Prostate Cancer & Mortality
The same statistics for 2018 also reveal that Prostate Cancer is the fifth leading cause of cancer death in men worldwide with the highest mortality rates in black populations, followed by America and very low in Asian populations. And even though death rates are declining as per trends drawn from past data, patients must remember that each persons treatment journey is unique, has a unique prognosis, has a unique survival rate, and the outcome of such treatments are totally dependent on the biological type of Prostate Cancer , the stage of the disease, and on how early it gets detected.
An Evolving Standard Of Care
Hormone-sensitive prostate cancer means a patients tumors are still largely being fueled by male sex hormones called androgens. For many years, metastatic hormone-sensitive prostate cancer was treated with ADT alone, which blocks the production of androgens by the testicles.
In 2014, a large clinical trial showed that adding the chemotherapy drug docetaxel to ADT improved survival in men with metastatic hormone-sensitive prostate cancer. Since then, this combination has become the standard of care for this group of patients.
More recently, studies have shown that adding other drugs that block the production or binding of androgensincluding abiraterone , enzalutamide , and apalutamide to ADT also helps people with metastatic hormone-sensitive prostate cancer live longer. In a trial combining apalutamide with ADT, for example, approximately 82% of men were still alive after 2 years compared with 74% of men treated with ADT alone.
Several clinical trials were then launched to see if combining any of these drugs with ADT and docetaxel could build on those survival gains. Results of those studies, however, have been mixed, with one showing an improvement in survival without the disease progressing and another finding no increase in overall survival.
Understanding The Statistics: Cancer Survival
It is important to remember that all cancer survival numbers are based on averages across huge numbers of people. These numbers cannot predict what will happen in your individual case.
Survival rates will not tell you how long you will live after you have been diagnosed with bladder cancer. But, these numbers can give you an idea of how likely your treatment will be successful. Also, survival rates take into account your age at diagnosis but not whether you have other health conditions too.
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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.
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.
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Outlook For Men With Localised Prostate Cancer
Most localised prostate cancer is slow-growing and may not need treatment or shorten a mans life. For many men who have treatment for localised prostate cancer, the treatment will get rid of the cancer. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.
What Are The Side Effects Of External Beam Radiation Therapy
As with most prostate cancer treatments, external beam radiation therapy can also cause side effects. The severity can depend on the type of radiation, dose size, length of treatment and area of treatments. These frequently include:
- Skin irritation
- Erectile dysfunction
- Secondary malignancy
If you are considering prostate cancer treatment with a form of EBRT, talk with your radiation oncologist to discuss options, potential side effects, and how those side effects will be managed.
Recently, the FDA approved the use of Space OAR, a hydrogel product for men choosing radiation therapy that can reduce the radiation received by the rectum during treatment. This can help decrease the chances of developing rectal complications such as the inability to control your bowels. The hydrogel is injected between the prostate and rectum where the gel solidifies and creates a space before radiation begins. To learn more about this product, visit the manufacturers site here.
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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.
Multiple Imputation And Missing Data
We used multiple imputation to impute missing data taking the variables of T-stage and histopathologic grading, age, and treatment into account. Missing data were mostly confined to the grading parameter in the German data . For propensity score matched analyses and year-specific Cox regression analyses, we used PROC MI in SAS. In piecewise proportional hazard models, we applied the mice package in R. Matching results for the complete data are shown in Table S2, which indicate equal mean values and proportions between treatment groups.
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What Is The Survival Rate Of Stage 4 Prostate Cancer
Doctors use the term stage to characterize the characteristics of the original tumor itself, such as its size and how far prostate cancer has spread when it is discovered, as they do with all malignancies.
Staging systems are difficult to understand. Most malignancies, including prostate cancer, are staged using three different elements of tumor growth and dissemination. The TNM system stands for tumor, nodes, and metastasis:
- T, for tumor describes the size of the main area of prostate cancer.
- N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
- M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.
The TNM approach allows each mans prostate cancer to be characterized in depth and compared to the prostate cancers of other men. Doctors utilize this information to conduct research and make treatment decisions.
However, in terms of prostate cancer survival statistics, the staging method is straightforward. As previously stated, males with prostate cancer can be split into two groups in terms of survival rates:
- Men with prostate cancer that is localized to the prostate or just nearby.
- Prostate cancer has a high long-term survival percentage in these men. Almost all men will live for more than five years after being diagnosed with prostate cancer, and many will live for much longer.
- Men whose prostate cancer has spread to distant areas, like their bones.
Ajcc Stage Groupings And Tnm Definitions
The AJCC has designated staging by TNM classification.
| Grade Group | Gleason Score | Gleason Pattern |
|---|---|---|
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | ||
| 1 | ||
| 4+4, 3+5, or 5+3 | ||
| 5 | 4+5, 5+4, or 5+5 |
| Stage | Gleason Score Gleason Pattern g | Illustration | |
|---|---|---|---|
| T = primary tumor N = regional lymph nodes M = distant metastasis cT = clinical T PSA = prostate-specific antigen pT = pathological T. | |||
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | |||
| The explanations for superscripts b through g are at the end of Table 5. | |||
| I | cT1ac, cT2a, N0, M0 | cT1 = Clinically inapparent tumor that is not palpable. | < 10 |
| cT1a = Tumor incidental histologic finding in 5% of tissue resected. | |||
| cT1b = Tumor incidental histologic finding in > 5% of tissue resected. | |||
| cT1c = Tumor identified by needle biopsy found in one or both sides, but not palpable. | |||
| cT2 = Tumor is palpable and confined within prostate. | |||
| cT2a = Tumor involves ½ of one side or less. | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. | |||
| Gleason Score, 6 Gleason Pattern, 3+3 . | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. |
References
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A New Us Study Found That Prostate Cancer Patients With Certain Heart Conditions Who Received Hormone Therapy Either Before Or With Radiation Therapy Were At Higher Risk Of Death Than Equivalent Patients Who Did Not Have Hormone Therapy The St
A new U.S. study found that prostate cancer patients with certain heart conditions who received hormone therapy either before or with radiation therapy were at higher risk of death than equivalent patients who did not have hormone therapy. The study showed that the risk of death nearly doubled for men with coronary artery disease-induced congestive heart failure or heart attack when they received hormone therapy in addition to radiation therapy.
The research was done by Akash Nanda of Brigham & Women’s Hospital-Dana-Farber Cancer Institute, in Boston.
Other studies have already shown that adding hormone therapy to radiation therapy treatment for prostate cancer in men with lower survival prospects can increase survival rates, unless the men also have other moderate to severe health conditions. However, what has not been clear is what these conditions are and the effect they have either individually or together.
The researchers concluded that:
n “Neoadjuvant HT use is significantly associated with an increased risk of all-cause mortality among men with a history of CAD-induced CHF or MI but not among men with no comorbidity or a single CAD risk factor.”
Can People Recover From Metastatic Prostate Cancer
Recovery depends on the aggressiveness and location of the cancer spread. Local spread and nonaggressive types have a better outlook. Researchers are developing new therapies more quickly than ever before. It is worthwhile for people to check with their doctor about treatment options and participation in clinical trials.
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Psa And Gleason Score
Two other important factors that doctors and specialists use to assess cancer cells are the prostate specific antigen and the Gleason score.
PSA levels: PSA is a protein that appears in higher levels in the bloodstream when there is a problem with the prostate. Normally, PSA levels in the blood are very low, and a test cannot detect them. However, in some circumstance, such as prostate cancer, PSA levels start to rise.
Screening for prostate cancer uses a blood test for PSA. If PSA levels are high, the doctor may recommend further tests to see if prostate cancer is present.
There are various other reasons why PSA levels may rise, including sexual stimulation or an infection.
The grade and Gleason score: Different types of cancer cell act differently. Some types, or grades, are more aggressive and can spread more easily. The Gleason score and grade are different measures, but they both reflect how likely it is that a tumor will spread, and how quickly it will do so. Either a biopsy or surgery can determine the types of cancer cells present in the prostate tissues.
Nearly 50% of males have a condition known as prostatic intraepithelial neoplasia by the time they are 50 years old. PIN is when there are changes in the cells that line the prostate gland.
High grade PIN is not cancer, but the cells can become cancerous in the future. For this reason, a doctor may recommend treatment to remove the cells.
Staging Spread And Survival Rates
As with all cancers, doctors use the term stage to describe the characteristics of the primary tumor itself, such as its size and how far prostate cancer has spread when it is found.
Staging systems are complicated. The staging system for most cancers, including prostate cancer, uses three different aspects of tumor growth and spread. It’s called the TNM system, for tumor, nodes, and metastasis:
- T, for tumor describes the size of the main area of prostate cancer.
- N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
- M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.
Using the TNM system, each man’s prostate cancer can be described in detail and compared to other men’s prostate cancer. Doctors use this information for studies and to decide on treatments.
As far as survival rates for prostate cancer go, however, the staging system is pretty simple. As we’ve mentioned, in terms of survival rates, men with prostate cancer can be divided into two groups:
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Tnm Staging System The Most Widely Used Staging System For Prostate Cancer Isthe Ajcc Tnm System For Prostate Cancerthere Are 4 Stages Often The Stages 1 To 4 Are Written As The Roman Numeralsi Ii Iii And Iv Generally The Higher The Stage Number The More The Cancerhas Spread The Stages Can Be Further Divided Into A B Or C An Earlier Lettermeans A Lower Stage Talk To Your Doctor If You Have Questions About Staging Tnm Staging Is Based On The Following: T Describes Thetumour And Whether Doctors Can Feel It Or See It On Imaging Tests It Alsodescribes Whether The Tumour Has Grown Outside Of The Prostate To Thesurrounding Tissues T Is Usually Given As A Number From 1 To 4 A Highernumber Means That The Tumour Takes Up More Of The Prostate Or That The Tumourhas Grown Outside Of The Prostate Into Nearby Tissues Some Stages Are Alsodivided Further Into A B Or C An Earlier Letter Means A Lower Stage The Clinical T Is Your Doctors Best Estimate Of Theextent Of The Cancer Based On A Physical Exam A Digital Rectal Exam A Prostatebiopsy And Imaging Tests If You Have Surgery To Remove Your Prostate Apathological T Will Be Given Pt Is More Accurate Than Ct T The Tumour Has Grown Outside The Prostate And Into The Seminal Vesicles T4 The Tumour Has Grown Outside The Prostate And Into Nearby Structures Suchas The Bladder Rectum Pelvic Muscles And Pelvic Wall
N describeswhether the cancer has spread to lymph nodes near the prostate. N0 means that thecancer hasnât spread to any nearby lymph nodes. N1 means that it has spread tonearby lymph nodes.
M describeswhether the cancer has spread to other parts of the body. M0 means that the cancerhas not spread to other parts of the body. M1 means that it has spread to otherparts of the body.
PSA level describes the amount of the prostate-specificantigen in the blood.
Grade Group is a measureof how likely the cancer is to grow and spread.
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Hope For Advanced Cancer
Your doctor will continue to monitor your PSA levels and may perform other tests after treatment for prostate cancer. If it recurs or spreads to other parts of the body, additional treatment may be recommended. Lifestyle choices may matter, too. One study found that prostate cancer survivors who exercised regularly had a lower risk of dying, for example.
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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.