Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.
Where Prostate Cancer Spreads
If left untreated, diagnosed prostate cancer can grow and possibly spread outside of the prostate to local tissues or distantly to other sites in the body. The first sites of spread are typically to the nearby tissues.
The cancer can spread down the blood vessels, lymphatic channels, or nerves that enter and exit the prostate, or cancer could erode directly through the capsule that surrounds the prostate.
The seminal vesicles are a site of particularly common early spread. More extensive local spread can occur with cancer invading the nearby bladder or rectum.
Further advancement of cancer can occur when cancer cells enter the blood vessels and lymphatic channels. Once cancer has entered into these vessels, prostate cancer cells can seed into virtually any other part of the body.
Prostate cancer is known to have a particular affinity for spreading or metastasizing to the bones especially the lower spine, pelvis, and femur. Other organs such as the liver, brain, or lungs can also be the sites of spread, but these are much rarer.
How Prostate Cancer Spreads
- The cells escape into the bloodstream, initially by invading small blood vessels around the tumor, then traveling to larger blood vessels that enable the cells to circulate around the body .
- The cells are filtered through the bodys lymph system although some are captured in lymph nodes, others may travel elsewhere in the body.
- The cells migrate along the length of a nerve, escaping from the prostate into adjacent soft tissue .
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How Does Prostate Cancer Kill You In The End
Prostate cancer is the most common cancer after skin cancer in men in the US and the second leading cause of cancer death. Prostate-specific antigen testing has made the detection of prostate cancer easier in its early stages. Ninety-two out of 100 men get diagnosed when the cancer is limited to the prostate.
Most men are diagnosed with prostate cancer in their senior years and only 1 out of 36 men die from it. Death from prostate cancer most often happens when cancer has spread to other organs in the body. This is known as the advanced stage of prostate cancer.
The chances of survival decrease as cancer spreads beyond the prostate. If cancer has metastasized to other parts of the body, only three out of 10 men will survive for five years after the diagnosis.
Advanced stage prostate cancer or metastasized prostate cancer
Cancerous cells may spread to organs other than the site of origin. In the case of prostate cancer, this tendency is decreased, but it can happen. Advanced stage prostate cancer is defined based on the Gleason score, which is based on the TNM staging of cancer. T stands for tumor size, N stands for lymph node involvement and M stands for metastasis.
Prostate cancer can kill in the end through metastases that can develop in
Metastasis to the liver can affect the livers ability to filter out toxins from the body. This can eventually lead to jaundice, nausea, loss of appetite and weight loss.
What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life, making healthy choices and feeling as good as you can.
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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
- Bones
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
How Your Doctor Monitors You After Treatment
After treatment you have follow up appointments, which usually include regular blood tests to check the levels of a protein called prostate specific antigen . They check to see if your PSA level rises. And they also look at how quickly it rises.
An increase in PSA can mean there are prostate cancer cells in your body. The cells might be in or around the prostate. Or they might have spread to other parts of your body. You might need treatment if it rises.
Prostate cancer that comes back after treatment is called recurrent prostate cancer.
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Nutrition And Dietary Supplements
Some studies have suggested that eating a healthy diet that is rich in vegetables and lower in animal fats might be helpful, but more research is needed to be sure. However, we do know that a healthy diet can have positive effects on your overall health, with benefits that extend beyond your risk of prostate or other cancers.
So far, no dietary supplements have been shown to clearly help lower the risk of prostate cancer progressing or coming back. In fact, some research has suggested that some supplements, such as selenium, might even be harmful. This doesnt mean that no supplements will help, but its important to know that none have been proven to do so.
Dietary supplements are not regulated like medicines in the United States they do not have to be proven effective before being sold, although there are limits on what theyre allowed to claim they can do. If you are thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that could be harmful.
Could You Live With Untreated Prostate Cancer
Any diagnosis of cancer is frightening, but men with prostate cancer face some particularly difficult choices. Many prostate tumors are slow-growing so much so that they’ll never get big enough to cause any harm. You can see this from autopsy results. About 60 in 100 men have cancer cells in their prostate when they die, although many of these men will have died of something else.
For early stage prostate cancer, doctors increasingly recommend a wait-and-see approach, which they call active surveillance . You have regular tests, and if your cancer becomes more aggressive, you start treatment. If it doesn’t, you avoid the side effects of surgery or radiation therapy. However, this approach does mean living with untreated cancer. Even the bravest of men could be forgiven for finding that idea frightening.
The study suggests that most men who choose active surveillance cope well, although it’s worth remembering that the men were taking part in a clinical trial, so probably got closer attention than a typical patient. This might mean they had fewer anxieties about their care. In fact, some men said that filling in the questionnaires made them feel better, because they appreciated that the researchers were interested in their feelings.
What you need to know.
Philip Wilson, patient editor, BMJ Group
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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If Your Prostate Cancer Has Spread
If cancer has spread to other parts of your body it cant be cured. This is advanced prostate cancer. Treatment can help to control the cancer and your symptoms. This might be:
- hormone treatment to lower your testosterone levels
- bisphosphonates to help with bone pain
- radiotherapy to particular parts of the skeleton
- radioactive liquid treatment radiotherapy , such as radium-223
If hormone therapy is no longer working for you, you might have:
- chemotherapy
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When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety
Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.
The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.
For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.
You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, usually those who are younger and had full erections prior to surgery.
Treatment Options After Recurrence
After surgery to remove your prostate
PSA levels are usually extremely low about a month after surgery. You may hear your doctor saying that your PSA level is undetectable . If your PSA level starts to rise, this might mean the cancer has come back.
Your doctor might recommend:
- hormone treatment
After external beam radiotherapy
PSA levels usually get lower slowly over months or years. Defining the limit for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence, or 3 increases in a row .
Your treatment options may be:
- surgery to remove your prostate
- hormone treatment
- high frequency ultrasound
After internal beam radiotherapy
PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence.
After hormone treatment
If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static. If it rises this may suggest the cancer is becoming resistant to the hormone treatment.
If hormone treatment is no longer controlling your cancer, your doctor may suggest:
- abiraterone
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Common Thoughts And Feelings
You may feel all sorts of things after you finish treatment. Some men are relieved and feel ready to put the cancer behind them and get back to normal life. But others find it difficult to move on. Adjusting to life after cancer can take time.
For some men, the emotional impact of what they have been through only hits them after they have finished treatment. You might feel angry for example, angry at what you have been through, or about the side effects of treatment. Or you might feel sad or worried about the future.
Follow-up appointments can also cause different emotions. You might find it reassuring to see the doctor or nurse, or you may find it stressful, particularly in the few days before your appointments.
Worries about your cancer coming back
You may worry about your cancer coming back. This is natural, and will often improve with time. There are things you can do to help manage your concerns, such as finding ways to reduce stress. Breathing exercises and listening to music can help you relax and manage stress. Some people find that it helps to share what theyre thinking with somebody else, like a friend. If you are still struggling, you can get help for stress or anxiety on the NHS you can refer yourself directly to a psychological therapies service or ask your GP.
If youre worried about your PSA level or have any new symptoms, speak to your doctor or nurse. If your cancer does come back, youâll be offered further treatment.
Feeling isolated
Where Does Prostate Cancer Spread
The most common place for prostate cancer to spread to is the bones. It can also spread to the lymph nodes, liver and lungs and other organs.
A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.
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Getting Regular Physical Activity
Some research has suggested that men who regularly after treatment might be less likely to die from their prostate cancer than those who dont. Its not clear exactly how much activity might be needed, but more seems to be better. More vigorous activity might also be more helpful than less vigorous activity. Further studies are needed to follow up on these findings.
How Is Advanced Prostate Cancer Treated
The primary treatment of prostate cancer is prostatectomy, which is a surgery to remove a part of the prostate gland or the entire prostate gland in younger patients.
Androgen deprivation therapy is usually the choice of treatment of metastatic prostate cancer. Also known as hormone therapy, it is also used for treating patients who are unfit or unwilling to undergo surgery or/and radiation therapy.
Examples of hormone therapies for advanced prostate cancer include
- Abiraterone
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Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- having blood in your urine or semen
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
- stomach pain
When Prostate Cancer Spreads Where It Goes Matters A Lot
And if the cancer progresses or spreads beyond his prostate? We can treat it then, Callaghan said.
The study shows that you have no business treating low-grade prostate cancer in someone with a life expectancy of less than 15 years because the side effects outweigh any benefits, said urological surgeon Dr. Peter Albertsen of the University of Connecticut Health. The Oxford scientists reported that 46 percent of men who had their prostate removed were using adult diapers six months later . Similarly, only 12 percent of men who got surgery and 22 percent who had radiation could sustain an erection, compared to 52 percent of the monitoring group.
An estimated 180,890 men in the US will be diagnosed with prostate cancer this year, according to the American Cancer Society. Some 26,120 will die of it in 2016, almost always because it has spread to a vital organ.
In an editorial accompanying the study, radiation oncologist Dr. Anthony DAmico of Brigham and Womens Hospital focused on the finding that men who opted for monitoring were more than twice as likely to develop metastatic prostate cancer. That is, malignant cells reached the bones, lung, liver, or brain.
Garnick agreed: The intermediate-risk men we would never assign to active monitoring. If the increased metastases came from these patients, it would explain those differences and even more strongly encourage the role of active management in truly low-risk prostate cancer.
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