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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Sexuality And Feeling Good About Your Body
Prostate cancer treatment can often affect sexual function. Learning to be comfortable with your body during and after prostate cancer treatment is a personal journey, one that is different for everyone. Information and support can help you cope with these changes over time. Learn more in Sex and the Man With Cancer.
What Are The Stages Of Prostate Cancer
Cancer staging is first described using what is called a TNM system. The “T” refers to a description of the size or extent of the primary, or original, tumor. “N” describes the presence or absence of, and extent of spread of the cancer to lymph nodes that may be nearby or further from the original tumor. “M” describes the presence or absence of metastases — usually distant areas elsewhere in the body other than regional lymph nodes to which the cancer has spread. Cancers with specific TNM characteristics are then grouped into stages, and the stages are then assigned Roman numerals with the numerals used in increasing order as the extent of the cancer being staged increases or the cancer prognosis worsens. Prognosis is finally reflected by considering the patient’s PSA score at presentation as well as their Gleason score in assigning a final stage designation.
The American Joint Commission on Cancer system for prostate cancer staging is as follows:
Traditionally, advanced prostate cancer was defined as disease that had widely metastasized beyond the prostate, the surrounding tissue, and the pelvic lymph nodes and was incurable. However, a more contemporary definition includes patients with lower grade disease with an increased risk of progression and/or death from prostate cancer in addition to those with widely metastatic disease.
The National Cancer Institute and the National Comprehensive Cancer Network guidelines on prostate cancer version 2.2017 indicate the following:
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Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
Giulianis Prostate Cancer Figure Is Disputed
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I had prostate cancer five, six years ago, Mr. Giuliani, a Republican presidential candidate, said in a speech that has been turned into the radio commercial. My chance of surviving prostate cancer and, thank God, I was cured of it in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44 percent under socialized medicine.
Mr. Giulianis Democratic rivals would argue that they are not advocating government-run health care in their plans to extend coverage to the uninsured. But, beyond that, the 44 percent figure that Mr. Giuliani has been citing is in dispute.
The Office for National Statistics in Britain says the five-year survival rate from prostate cancer there is 74.4 percent. And doctors also say it is unfair to compare prostate cancer statistics in Britain with those in the United States because in the United States the cancer is more likely to be diagnosed in its early stages.
Certainly, if you intensively screen for prostate cancer, you will find early disease, said Dr. Ian M. Thompson, chairman of the department of urology at the University of Texas at San Antonio. And simply because you find it earlier, you will always have longer survival after the disease is diagnosed.
That article, titled The Ugly Truth About Canadian Health Care, was written by Dr. David Gratzer, a senior fellow at the Manhattan Institute and an adviser to the Giuliani campaign.
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Survival For All Stages Of Prostate Cancer
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 for 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.
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Doctor Visits And Tests
Your doctor visits will usually include PSA blood tests, possibly with digital rectal exams if your prostate hasnt been removed. These will probably begin within a few months of finishing treatment. How often you need follow-up visits and tests might depend to some extent on the stage of your cancer and the chance of it coming back. Most doctors recommend PSA tests about every 6 months or so for the first 5 years after treatment, and at least yearly after that. Bone scans or other imaging tests might also be done, depending on your medical situation and symptoms.
Prostate cancer can recur even many years after treatment, which is why its important to keep regular doctor visits and report any new symptoms .
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Does Overdiagnosis Lead To Overtreatment Of Older Men
The widespread use of PSA screening has led to an increase in the diagnosis and treatment of early localized prostate cancer. Data from the US Cancer of the Prostate Strategic Urological Research Endeavor database suggest a significant decrease in risk in the last 2 decades in the United States, with more patients being identified with low-risk disease at diagnosis, but the role of active treatment of low- and intermediate-risk disease in elderly men remains controversial.
The median time from diagnosis to death from prostate cancer for men with nonpalpable disease is approximately 17 years., Considering that the US male life expectancy at the age of 65 years is 16 years, aggressive therapy will hardly extend life expectancy of older men with no palpable prostate cancer at the time of diagnosis. Twenty to 30% of prostate cancers detected by PSA screening programs show Gleason scores of 6 or lower and, thus, are not poorly differentiated and have volumes smaller than 0.5 cm3.
Histologic evaluation of radical prostatectomy specimens demonstrated that about 20% to 30% of cancers are small volume, show low Gleason scores, and are consequently clinically harmless., Many of these cancers pose little threat to life, especially for older men. Has PSA screening resulted in prostate cancer overdiagnosis?
Keeping Health Insurance And Copies Of Your Medical Records
Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and although no one wants to think of their cancer coming back, this could happen.
At some point after your cancer treatment, you might find yourself seeing a new doctor who doesnt know your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
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Are Older Men Undertreated
Schwartz and colleagues reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.
Thompson and colleagues investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.
How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the American Joint Committee on Cancers TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
- grade groups
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Nutrition And Dietary Supplements
Some studies have suggested that eating a healthy diet that is rich in vegetables and lower in animal fats might be helpful, but more research is needed to be sure. However, we do know that a healthy diet can have positive effects on your overall health, with benefits that extend beyond your risk of prostate or other cancers.
So far, no dietary supplements have been shown to clearly help lower the risk of prostate cancer progressing or coming back. In fact, some research has suggested that some supplements, such as selenium, might even be harmful. This doesnt mean that no supplements will help, but its important to know that none have been proven to do so.
Dietary supplements are not regulated like medicines in the United States they do not have to be proven effective before being sold, although there are limits on what theyre allowed to claim they can do. If you are thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that could be harmful.
It May Grow Slowly And It’s Typically Treatable
Being armed with information is vital to begin the fight. If you have been diagnosed with adenocarcinoma cancer, you have a cancer that developed in one of the glands that lines the inside of your organs. Although it is the most commonly diagnosed cancer in american women, breast cancer can impact people of all genders. There are a number of different treatments doctors recommend. If breast cancer is diagnosed at an early enough stage, it’s treatable. Adenocarcinoma cancers being usually in one of the following organs: The american cancer society provides detailed information on prostate cancer and its treatment. One in seven men in the united states will receive a prostate cancer diagnosis during his lifetime. The pancreas is a bodily organ that few people think about. When malignant cancer cells form and grow within a person’s breast tissue, breast cancer occurs. Find the information you need today. It may grow slowly and it’s typically treatable. The earlier the detection of prostate cancer, the better the patient’s chance of survival is.
If you have been diagnosed with adenocarcinoma cancer, you have a cancer that developed in one of the glands that lines the inside of your organs. Find the information you need today. It may grow slowly and it’s typically treatable. Of course, your specialist is the main person whose advice you should follow but it doesn’t do anyone harm. However, as with other types of cancer,.
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Impact Of Age On Treatment
The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests. Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.,
Chodak and associates evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.
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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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.
Survival By Disease Recurrence
If a man develops an elevated PSA level after cancer surgery, then the disease is viewed as recurrent.
The number of lymph nodes at the time of prostatectomy can influence the risk of recurrence. One study suggests the removal of a large number of nodes is associated with an improvement in odds of recurrence, but this doesn’t appear to impact overall survival.
But disease recurrence doesn’t always influence survival times. If a recurrence does occur, the 15-year survival rate at the time of diagnosis may be as high as 94% in those with low-risk recurrence.
The main factors influencing survival rates are:
- The Gleason score
- The PSA doubling time
- Whether the recurrence occurred within three years or after three years
A recurrence that occurs within three years reduces survival rates by anywhere from 15 to 20%and even more, if the doubling time is short.
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