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.
Questions To Ask Your Doctor Or Nurse
- What type of hormone therapy are you offering me and why?
- Are there other treatments I can have?
- What are the advantages and disadvantages of my treatment?
- What treatments and support are available to help manage side effects?
- Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
- How often will I have check-ups and what will this involve?
- How will we know if my cancer starts to grow again?
- What other treatments are available if that happens?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
What Is Metastatic Cancer
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
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Cox Regression Analysis For Os
At univariate analyses, 4 positive LNs , pT3b , pT4 , pGS 810 , positive surgical margins , and salvage ADT were predictors of worse OS . At multivariate analysis, pGS 810 , the cutoff of 4 positive LNs , and salvage ADT were independently associated with worse OS .
Table 5. Uni- and multivariate analyses of predictors of a worse overall survival.
Cox Regression Analysis For Css
At univariate analyses, 4 positive LNs , pT3b , pT4 , pGS 810 , positive surgical margins , adjuvant ADT , and salvage ADT were predictors of worse CSS . At multivariate analysis, pT4 , pGS 810 , salvage ADT , and the cutoff of 4 positive LNs were confirmed to be independently associated with worse CSS .
Table 4. Uni- and multivariate analyses of predictors of a worse CSS.
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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.
Grade And Gleason Score
Although they are not always predictive, grade and Gleason scores consistently are correlated with the risk of lymph node disease., Historically, for Gleason scores 2 through 4, the risk is from 0% to 20% for Gleason scores 5 through 7, the risk is from 31% to 38% and, for Gleason scores 8 through 10, the risk is from 62% to 93%. This differs from the lower rates in more contemporary reports, with a risk from 3% to 9% in lower grade tumors and 20% to 29% in higher grade tumors.
Grade clearly had an impact on survival in multiple studies., , – In several of those studies, grade was the most significant factor in predicting disease outcome., , For patients with lymph node-positive disease who had well differentiated tumors, the 5 year survival rate was from 83% to 85% for patients with moderately differentiated disease, the 5-year survival rate was from 72% to 85% and, for patients with poorly differentiated disease, the survival rate was 36% to 51%. In line with expectations, there also was a correlation with disease recurrence. At 5 years, from 25% to 39% of moderately and well differentiated tumors recurred compared with from 45% to 76% of poorly differentiated tumors.,
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%.
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.
What Are The Stages Of Prostate Cancer
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score .
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.
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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Treatments To Control And Prevent Symptoms Caused By The Spread Of Prostate Cancer To The Bones
Palliative External beam radiotherapy
Radiopharmaceuticals: Strontium-89 , samarium-153
Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment.
Zolidronic acid is a bisphosphonate given by a 15-minute intravenous infusion every 34 weeks. It reduces the risk of bone complications, including pain and fractures.
Xgeva : this is a newly licensed drug available at BPC.
Surgery may be undertaken to treat bone fractures or to relieve the pressure on the spinal cord by bone metastases.
Pathological Stage: A Look At The Actual Cancer Cells And Their Distribution Within The Pelvic Area
This system assesses how pervasive the cancer cells are within and around the prostate. These stages begin at T2.
T2: The tumor is located in the prostate only.T3: The tumor has breached the prostate border on 1 or more sides.T3b: The tumor has begun to grow in the seminal vesicles.T4: The tumor has grown into other neighboring structures, like the bladder, the rectum, or the pelvic wall.
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Lymphangiogenesis & Lymph Node Metastasis
During embryogenesis lymphatic vessels develop from blood vessels . Therefore, lymphangiogenesis and angiogenesis are stimulated by the same family of growth factor proteins. VEGF-A/VPF is the most potent growth factor for angiogenesis . Other VEGF family members, such as VEGF-C and VEGF-D, are potent lymphangiogenic factors . Flt-4, also known as VEGF receptor-3 , is the tyrosine kinase receptor for VEGF-C or -D in lymphatic endothelial cells. Upon activation, this receptor triggers signaling events to initiate the proliferation and migration of lymphatic endothelial cells . Neuropilin-2, a nontyrosine kinase receptor, is also expressed in lymphatic endothelial cells and acts as a coreceptor for VEGF-C during lymphangiogenesis . Both VEGF-C and -D are expressed by tumor cells and, therefore, promote lymphangiogenesis from the tumor-associated surrounding lymphatics . Importantly, cancer cells have also been shown to express neuropilin-2 and/or VEGFR-3, thus suggesting autocrine regulation of lymphangogenic growth factors . Our laboratory has reported one such autocrine regulation of VEGF-C and its receptor neuropilin-2 in prostate cancer this autocrine function promotes the survival of prostate cancer cells during oxidative stress and, thereby, is important for metastatic progression .
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Lymph Nodes And What They Do
Lymph vessels send lymph fluid through nodes throughout the body. Lymph nodes are small structures that work as filters for foreign substances, such as cancer cells and infections. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid. Lymph nodes are located in many parts of the body, including the neck, armpit, chest, abdomen , and groin. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid.
There are hundreds of lymph nodes throughout the body. Each lymph node filters the fluid and substances picked up by the vessels that lead to it. Lymph fluid from the fingers, for instance, works its way toward the chest, joining fluid from the arm. This fluid may filter through lymph nodes at the elbow, or those under the arm. Fluid from the head, scalp, and face flows down through lymph nodes in the neck. Some lymph nodes are deep inside the body, such as between the lungs or around the bowel, to filter fluid in those areas.
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How Prostate Cancer Spreads
Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries tiny blood vessels at some distant location.
The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.
Most break-away cancer cells form new tumors. Many others dont survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.
The Ajcc Tnm Staging System
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCCTNM system, which was most recently updated in 2018.
The TNM system for prostate cancer is based on 5 key pieces of information:
- The extent of the main tumor *
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to other parts of the body
- The PSA level at the time of diagnosis
- The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .
*There are 2 types of T categories for prostate cancer:
- The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
- If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.
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How To Detect Early Signs Of Cancer Of The Lymph Nodes
When cancer cells have spread to the lymph nodes, there are symptoms that will appear. These may include:
- Lymph node swelling or detectable lumps in the neck, under your arm, or in your groin area
- Shortness of breath
There are patients that will experience all of these symptoms and some that will experience none. Therefore, a follow-up question may be: is cancer of the lymph nodes terminal if there are more symptoms?
The fact is symptoms vary based on where cancer has spread to and how aggressive it is. Its important to identify cancerous growths immediately to prevent their spread to other areas. When isolated to a certain region, the chances of it being terminal are less likely.
Diagnosing Cancer Of The Lymph Nodes
In addition to a biopsy, the TNM system is commonly used to issue a diagnosis and determine which type of treatment is best. The T refers to the size of the tumor or cancerous growth. The N refers to the number of lymph nodes that contain cancerous cells. And, the M is for metastasis, which refers to cancer thats spread to areas far from the originating tumor.5
This categorization is used in addition to other diagnostic tests and tools to determine the cancer stage such as:
- Imaging tests X-rays, CT scans, MRIs, and other types of imaging tests can provide a clearer picture and more information about where the cancer is located and how much is present.
- Endoscopy exams An endoscope is a thin, lighted tube with a video camera attached that looks around on the inside of the body for cancerous areas.
In general, cancers assigned as Stage I are less advanced and have a better prognosis and response to treatment. Whereas, a higher stage indicates that the cancer has spread further and requires a more intense or multiple types of treatment. Other factors that affect treatment are:
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Where Can I Find Support
It can be very difficult to deal with a diagnosis of advanced prostate cancer. Its natural to wonder if youre doing all you can to fight the cancer and how to handle guilt, intimacy with a partner, and concerns about masculinity. And finding and paying for the best care can, of course, be a challenge.
But emotional and practical support can help you move forward. An important thing to remember is that youre not alone. There are many kinds of help available, and the right cancer resources can make a world of difference.
Ask your doctor for resources you can contact, including social workers and support systems in your community. The Patient Navigator Program of the ACS can be reached at 1-800-227-2345 youll be connected to a patient navigator at a cancer treatment center who can help you with practical and emotional issues.
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