Survival Of Men With Metastatic Castration
There has been regular discussion here and elsewhere about the degree to which new forms of therapy have impacted patient survival since the original approval of docetaxel for treatment of metastatic, castration-resistant prostate cancer . The one thing that has always been clear is that one couldnt just add up the median survival benefits of all the new drugs and assume that the total would be the degree of absolute benefit.
We had not noticed this at the time, but as of February 2018 we have had some much more concrete information about this topic from one of the very best cancer centers in the world: the Dana-Farber Cancer Institute in Boston.
At the Genitourinary Cancers Symposium in San Francisco, earlier this year, Francini et al. reported data from a total of 583 patients, all diagnosed with and treated for mCRPC at DFCI and whose data were compiled in the DFCI Clinical Research Information System.
Francini et al. subdivided these patients into two cohorts, as follows:
Here are the core study findings:
- Average follow-up was
- 10.6 years for patients in Cohort A
- 4.6 years for patients in Cohort B
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
Prostate Cancer Prognosis: Life Expectancy After Diagnosis
As with any other type of cancer, receiving a prostate cancer diagnosis can be a devastating experience, which can set off a cascade of emotions and a deep-seated fear of the unknown,
If your doctor has just delivered the dreadful news, it makes sense to know all of the important details about your diagnosis and treatment. Read on to learn about what might have caused your prostate cancer, the treatment options available for it, and what your prognosis might be.
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Justification For A New Guideline
Clinicians treating men with advanced prostate cancer are challenged with the rapidly evolving prostate cancer landscape given the approval of new classes of agents for use in various prostate cancer disease states. The increasing complexity of advanced prostate cancer management underscores the need for the current clinical practice guideline, developed to provide a rational basis for treatment of patients with advanced disease, based on currently available published data. To assist in clinical decision-making, guideline recommendations are furnished according to disease state across the entire continuum of advanced prostate cancer.
Prostate Cancer Survival Rates Are Favorable Overall
Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.
To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides what’s called the relative survival rate for prostate cancer.
Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, we’re not counting men with prostate cancer who die of other causes:
- 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
- Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.
Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:
- the relative 10-year survival rate is 98%
- the relative 15-year survival rate is 95%
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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 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 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 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.
Whos A Good Candidate For This Procedure
Your doctor may do this surgery to treat breast cancer or prostate cancer. Without the testicles, your body cant make as much testosterone. Testosterone is a hormone that can cause prostate or breast cancer to spread more quickly. Without testosterone, the cancer may grow at a slower rate, and some symptoms, such as bone pain, may be more bearable.
Your doctor may recommend orchiectomy if youre in generally good health, and if the cancer cells have not spread beyond your testicles or far beyond your prostate gland.
You may want to do an orchiectomy if youre transitioning from male to female and want to reduce how much testosterone your body makes.
This surgery effectively treats prostate and breast cancer. You can try hormone therapies with antiandrogens before considering an orchiectomy, but these can have side effects, including:
- damage to your thyroid gland, liver, or kidneys
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General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
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Metastatic Prostate Cancer Prognosis Calculator
Impact of obesity upon prostate cancer-associated mortality: A meta-analysis of 17 cohort studies.Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies.20-year outcomes following conservative management of clinically localized prostate cancerContribution of obesity to international differences in life expectancy
The metastatic prostate cancer prognosis calculator assesses life expectancy and mortality risk connected to prostate cancer diagnosis in men.
|Please, remember – all the calculations are only estimations and are based on the general population statistics. Math cannot predict the future – every single case, history and disease is different and unrepeatable.|
Follow the article below to find out more about prostate cancer, its risk factors, and overall survival. We will also talk about the risk assessment process used in our prostate survival calculator.
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.
Stage 4 Cancer Explanation
What are stage 4 metastatic cancers? First of all, before we go to the life expectancy part, you should know more about this stage. As we mentioned above, this is the last or the most severe stage. It means cancer at this stage has a high mortality rate. It can kill the patients most of the time when they receive no proper treatment.
Why does it have a high mortality rate? You can see it from its name. Cancer in this stage has metastasized. It means the cancer cells have spread and attacked another area or organ outside the initial area where it appears. For example, if you have lung cancer in this stage, the cancer cell has spread to other organs near the lungs, such as the heart and liver.
Compared to the earliest stage, metastasized cancer is more challenging to treat. We can even call it impossible for certain cases. The cancer cell has grown significantly, so the focused treatment doesnt work for it. Because of that, it is also known for its high mortality rate.
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Differences Among Risk Groups
Men with PCa have been classified into low-, intermediate- and high-risk Groups for tumor recurrence and disease specific mortality, based on PSA level, clinical or pathological staging and GS. High-risk patients have PSA level 20ng/mL or GS 8 or clinical/pathological stage T2c . Lymph-node positive and PSM have also been reported as poor prognosis factors.
Risk Group classification predicts biochemical and clinical progression as well as PCa specific mortality and overall survival. The risk of disease progression in these groups has been validated for patients submited to RP in many studies. In patients from Mayo Clinic, BCR rates were 2.3 and 3.3-fold greater in high and intermediate-risk in comparison with low-risk patients, respectively. In those patients, mortality rates in high and intermediate-risk patients were greater than 11 and 6-fold over low-risk men .
Therefore, it is crutial to understand the role of each clinical and pathologic feature in PCa BCR and disease progression.
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First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
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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:
What Else Do You Need To Make Your Decision
Check the facts
- Sorry, thatâs not right. One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
- Youâre right. One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
- It may help to go back and read âGet the Facts.â One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
- Thatâs right. The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
- Thatâs not right. The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
- It may help to go back and read âGet the Facts.â The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
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Recurrence Of Prostate Cancer Life Expectancy
According to the table above, when the prostate cancer recurrence rate is low, then life expectancy generally is 10 years or higher. When calculating life expectancy to a prostate expectancy too.
Meanwhile, if the recurrence rate is high, then most probably the tumor will involve the adjacent areas. And often the recurrence seems to occur after 6-8 years of radical prostatectomy.
In cases of metastastasis, it is difficult to assess the period of relapse. This is actually considered as very high risk zone.
Sometimes, the actual cause is not the prostate cancer, but some other associated problems. Thats why, it is highly recommended regular annual check-ups not only to tackle prostate cancer, but also a scheduled check-up to detect its recurrence and related problems too.