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.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
Its possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
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.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
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What Is The Most Effective Treatment For Prostate Cancer
For most men with prostate cancer, the most effective treatment will be surgery to remove the tumor or the entire prostate. The different types of prostate cancer surgery include:
- Radiofrequency ablation A minimally invasive procedure, RFA uses ultrasound or another imaging technique to guide a needle electrode into the cancerous tumor. The electrode then emits high-frequency electrical currents to destroy cancer cells.
- Laparoscopic radical prostatectomy During this procedure, a surgeon will remove the entire prostate. The surgeon will make a few small incisions and insert special instrumentsone of which has a video camera attachedto complete the procedure.
- Robotic surgery For certain procedures, surgeons can use robotic assistance, which can improve precision.
Some patients may also undergo radiation therapy after their surgery to eliminate any lingering cancer cells.
As with other cancers, prostate cancer has the most favorable survival rates when patients are diagnosed early. When prostate cancer is detected before it has spread to the lymph nodes , it is most responsive to treatment and, therefore, more easily cured.
What Is Prostate Cancer
Prostate cancer is cancer that affects the prostate glands present in men. Prostate cancer is the second-leading cause of cancer deaths for men in the United States.
Growth in the prostate can be of two types:
- Benign growths: These are noncancerous growths and are rarely a threat to life .
- Malignant growths: These are cancerous growths that are potentially life-threatening.
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How To Understand The Gleason Score
For instance, if the Gleason Score is written 4+3=7, this means 4 is the grade assigned to the most cancerous cells, while 3 is the grade of the next largest section of the tumor. Together they make up the total Gleason Score, in this instance 7.
A Gleason Score of 6 is considered low-grade. It describes cancer cells that resemble the normal cells and, therefore, the cancer is slow-growing.
A Gleason Score of 7 is considered an intermediate grade, with a medium risk of aggressive cancer. In this case, it is very important to know what is the primary grade . If the primary grade is 3 and the secondary grade is 4, the cancer is not that likely to spread so quickly or cause important problems while a Gleason Score of 7, with the primary grade of 4 and the secondary grade of 3 is more likely to be more aggressive and high-risk.
Consider asking about your primary Gleason Grade, especially when your Gleason Score is 7 and the Gleason Grades are not specified.
A Gleason score of 8-10 is considered to be high-risk. Cancers are likely to spread more quickly and be more aggressive.
For a better understanding of your particular situation, do not hesitate to contact a urologist!
Differences Among Risk Groups
Men with PCa have been classified into low-, intermediate- and high-risk Groups for tumor recurrence and disease specific mortality, based on PSA level, clinical or pathological staging and GS. High-risk patients have PSA level 20ng/mL or GS 8 or clinical/pathological stage T2c . Lymph-node positive and PSM have also been reported as poor prognosis factors.
Risk Group classification predicts biochemical and clinical progression as well as PCa specific mortality and overall survival. The risk of disease progression in these groups has been validated for patients submited to RP in many studies. In patients from Mayo Clinic, BCR rates were 2.3 and 3.3-fold greater in high and intermediate-risk in comparison with low-risk patients, respectively. In those patients, mortality rates in high and intermediate-risk patients were greater than 11 and 6-fold over low-risk men .
Therefore, it is crutial to understand the role of each clinical and pathologic feature in PCa BCR and disease progression.
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Obesity And Dietary Habits
High-fat intake, the Western diet, obesity, and sedentary behavior are all associated with a higher incidence of prostate cancer. High calcium intake and a diet high in milk products can increase the risk. After being diagnosed with prostate cancer, calcium can increase the risk of aggressive types. On the other hand, whole milk increases the risk of recurrence of prostate cancer. Obese and overweight men are particularly prone to this increase in recurrence. Another dietary risk factor is vitamin D insufficiency. Meat consumption increases cancer risk, while fish consumption lowers the mortality rate.
What Are The Treatment Options For Prostate Cancer
Treatment for prostate cancer is determined based on the size of the tumor and extent of metastasis and may include the following:
Hormone therapy
Hormone treatment deprives the body of the male hormones needed for prostate cancer growth. Orchiectomy or luteinizing hormone-releasing hormone analogs are used alone or in conjunction with an anti-androgen.
Newer hormonal drugs that decrease androgen production and block androgen receptor signaling have been approved by the FDA for the treatment of metastatic prostate cancer following chemotherapy, and they are being studied for early usage in the disease.
Abiraterone
Abiraterone is an oral targeted medication that inhibits androgen synthesis not only in the testes but also in the adrenal glands and the tumor itself. When used with prednisone, abiraterone has been demonstrated to improve quality of life and decrease pain progression in patients with hormone-refractory prostate cancer .
Although this drug is normally well tolerated, adverse effects such as tiredness, elevated blood pressure, and electrolyte or liver problems are possible, and patients must be checked on a regular basis.
Enzalutamide
Enzalutamide interferes with molecular processes that enable prostate cancer growth by targeting various stages in the androgen-receptor-signaling cascade. Furthermore, the medicine does not cause the typical adverse effects of chemotherapy, such as nausea and hair loss.
Chemotherapy
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Factors Affecting Your Prognosis
Researchers point to several factors that have an impact on your prognosis.
- The stage of your cancer when it is discovered: Doctors look at how much of the prostate is affected by the cancer and whether it has spread outside the prostate to nearby or distant organs.
- Your age: Overall, the lifetime risk of having prostate cancer is 1 in 7 and prostate cancer in men younger than 40 is rare. Older men with prostate cancer are more likely to have other health conditions, which can affect how their bodies fight cancer and handle treatment.
- Whether the cancer recurs: About one-third of men who have had their prostates removed will see evidence of recurrence, such as rising PSA levels in their blood. But not all recurring cancers are aggressive. There are both high-risk and low-risk recurrences, indicated by factors such as how quickly the PSA level rises after surgery.
If you have any questions or concerns about your prognosis, its always best to discuss these with your healthcare provider. Each persons illness is individual and subject to many factors. These survival and prognosis rates reflect the most recent research available, but they are general and dont necessarily tell your story.
Prostate Cancer Survival By Age
Five-year survival for prostate cancer shows an unusual pattern with age: survival gradually increases from 91% in men aged 15-49 and peaks at 94% in 60-69 year olds survival falls thereafter, reaching its lowest point of 66% in 80-99 year olds patients diagnosed with prostate cancer in England during 2009-2013. The higher survival in men in their sixties is likely to be associated with higher rates of PSA testing in this age group.
Prostate Cancer , Five-Year Net Survival by Age, Men, England, 2009-2013
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Add Tomatoes To Your Shopping List
Tomatoes have lycopene, a potent phytonutrient that protects plants. This is a free radical scavenger, an antioxidant. According to studies, lycopene consumption reduces the damage to the DNA in prostate cells. Tomatoes are one of the best sources of lycopene. You will benefit from there even more by cooking tomatoes instead of eating them raw.
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.
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Prostatecancer Is Common With Aging
Talking about prostate cancer can be a bit scary for senior men. It is statistically very likely that you will grow prostate cancer cells at some point. 1 in 7 men is diagnosed with prostate cancer. The remaining 6 men who are not diagnosed can have prostate cancer cells, too. But since they are slow-growing and not causing symptoms, prostate cancer is only detected in autopsies.
Aging is one of the most important triggers of this disease. The incidence increases as we age. The most common age of diagnosis is between 65 and 74 years. After 80 years, the prostates chance of malignancy is very high .
However, no screening is typically made in this age group. That is because prostate cancer usually has a very long survival rate. Thus, they are more likely to continue living without a complication and die from other causes .
There is a type of prostate cancer diagnosed in young males. It is early-onset prostate cancer, and it is diagnosed before age 55 years. Fortunately, this type is not the most common because it is usually more aggressive. This group of patients is likely to have an underlying cause that triggers the disease at a younger age. The rest of us will start having some risk after 55 years, increasing as we get older.
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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Why Do Survival Rates Vary Across Cancers
Survival rates vary by cancer type as well as being influenced by stage of detection, diagnosis and treatment. For example, the latest UK data shows the 5-year age-standardised survival rate for breast cancer that is, the percentage of people who are alive 5 years after diagnosis is over 80%. However, some cancers, such as lung cancer, have a 5-year survival rate of less than 20%.
A partial explanation for higher survival rates for some cancer types is the greater proportion of patients diagnosed at an earlier stage. This may be due to the availability and uptake of screening programmes, leading to earlier detection and diagnosis.
Survival can also depend on an individuals health, presence of comorbidities and other tumour-related factors. Despite advances in research and technology, some cancer types remain difficult to diagnose and/or treat in comparison to other cancer types.
Prostate Cancer: Survival Rates And Prognosis
- What are the survival rates for prostate cancer?
- Which men are at higher risk of prostate cancer?
- What factors affect my prognosis with prostate cancer?
Prostate cancer is the second-leading cause of cancer death among American men, expected to kill 33,330 in 2020. About 2.8 million men live with the disease now, with 191,930 new cases expected to be diagnosed in 2020.
However, the good news is survival rates have increased dramatically in the past decade, thanks to improvements in detection and treatment. The relative five-year and 10-year survival rates for prostate cancer patients is close to 100%. Also leading to optimism: new advances in the study of the disease, which are leading to more ways to prevent it, find it, and treat it.
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Gleason Score Vs Grade Groups
The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.
One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:
- 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
- 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.
So, although both situations give a Gleason score of 7, they actually have very different prognoses.
Heres an overview of how the two grading systems compare:
| Cancer grade | |
|---|---|
| grade group 5 | 910 |
Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.
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Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. That’s because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes — not their prostate cancer.
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