if it is left untreated indefinitely.

With regard to prostate cancer, most cases of the disease are discovered while the cancer is still confined to the prostate itself. This is called local disease or localized disease.

The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present.

If left untreated, however, prostate cancer can proceed on a number of different paths.

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Staging And Grading Of Advanced Prostate Cancer

The stage of a cancer describes its size and how far it has spread, based on your test results. Doctors often use the TNM staging system or a number staging system.

A doctor decides the grade by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread. You and your doctors can then talk about the best treatment choices for you.

What Is A Patients Life Expectancy After A Stage 4 Prostate Cancer Diagnosis

A Stage 4 prostate cancer diagnosis is reserved for those whose cancer has progressed outside the prostate to other organs. Usually the cancer is no longer responding to hormonal therapy at this point. There are a variety of medications available for patients with this diagnosis to help extend their length and quality of life. Dr. Howard Tay discusses these medications and life expectancy with Stage 4 prostate cancer in this video.

To learn more about Stage 4 prostate cancer watch Treatment Options for Stage IV Prostate Cancer with Dr. Howard Tay.

Video Transcripts

Howard P. Tay, MD: How long does a patient with stage 4 prostate cancer live?

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What Are Bone Metastases With Prostate Cancer

The ACS describes bone metastases as areas of bone containing cancer cells that have spread from another place in the body. In the case of prostate cancer, the cells have spread beyond the prostate gland. Since the cancer cells originated in the prostate gland, the cancer is referred to as metastatic prostate cancer.

The cancer cells spread to the bones by breaking away from the prostate gland and escaping attack from your immune system as they travel to your bones.

These cancer cells then grow new tumors in your bones. Cancer can spread to any bone in the body, but the spine is most often affected. Other areas cancer cells commonly travel to, according to the ACS, include the pelvis, upper legs and arms, and the ribs.

Castrate Refractory Prostate Cancer: A Wider Range Of Options

In this section, we explain the treatments available at Birmingham Prostate Clinic for patients once their disease becomes resistant to hormone treatment, called castrate refractory prostate cancer. Two types of treatments are needed to:

• Control the cancer and preventing further spread of cancer
• Control or prevent the symptoms caused by the spread of prostate cancer to the bones

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Talking To Andrew’s Doctor

For fifteen months, Andrew responded really well to treatment and was feeling reasonably good. But then he developed a very bad spinal cord compression. He was unable to walk and at that point it was clear that things were very serious. He spent nearly a month in hospital and his consultant told us that the cancer was back with a vengeance and that they wanted to fast track him home.

Andrew didnt want to know how long he might have. I know that he knew what the score was but that he just didnt want to speak about it.

Andrew didnt want to know how long he might have.

I asked Andrews doctor how long he might live for. She told me that she could give me some indication of how long Andrew might live for if I wanted to know. I wasnt sure that I wanted to know if Andrew didnt it might have created a barrier between us.

I wanted to know what I should expect. But I wasnt sure that I wanted to know how long Andrew would live for if he didn’t know.

But I wanted to know what I should expect. I needed to plan what was going to happen when he came home, the arrangements that would need to be made and whether I needed to speak to other members of our family and friends. At this point I think I felt quite out of control, so speaking to the consultant was my way of regaining some of that control and it helped me to plan for his homecoming.

Its difficult to accept that cancer takes its own route at its own pace.

Types Of Cancers That Are More Likely To Go Undetected

Some cancers are more easily detected than others. For example, certain types of skin cancer can be diagnosed initially just by visual inspection though a biopsy is necessary to confirm the diagnosis.

But other cancers can form and grow undetected for 10 years or more, as one study found, making diagnosis and treatment that much more difficult.

This table provides an overview of common cancers that often display little or no symptoms early on, and how theyre typically detected and diagnosed:

Type of cancer

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Death From Other Causes

The mean age at metastatic prostate cancer diagnosis in the study was roughly 71 years. Most of the cohort was White and had a diagnosis of stage M1b metastatic prostate cancer , which means the cancer had spread to the bones.

Among men in the cohort, the rates of death from septicemia, suicide, accidents, COPD, and cerebrovascular diseases were significantly increased compared with the general US male population, the team observes.

Thus, the study authors were concerned with not only with death from metastatic prostate cancer, but death from other causes.

That concern is rooted in the established fact that there is now improved survival among patients with prostate cancer in the US, including among men with advanced disease. “Patients tend to live long enough after a prostate cancer diagnosis for noncancer-related comorbidities to be associated with their overall survival,” they write.

The editorialists agree: prostate cancer “has a high long-term survival rate compared with almost all other cancer types and signals the need for greater holistic care for patients.”

As noted above, cardiovascular diseases were the most common cause of non-prostate cancer-related deaths in the new study.

As in the management of other cancers, there is concern among clinicians and researchers about the cardiotoxic effects of prostate cancer treatments.

The study had no specific funding. The study authors and editorialists have disclosed no relevant financial relationships.