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.
How Is Prostate Cancer Diagnosed
Doctors describe the growth and spread of prostate cancer in stages. Doctors use these stages as guides when choosing treatment options or offering prognoses to their patients.
Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests such as a digital rectal exam or prostate-specific antigen test and imaging studies like bones scans, MRIs, CT scans, and trans-rectal ultrasounds.
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.
Recommended Reading: Should I Poop Before Prostate Exam
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
Donât Miss: Screening For Prostate Cancer Icd 10
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 of 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.
Recommended Reading: Is Saw Palmetto Good For Enlarged Prostate
Early Mortality And Year Of Diagnosis
For year-specific survival analyses, we used Cox regression models estimating the average of the hazard ratio during the time of 24-months for the years of diagnosis between 2005 and 2013 according to the time of diagnosis. Models were adjusted for age, age squared, grading differentiation between a Gleason score below and above 6, and risk , respectively, allowing for the interaction between year of diagnosis and each main effect covariate, and thus for a temporal variation of potential confounders.
Recommended Reading: Does Cialis Help With Enlarged Prostate
Outlook For Men With Advanced Prostate Cancer
While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.
Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer.
Recommended Reading: Prevalence Of Prostate Cancer By Age
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.
Prostate Cancer Survival Rate By Age
The age of the patient at the time he receives a diagnosis is a highly influential factor in the way the prostate tumor is going to evolve. Given that prostate tumors exhibit peculiar traits in younger men, the peak survival rate is attained in the middle age groups. From there, the survival starts dropping once more. Lets take a look at the numbers:
- 15-49 age group: 91% prostate cancer survival rate
- 50-59 age group: 92% prostate cancer survival rate
- 60-69 age group: 94% prostate cancer survival rate
- 70-79 age group: 89% prostate cancer survival rate
- 80-99 age group: 66% prostate cancer survival rate.
You May Like: How To Help Enlarged Prostate
You May Like: Best Foods For Prostate Health
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?
Read Also: How Is A Prostate Biopsy Done
Metastatic Prostate Cancer Prognosis
Prostate cancer prognosis varies from person to person, as every situation is different. Five-year relative survival rates are categorized by the type of cancer: localized, regional and distant.
According to the American Cancer Society, localized cancer has a five-year relative survival rate of more than 99 percent. For regional cancer , the five-year relative survival rate is also more than 99 percent.
For distant cancer , the five-year relative survival rate drops to 31 percent.
Recommended Reading: Does High Psa Always Mean Prostate 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 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 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:
The primary tumor
Traditionally, advanced prostate cancer was defined as a 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 the lower-grade disease with an increased risk of progression and/or death from prostate cancer in addition to those with widely metastatic disease.
CT scan is used for the initial staging in select patients including
The regional lymph nodes
The distant metastasis
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.
Also Check: Environmental Causes Of Prostate Cancer
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.
It’s 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 .
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.
Also Check: What Is A Prostate Specialist Called
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
The Frequency Of Bcr Cp Crd And Rates Of Bpfs Cpfs Css
Median time of follow-up after RP was 64 months. Over this time, 207 men experienced BCR. One hundred twenty-seven men had BCR in the following year after RP, 27 in the second year, 16 in the third, 14 in the fourth, 7 in the fifth, and 16 patients had BCR after 5 years . Of 207 men, 181 received salvage radiotherapy or hormone therapy or both sRT + HT due to BCR.
Figure 1. Risk of biochemical recurrence by the following year after radical prostatectomy .
CP was diagnosed in 49 cases. Median time from BCR to CP was 17 months. Twelve men had metastases in lymph nodes, 11 had metastases in bones, 19 had metastases in lymph nodes and bones, 1 had visceral metastases, and 6 had local recurrence in the surgical bed. During the follow-up, 72 patients died. In 24 cases PCa was the cause of death.
According to the DAmico risk classification, the 5-year BPFS rate after RP of patients with one risk factor was 57.7%, and that with two factors was 34.4%. All patients with three risk factors had BCR in the first 5 years after RP .
In all study cohorts, 5- and 10-year BPFS rate was 49.2 and 34.2%, respectively. CPFS rate was 89.2 and 81% and CSS rate was 95.6 and 90.1%, respectively.
Read Also: Elevated Prostate Levels Blood Test
Don’t Miss: Gleason Level 6 Prostate Cancer
How Do Health Care Professionals Determine Bladder Cancer Staging
Bladder cancer is staged using the tumor node metastases system developed by the International Union Against Cancer in 1997 and updated and used by the American Joint Committee on Cancer . In addition, the American Urologic Association has a similar staging system that varies slightly from that used by the AJCC. The combination of both staging systems appears below. This staging gives your physician a complete picture of the extent of the persons bladder cancer.
The T stage refers to the depth of penetration of the tumor from the innermost lining to the deeper layers of the bladder. The T stages are as follows:
- Ta Noninvasive papillary carcinoma
The presence and extent of involvement of the lymph nodes in the pelvic region of the body near the urinary bladder determines the N stage. The N stages are as follows:
The metastases or the M stage signifies the presence or absence of the spread of bladder cancer to other organs of the body.
- Mx Distant metastasis cannot be evaluated
- M0 No distant metastasis
A health care professional then assigns a stage:
Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
Don’t Miss: Prostate Biopsy Cost In Usa
Managing Bone Pain And Weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
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.
Read Also: Dr Song 3d Prostate Treatment
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.
Dont Miss: What To Expect With Prostate Radiation