Is Prostate Cancer Always Fatal

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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What Are The Symptoms Of Prostate Cancer

In most cases, prostate cancer causes no symptoms.

In rare cases, men may experience certain symptoms when they have advanced prostate cancer. However, these symptoms are also present in many men who do not have cancer, so it is best to discuss them with a doctor before jumping to any conclusions. Some of these symptoms can include difficulty emptying the bladder, blood in the urine, and bone pain.

Treatments To Control And Prevent Symptoms Caused By The Spread Of Prostate Cancer To The Bones

Palliative External beam radiotherapy

Radiopharmaceuticals: Strontium-89 , samarium-153

Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment.

Zolidronic acid is a bisphosphonate given by a 15-minute intravenous infusion every 34 weeks. It reduces the risk of bone complications, including pain and fractures.

Xgeva : this is a newly licensed drug available at BPC.

Pain medications

Surgery may be undertaken to treat bone fractures or to relieve the pressure on the spinal cord by bone metastases.

*https://www.cancerresearchuk.org/about-cancer/prostate-cancer/survival

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What Can Affect My Outlook

No one can tell you exactly what will happen. How prostate cancer affects you will depend on many things.

• Your stage Whether your cancer is localised, locally advanced, or advanced.
• Your Gleason score or grade group The higher your Gleason score, the more aggressive the cancer, and the more likely it is to spread.
• Your treatment options You may be able to have treatment aimed at getting rid of the cancer. Or you may be able to have treatment to keep the cancer under control. Read more about choosing your treatment.
• Your health If you have other health problems, you may have fewer treatment options. And you may be more likely to die from another condition, such as heart disease.
• Your PSA level After youve been diagnosed, PSA tests are a good way of monitoring your prostate cancer and seeing how youre responding to treatment.
• How successful your treatment is Your treatment may be successful at getting rid of your cancer or keeping it under control. But for some men, treatment may not work as well as expected.

Often Prostate Cancer Is Low

Many prostate cancers are found with a PSA blood test. Often these cancers are low-risk. This means:

• The tumor is small.
• It is contained within the prostate.
• It is probably growing so slowly that it will not become life-threatening.

Usually a man with low-risk prostate cancer dies of something else, even if he doesnt get treatment.

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Exceptions And Barriers To Active Surveillance

In his UCSF program, Dr. Cooperberg said, about 95% of men diagnosed with low-risk prostate cancer are put on active surveillance. As an academic center that began implementing and studying active surveillance in the mid-1990s, thats likely higher than what is typically seen in the United States, he acknowledged.

But a reasonable target for the time being is around 80%, he said. Thats consistent with where rates top out in countries like Sweden and in other large, integrated health care systems in Europe where active surveillance has long been standard practice.

The bottom line, Dr. Cooperberg said, is that even though the vast majority of men with low-risk prostate cancer should be put on active surveillance, there will always be exceptions.

Those exceptions, for example, can include men with a strong family history of prostate cancer or who have urological symptoms related to the disease that immediate treatment can help to alleviate.

There can also be considerations that go beyond clinical or biological factors. For patients in rural areas or those who lack reliable transportation, anything that requires regular visits to the hospital or doctors office over a long period could push some men toward choosing immediate treatment, Dr. Watts said.

In addition, she noted, it can be challenging to explain the medical basis for active surveillance. In some patients minds, opting for active surveillance means missing a window of opportunity for cure, she said.

Stage I Prostate Cancer Treatment

In This Section

Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer. In the CLIN1001 PCM301 randomized trial, 413 men with low-risk cancer were randomly assigned in an open-label trial to receive either the photosensitizing agent, padeliporfin , or active surveillance. Median time to local disease progression was 28.3 months for patients receiving padeliporfin and 14.1 months for patients who were assigned to active surveillance . However, the appropriate population for photodynamic therapy may be quite narrow, as it may overtreat men with very low-risk disease and undertreat men with higher-risk disease.

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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.

What Happens When Prostate Cancer Is Left Untreated

While most men undergo some form of treatment for their prostate cancer, some men today choose to not be treated for their prostate cancer. Instead, they may choose to have their healthcare providers monitor their cancer.

Known as active surveillance, it is common when the cancer is expected to grow slowly based on biopsy results, confined to the prostate, not causing any symptoms, and/or small. In active surveillance, healthcare providers will initiate cancer treatment only if cancer starts growing.

Others men may choose to not undergo cancer treatment because of a short life expectancy or other serious medical problems. They may feel that the risks or side effects of cancer treatment outweigh their potential benefits.

This option is certainly OK and reasonable in the right circumstancesrequiring a careful and thoughtful discussion with your healthcare provider and family.

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What Happens If My Cancer Starts To Grow Again

Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.

You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:

• clinical trials

Which treatments are suitable for me?

Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.

Prognosis For Prostate Cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.

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What Are Prostate Cancer Survival Rates By Stage

Staging evaluation is essential for the planning of treatment for prostate cancer.

• A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
• Further testing and calculations may be performed to best estimate a patients prognosis and help the doctor and patient decide upon treatment options.

Prognosis refers to the likelihood that the cancer can be cured by treatment, and what the patients life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.

If a cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If the cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival based again on group statistics for people who have been in the same situation.

Nomograms are charts or computer-based tools that use complex math from analysis of many patients treatment results.

The prognosis for prostate cancer varies widely, and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and the cancers responsiveness to treatment, among other factors.

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.

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Talk To Your Cancer Care Team

Your team is an important source of advice. Some men may benefit from having a low-risk tumor treated right away, even if they might have side effects. Discuss your treatment options and quality-of-life issues with your team.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

04/2014

How We Treat Prostate Cancer

The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.

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Treatment Options Under Clinical Evaluation

Treatment options under clinical evaluation for patients with prostate cancer include the following:

Cryosurgery

Cryosurgery, or cryotherapy, is under evaluation for the treatment of localized prostate cancer. It is a surgical technique that involves destruction of prostate cancer cells by intermittent freezing of the prostate with cryoprobes, followed by thawing. There is limited evidence regarding its efficacy and safety compared with standard prostatectomy and radiation therapy, and the technique is evolving in an attempt to reduce local toxicity and normal tissue damage. The quality of evidence on efficacy is low, currently limited to case series of relatively small size, short follow-up, and surrogate outcomes of efficacy.

Serious toxic effects associated with cryosurgery include bladder outlet injury, urinary incontinence, sexual impotence, and rectal injury. Impotence is common, ranging from about 47% to 100%.

The frequency of other side effects and the probability of cancer control at 5 years’ follow-up have varied among reporting centers, and series are small compared with surgery and radiation therapy. Other major complications include urethral sloughing, urinary fistula or stricture, and bladder neck obstruction.

Proton-beam therapy

Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer.

Neoadjuvant hormonal therapy

The role of neoadjuvant hormonal therapy is not established.

Bicalutamide

Definitions Of Disease Categories

ICD codes used in the disease categories were the following : myocardial infarction , other coronary heart disease , cerebrovascular accident , arterial disease , heart failure , pneumonia , chronic lower respiratory disease , external causes , complications of diagnostic or surgical procedures , complications of therapeutic drug or vaccine usage , suicide , traffic accident , falls , other heart disease , gastrointestinal disease , dementia , diabetes , complications of heart disease , urinary system disease , symptoms , pulmonary circulation , nervous system disease , hypertensive disease , other bacterial disease , psychic disease , anemia , tumors other than prostate cancer , and prostate cancer .

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Myth: If The Cancer Comes Back It Cant Be Treated Again

Fact: Recurrence of prostate cancer can be wrenching. But just because a cancer comes back doesnt mean you cant reach remission again. What it does mean is that youll likely have to try another approach to treatment.

Your first cancer cure is always the best, says Sartor. But you do have a possibility for cure if it comes back particularly if youve had an initial radical prostatectomy, in which case if you catch early, you can radiate and get a pretty good cure rate.

Sartor adds that one of the reasons he often recommends surgery before radiation is for this reason so that people get a second chance at cure if the cancer comes back and they monitor their condition appropriately.

More Active Surveillance But Not Enough

To conduct their study, Dr. Cooperberg and his colleagues looked at data from all men newly diagnosed with prostate cancer in the AUA Quality Registry. This registry collects real-time data from more than 240 participating US urology practices and more than 2,100 urologists.

Overall, of the more than 84,000 patients covered by the study, 20.3% were diagnosed with low-risk disease. The number of men diagnosed with low-risk disease actually fell during the study period, from about 24.6% in 2014 to 14.0% in 2019. That finding is consistent with other recent studies showing a decline in low-risk diagnoses, which researchers have attributed to fewer men being screened via PSA testing.

But even as diagnoses of low-risk disease have dropped, more men with low-risk disease are opting for active surveillance, Dr. Cooperberg reported. In 2014, 26.5% of men with low-risk prostate cancer chose active surveillance. By the end of 2021, 59.6% did.

Rates of active surveillance also increased among men diagnosed with intermediate-risk prostate cancer, which is considered to have a modestly greater likelihood than low-risk prostate cancer of progressing to the point where it could be fatal.

The variability in the use of active surveillance is alarming, Dr. Parnes said. It likely reflects, at least to some degree, entrenched patterns of care among some urologists. For some, I suspect their feeling is, I treat cancer, and this is cancer. Im not having this conversation , he said.

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Gleason Score Vs Grade Groups

The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.

One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:

• 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
• 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.

So, although both situations give a Gleason score of 7, they actually have very different prognoses.

Heres an overview of how the two grading systems compare:

Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.

Untreated Prostate Cancer Is Always Fatal

—-Prostate cancer is the most common cancer in men. Leftundetected, it can spread to bones, in which case it is alwaysfatal. If it is discovered early enough, however, full recovery isusually assured.

”The easiest way to protect yourself is with an annualcheckup,” says Dr. Paul Lang, professor and chairman of theDepartment of Urology at the University of Washington School ofMedicine. ”This is particularly vital for men 50 years of age andolder,” he adds.

”In the past, a rectal exam was the only method used,” heexplains. ”Today there is a new blood test that can be used, aswell as an ultrasound inspection of the area.” The effectivenessof the new test is being studied through the UW, in associationwith the American Association of Retired Persons.

Lange says the UW Medical Center and several others areevaluating all three tests to determine the comparative costs and effectiveness of each. Headds that to be completely thorough, all three would have to beadministered, but that costs would be too great.

”We are looking at a scenario like this: Perhaps we can use theblood test annually the rectal examination less frequently and theultrasound at other intervals,” he says. ”This way, each test canbe used when it is most appropriate and most efficient, and at lesscost and trouble to the patient.”

Lange says he hopes there comes a day when annual prostatecancer exams for men become as commonplace as the pap smear ormammogram has become for women.

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