What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
Survival Rates In Prostate Cancer: The Facts
For you as a patient, the disease-specific survival rate is the decisive aspect: what are the chances of surviving prostate cancer? 98 % of our patients who underwent radical prostatectomy, and in whom the tumor was confined to the prostate gland , were still alive 10 years after their operation. Even in patients with an advanced stage tumor , the survival rates are between 72 and 95 %.
Disease-speciic survival rates of our patients after 10 years in percent
The table on the page Results shows the disease-specific survival rate of our patients following surgery, according to the stage of the tumor.
- If the tumor was confined to the protstate or had only spread to the periphery of the prostate, the 10-year survival rate was more than 98%.
- If cancer cells had already spread to the seminal vesicle or to the area surrounding the prostate, the rate was between 87% and 77% respectively.
- If the lymph nodes were affected , 81% of our patients survived.
- If the preoperative PSA value was > 20 ng/mL , the disease-specific survival rate was 93%.
- If the preoperative Gleason Score was 8 or higher, 70% of the patients survived.
Treatment Option Overview For Prostate Cancer
In This Section
Local treatment modalities are associated with prolonged disease-free survival for many patients with localized prostate cancer but are rarely curative in patients with locally extensive tumors. Because of clinical understaging using current diagnostic techniques, even when the cancer appears clinically localized to the prostate gland, some patients develop disseminated tumors after local therapy with surgery or radiation.
Treatment options for each stage of prostate cancer are presented in Table 6.
| Stage | Standard Treatment Options |
|---|---|
| EBRT = external-beam radiation therapy LH-RH = luteinizing hormone-releasing hormone PARP = poly polymerase TURP = transurethral resection of the prostate. | |
| Stage I Prostate Cancer | |
| PARP inhibitors for men with prostate cancer and BRCA1, BRCA2, and/or ATM mutations |
Side effects of each of the treatment approaches are covered in the relevant sections below. Patient-reported adverse effects differ substantially across the options for management of clinically localized disease, with few direct comparisons, and include watchful waiting/active surveillance/active monitoring, radical prostatectomy, and radiation therapy. The differences in adverse effects can play an important role in patient choice among treatment options. Detailed comparisons of these effects have been reported in population-based cohort studies, albeit with relatively short follow-up times of 2 to 3 years.
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A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms male, female, or both to refer to sex assigned at birth. .
There are different ways of classifying cancer stages, including prostate cancer. Staging is when a doctor decides how far cancer cells have progressed and how much they may have spread.
Doctors determine the stage using the prostate-specific antigen and the Gleason score.
PSA is a protein that appears at higher levels in the bloodstream a problem with the prostate. The Gleason system can also help determine the stage by classifying cancer cells, which can act differently.
Some stages are more aggressive and can spread more easily. The Gleason score a calculation of how likely a tumor will spread and how quickly it will do so. This is called the grade.
Here is a brief overview of
| prostate, other parts of the body, and possibly surrounding tissues and lymph nodes |
A simpler way to stage cancer is to look at how far it has spread from its original site. These stages are:
- Localized cancer: Cancer cells remain in the area where they started. In this case, within the prostate gland.
- Regional cancer: Cancer has spread to nearby tissues and possibly nearby lymph glands, but not to other parts of the body.
- Distant cancer: Cancer has spread throughout the body and affects other organs, such as the lungs or liver.
Radical Prostatectomy Plus Radiotherapy Extends Os In Prostate Cancer
A study in Cancer found a lower risk of prostate cancerspecific death and improved overall survival when patients were treated with this combination.
Men with locally or regionally advanced prostate cancer treated initially with radical prostatectomy and adjuvant radiotherapy may have a lower risk of prostate cancerspecific death and improved overall survival compared with men treated with radiotherapy plus androgen deprivation therapy , according to research in Cancer.
Using Surveillance, Epidemiology, and End Results Medicare data, researchers evaluated 13,856 men with high-risk to very high-risk prostate cancers. The cohort included men with locally advanced disease and regionally advanced disease . Both treatment groups were matched by age, race, comorbid conditions, as well as tumor and nodal stage to control for factors that may influence outcomes. They then analyzed which group fared better 10 to 15 years after treatment.
In this study, all men were age 65 or older and were treated between 1992 and 2009. Among 13,856 men, 6.1% received RP plus radiotherapy and 23.6% received radiotherapy plus ADT.
The survival and functional outcomes data in our study need to be verified in the setting of a prospective clinical trial, and the data suggests the need to include a surgical arm in future trials for men with high-risk to very high-risk prostate cancer, Dr. Jang told Cancer Network.
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Survival Of Prostate Cancer
Survival depends on many factors. No one can tell you exactly how long you will live.
Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.
Survival for prostate cancer is generally good, particularly if you are diagnosed early.
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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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.
What Are The Five Stages Of Prostate Cancer
The Gleason grading system grades prostate cancer from 1 to 5. According to cells appearances under a microscope, this system grades the most common and second most common patterns of cells in a tissue sample collected via biopsy.
- Grade 1: The cells appear like normal prostate cells.
- Grades 2-4: Cells that score the lower look closest to normal and are suggestive of less aggressive cancer. Those that score higher look the furthest from normal and will probably grow faster.
- Grade 5: Most cells look vastly different from normal.
Depending on the Gleason score, the American Joint Committee on Cancer has classified prostate cancer into four stages.
Stage I cancer:
- This stage is known as localized cancer because the cancer has been found in only one part of the prostate .
- Stage I cancers cannot be felt during a digital rectal exam or seen with imaging tests.
- If the prostate-specific antigen is less than 10, it is most likely slow growing.
Stage II cancer:
- This stage of cancer is still localized but is more advanced than stage I.
- In stage II, the cells are less normal than stage I and may grow more rapidly.
- Stage IIA means that the cancer is found only on one side of the prostate, whereas stage IIB means that the cancer is found in both sides of the prostate.
Stage III cancer:
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Towards A Meaningful Definition Of High
In the United States, approximately 238,590 men were expected to be diagnosed with prostate cancer in 2013, and 29,720 prostate cancer patients were anticipated to die of their disease in 2013.2 Many of the patients who die of prostate cancer present initially with tumours seemingly confined to the gland this arguably represents true high-risk disease and new approaches are needed for these patients. By current estimates, high-risk disease accounts for 15% of all prostate cancer diagnoses3. The limitations of determining risk based on the T, N, M classification, which does not include Gleason score or PSA, have long been recognized. An important first step toward a more reliable schema was first proposed by DAmico et al.,4 using an endpoint of PSA failure and defining high-risk as a clinical T stage cT2c, a Gleason score 8, or a PSA > 20 ng/mL this definition has been adopted by the American Urological Association .5 The Radiation Therapy Oncology Group developed the first classification which associated specific baseline factors with overall survival and cause-specific survival, arguably more relevant measures. High risk in the RTOG classification includes 1) Gleason 8, or 2) Gleason =7 plus either cT3 or node-positive PSA adds little to this model for the prediction of cause-specific survival or overall survival.6 When combining the RTOG model with the Kattan nomogram, the ability to predict prostate cancerspecific survival is improved.7
Staging And Survival Rates
Staging is a method of describing where the cancer is located, where it has spread, and whether it is affecting other parts of the body.
Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests, such as the digital rectal exam and the prostate-specific antigen test.
Doctors use diagnostic tests to determine cancers stage. Staging may not be complete until these tests are finalized. Knowing the correct stage helps the doctor decide the best course of treatment and the possible outcomes.
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Stage 1 Prostate Cancer
In stage 1, the cancer is confined to the prostate. Stage 1 prostate cancer cant be detected during a digital rectal exam and is usually expected to be slow-growing. The tumor is one half of one lobe of the prostate or even less . There is no regional lymph node metastasis and no distant metastasis. . The PSA level is below 10ng/ml. The Grade Group is 1.
Stage Iii Prostate Cancer
The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells havent spread to the lymph nodes.
-
Stage IIIA: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. The PSA level is high.
- Stage IIIB: The tumor has grown outside of the prostate gland and may have invaded nearby structures, such as the bladder or rectum.
- Stage IIIC: The cancer cells across the tumor are poorly differentiated, meaning they look very different from healthy cells.
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What Will Happen After My Treatment
You will have regular check-ups during and after your treatment to check how well it is working. You may hear them called follow-up appointments. Youll have regular PSA blood tests ask the people treating you how often youll have these. If your PSA level goes down, this usually suggests your treatment is working.
Tell your doctor or nurse about any side effects youre getting. There are usually ways to manage side effects.
Make sure you have the details of someone to contact if you have any questions or concerns between check-ups. This might be your specialist nurse or key worker. You can also speak to our Specialist Nurses.
Read more about follow-up after prostate cancer treatments.
The Tnm Staging System
TNM stands for tumor, node, and metastasis, which the system evaluates.
The American Joint Committee on Cancer and the International Union Against Cancer adopted the TNM system to help oncologists identify cancer stages and provide an appropriate treatment plan.
The TNM system takes the Gleason score and the bloods PSA level into consideration. Heres how the scores break down:
- Stage I is usually silent and does not require any treatment options other than active surveillance. This stage is not considered as cancer.
- Stage II , IIb , IIc is considered cancer. As with stage I, the first approach is to wait and watch. The decision to undergo radical prostatectomy is made based on age and the desire to be treated.
- Stage III . The clinical-stage is considered advanced. Imaging tests are usually necessary to check on the distant lymph nodes and other distant organs like bone, liver, and lungs. Patients with stage III prostate cancer receive external-beam radiation therapy with or without hormonal treatment and ablation of one-half of the entire prostate.
- Stage IV is the most advanced of prostate cancer stages. In this case, the metastasis has spread to the bone. Hormonal and chemotherapy is necessary, as well as EBRT and palliative radiation therapy. Despite all the therapeutic efforts, the chance of survival at this stage is only 31%.
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Watchful Waiting Or Active Surveillance/active Monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrantconsideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Watchful waiting and active surveillance/active monitoring are the most commonly used terms, and the literature does not always clearly distinguish them, making the interpretation of results difficult. The general concept of watchful waiting is patient follow-up with the application of palliative care as needed to alleviate symptoms of tumor progression. There is no planned attempt at curative therapy at any point in follow-up. For example, transurethral resection of the prostate or hormonal therapy may be used to alleviate tumor-related urethral obstruction should there be local tumor growth hormonal therapy or bone radiation might be used to alleviate pain from metastases. Radical prostatectomy has been compared with watchful waiting or active surveillance/active monitoring in men with early-stage disease .
- Regular patient visits.
- Transrectal ultrasound .
- Transrectal needle biopsies .
Patient selection, testing intervals, and specific tests, as well as criteria for intervention, are arbitrary and not established in controlled trials.
Treatments May Have Side Effects
The treatment options for early-stage prostate cancer fall into three broad categories: surgery, radiation therapy, and active surveillance. Your doctor will make a treatment recommendation based on your numbers as well as a mathematical tool known as a nomogram, which can help you and your doctor better assess how extensive your cancer is likely to be and whether it is likely to become active in the future.
Yet clinical studies have not provided any evidence that one treatment is better than another or that any treatment at all actually prolongs life: The average 5-, 10-, and 15-year survival rates are virtually the same for all treatment options in early-stage prostate cancer, including active surveillance. Its also important to understand that no mathematical model is foolproof, and some men diagnosed with early-stage, locally confined disease will later find out that their cancer was more extensive than originally believed.
If you are diagnosed with early-stage prostate cancer, you have a number of treatments to choose from. A brief comparison is listed in Table 2.
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