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.
Should I Get A Second Opinion About My Gleason Score And Prostate Cancer Diagnosis
It is always the patients right to obtain a second opinion about a cancer diagnosis or any other medical condition. Talking to a radiation oncologist will allow them to review your pathology report and request any other tests they may need to make sure you have the right information to make a decision about your treatment plan.
If you would like one of our radiation oncologists to review your pathology report, you only need to sign a release so we can have your biopsy material sent to us. We can then determine the Gleason score our team sees. Most of the time, the Gleason score we determine is the same, but not always. Because the Gleason score is the most important issue about your particular cancer, we want it to be as accurate as possible.
Its critical to personally research prostate cancer treatment options to make an informed decision that is best for you and your family. And, with few exceptions, your first treatment gives you the best chance for success. If your urologist has told you that you have a Gleason score of 6 10, or you would like a second opinion, request an appointment for a consultation.
What Does Survival Rate Mean
A survival rate indicates the percentage of those diagnosed with a type of cancer who survive over a certain period of time compared to their peers without the disease. Survival rates are usually measured across a five-year or ten-year span.
For example, if the five-year survival rate of a cancer in men is 80%, that means men diagnosed with that cancer are 80% as likely as other men their age without the cancer to survive five years after diagnosis.
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What Treatments Are Available
If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.
Before you start treatment
Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.
If you have any questions, speak to our Specialist Nurses.
Where Prostate Cancer Spreads In The Body Affects Survival Time
EMBARGOED FOR RELEASE until 4 p.m. on Monday, March 7, 2016
DURHAM, N.C. — Patients with lymph-only metastasis have the longest overall survival, while those with liver involvement fare worst. Lung and bone metastasis fall in the middle.
Smaller studies had given doctors and patients indications that the site of metastasis in prostate cancer affects survival, but prevalence rates in organ sites were small, so it was difficult to provide good guidance, said Susan Halabi, Ph.D., professor of biostatistics at Duke and lead author of the study published online March 7 in the Journal of Clinical Oncology.
With the large numbers we analyzed in our study, we were able to compare all of these different sites and provide information that could be helpful in conveying prognosis to patients, Halabi said. This information could also be used to help guide treatment approaches using either hormonal therapy or chemotherapy.
Halabi and colleagues from leading U.S. and international cancer research centers pulled data from nine large, phase III clinical trials to analyze outcomes of 8,736 men with metastatic prostate cancer. The patients had all undergone standard treatment with the chemotherapy drug docetaxel.
Site of metastases was categorized into four groups: lung, liver , lymph nodes only, bone with or without lymph nodes and no other organ metastases.
Halabi said more research is needed to understand how and why prostate cancer spreads to different organs.
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Prostate Cancer Survival Rate
The prostate cancer survival rate is exceptionally high. Because this cancer grows very slowly and responds well to treatment, the majority of patients are able to lead long and healthy lives. According to the American Cancer Society, the five-year survival rate for both localized cancer and regional cancer is nearly 100%.
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 Are The Risks Of Radiation Treatment
Radiation treatment for prostate cancer may increase a mans risk for having another cancer later in life, such as bladder or rectal cancer.
Some radiation side effects, like urinary problems, are usually short-term problems that go away with time. But a radiation side effect can become a long-term problem. Common side effects from radiation treatment include:
- Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
- In one study, 67 out of 100 men had erections firm enough for intercourse before they had radiation. Six years later, 27 out of 100 men who had radiation had erections firm enough for intercourse.footnote 4
For men with intermediate-risk or high-risk prostate cancer, radiation treatment may be given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.
Your doctor might advise you to have surgery if:
- You are healthy enough to have major surgery.
- Radiation therapy isnt a good option for you because you have had previous radiation therapy to your pelvic area or you have a serious bowel disease such as ulcerative colitis.
Your doctor might advise you to have radiation if:
- You want to avoid the side effects of surgery, such as leaking urine and erection problems.
- You have other health problems that make surgery too risky.
Metastatic Prostate Cancer: Investigators Ponder New Path To Improve Survival
I am convinced that treating early and hard is better than late and less, said urologic oncologist Judd W. Moul, MD, the James H. Semans Distinguished Professor of Urologic Surgery at Duke University School of Medicine in Durham, North Carolina, who has been extensively involved with clinical trials of prostate cancer therapies. Some doctors still hold the good stuff in their back pocket and avoid or delay the most effective options up front.
Starting multiple therapies earlier in the disease course seems to provide the most benefit, said prostate cancer investigator Jonathan E. Shoag, MD, Associate Professor of Urology at University Hospitals Cleveland Medical Center and Case Western Reserve University, both in Cleveland, Ohio.
Despite all of the scientific advancements, metastatic prostate cancer is still a bad disease, Dr Shoag said. The goal should be preventing cancer from becoming metastatic in the first place. We can do this by screening, diagnosing, and intervening in the disease course earlier.
Advanced molecular imaging, such as positron emission tomography , should be used to identify metastasis as early as possible, before it spreads to distant anatomic sites, according to investigators. Potent treatments should be considered at this stage. Physicians also should try to delay development of both metastasis and castration-resistant prostate cancer , which clinical trial data suggest is possible.
The Expanding Armamentarium
Prolonged Survival
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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.
What Is The Most Effective Treatment For Prostate Cancer
For most men with prostate cancer, the most effective treatment will be surgery to remove the tumor or the entire prostate. The different types of prostate cancer surgery include:
- Radiofrequency ablation A minimally invasive procedure, RFA uses ultrasound or another imaging technique to guide a needle electrode into the cancerous tumor. The electrode then emits high-frequency electrical currents to destroy cancer cells.
- Laparoscopic radical prostatectomy During this procedure, a surgeon will remove the entire prostate. The surgeon will make a few small incisions and insert special instrumentsone of which has a video camera attachedto complete the procedure.
- Robotic surgery For certain procedures, surgeons can use robotic assistance, which can improve precision.
Some patients may also undergo radiation therapy after their surgery to eliminate any lingering cancer cells.
As with other cancers, prostate cancer has the most favorable survival rates when patients are diagnosed early. When prostate cancer is detected before it has spread to the lymph nodes , it is most responsive to treatment and, therefore, more easily cured.
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The Future Of Hormone Therapy For Prostate Cancer
Some experts arent sure how much further we can improve hormone therapy for prostate cancer.
Im not saying that weve reached the end of what we can do with hormonal therapy, Thrasher tells WebMD, but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.
Brooks argues that, overall, prostate cancer is only moderately affected by hormones. You can only do so much manipulating the levels of hormones, says Brooks. We have to find better ways to fight the basis of the cancer cells.
Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.
But Holden remains optimistic about the future of hormone therapy for prostate cancer.
Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy, he says. But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.
Its like an endless chess game, he says. You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
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Learn More About Prostate Cancer Care At Rcca
If youve been diagnosed with prostate cancer or are concerned about potential symptoms, contact RCCA today. Our team of cancer care specialists will assess the stage of your cancer using the latest diagnostic methods and work with you to design a fully individualized care plan that includes advanced treatment options, the potential for clinical trials, and support that addresses physical and emotional well-being. To speak with a representative right away, please call .
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Prostate Cancer Survival Trends Over Time
As with most cancers, survival for prostate cancer is improving. However, interpretation of prostate cancer survival trends is difficult as the case-mix on which they are based is likely to have changed over time with earlier diagnoses following the advent of TURP and PSA testing. The detection of a greater proportion of latent, earlier, slow-growing tumours in more recent time periods will have the effect of raising survival rates due to lead-time bias . Lead-time bias for prostate cancer is estimated to be between five and 12 years, varying with a mans age at screening. Data from the European Randomized Study of Prostate Cancer estimates that for a single screening test, mean lead times are 12 years at age 55 and six years at age 75. Some of the increase may also be attributed to genuine improvements in survival due to more effective treatment, for both early, aggressive prostate cancers and advanced cases.
One-year age-standardised net survival for prostate cancer has increased from 66% during 1971-1972 to 94% during 2010-2011 in England and Wales an absolute survival difference of 28 percentage points.
Prostate Cancer , Age-Standardised One-Year Net Survival, Men , England and Wales, 1971-2011
Prostate Cancer , Age-Standardised Five-Year Net Survival, Men , England and Wales, 1971-2011
Prostate Cancer , Age-Standardised Ten-Year Net Survival, Men , England and Wales, 1971-2011
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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.
Survival By Disease Recurrence
If a man develops an elevated PSA level after cancer surgery, then the disease is viewed as recurrent.
The number of lymph nodes at the time of prostatectomy can influence the risk of recurrence. One study suggests the removal of a large number of nodes is associated with an improvement in odds of recurrence, but this doesn’t appear to impact overall survival.
But disease recurrence doesn’t always influence survival times. If a recurrence does occur, the 15-year survival rate at the time of diagnosis may be as high as 94% in those with low-risk recurrence.
The main factors influencing survival rates are:
- The Gleason score
- The PSA doubling time
- Whether the recurrence occurred within three years or after three years
A recurrence that occurs within three years reduces survival rates by anywhere from 15 to 20%and even more, if the doubling time is short.
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Results Of Treating Prostate Cancer With Radiation Therapy
American Cancer Society. Radiation therapy for prostate cancer. January 2013.
Radiation therapy is best used as an early treatment for a lower-grade cancer that is confined within the prostate gland. The survival rates are similar to the results of radical prostatectomy. Radiation therapy treatments can also be used along with hormone therapy as a first step in treating prostate cancer that has spread outside of the prostate gland to nearby tissues. External beam radiation therapy can be focused on the prostate gland therefore, reducing the radiation exposure to the surrounding healthy tissues. This may increase survival rates over other forms of prostate cancer treatments.
National Cancer Institute at the National Institutes of Health. September 2012
Clinical trials show that external-beam radiation therapy does not seem to improve the survival rate of prostate cancer, but it does help to stop the progression of the disease. One such trial showed an increased progression-free survival at 4 years for patients with a 15% estimated risk of lymph node involvement who received whole-pelvic radiation therapy as compared with prostate-only radiation therapy With this in mind, radiation therapy treatments should be delayed 4 to 6 weeks after a TURP procedure in order to reduce incidence of stricture.
Stevens, G Firth, I. Audit in radiation therapy: long-term survival and cost of treatment. National Institute of Health. Feb. 1997