Prostate Cancer Survival Rates
Prostate cancer is the second leading cause of cancer death in the United States. A mans individual survival depends on the stage of cancer. Most prostate cancers are identified at an early stage when they are organ-confined. According to the American Cancer Society, the 5-year survival rate for men with local or regional prostate cancer is nearly 100%. The relative 10-year survival rate is 98% and the 15-year relative survival rate is 91%.
However, if the cancer is stage IVB and has spread to distant parts of the body such as the lungs, liver, or bones there is only a 30% relative 5-year survival rate.
Things to consider when understanding the statistics:
- These numbers/rates apply only for the first-diagnosed cancer
- There are many more factors that can influence the survival rate of an individual
- These rates are calculated over a 5-year period. Treatments improve over time and the survival rates may positively change.
Early detection makes this deadly disease curable. Do not ignore any prostate cancer signs or symptoms and get screened as early as possible, especially if you are at high risk of developing prostate cancer, based on your family history, race or age. Talk to your doctor about your Gleason Score, Grade Group and Stage and decide upon the best treatment option for prostate cancer.
How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
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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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.
The Future Of Active Surveillance
While confidence in conservative management for low-risk disease has increased significantly as the cohorts have matured, many unanswered questions remain. These include the following:
What are the molecular events that signal progression of low-grade disease?
How can we optimally identify the wolves in sheeps clothing-ie, those low-grade cases that harbor higher-grade cancer?
What is the effect of germline genetic alterations-eg, BRCA1/2 mutations-on eligibility for surveillance?
How should multiparametric MRI and biomarkers be integrated into treatment decision making?
Which intermediate-risk patients are candidates for surveillance?
What interventions are able to reduce the risk of biological progression in men on active surveillance, and thus are warranted?
What is the most efficient and cost-effective way to follow patients longitudinally? Is serial biopsy still required, and in whom?
Can risk stratification allow some patients to minimize the burden of follow-up?
Can the widespread adoption of surveillance for low-risk disease rehabilitate prostate cancer screening?
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Stages Of Prostate Cancer
In order to determine the stage of a patients prostate cancer, most doctors start by using the TNM staging system, which helps describe different aspects of the cancers growth.
- T the T category measures the size and extent of the Tumor
- N the N category measures whether and how far the cancer has spread to the Lymph Nodes
- M the M category whether the cancer has spread to other organs in the body (a process called Metastasis
The score for each of these categories is determined based on a pre-determined set of criteria. Your doctor cannot feel or see the tumor with a score of T1. A score of T3 means that the tumor has begun to grow outside of the prostate.
After calculating the TNM categories, doctors will combine the TNM score with the patients Gleason score and PSA levels assigning of a specific stage to the patients cancer.
Prostate cancer prognosis and survival rates can help give patients an idea of their chances of surviving the disease based on the stage and time of diagnosis. While some patients may find this information helpful, others may not want to know.
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.
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Estimation Of Life Expectancy For Newly Diagnosed Men With Prostate Cancer
A critical question for every patient newly diagnosed with prostate cancer is going to be, How long am I going to live? That question may be particularly important if a second and associated question is, How long am I going to live if I just monitor my cancer on active surveillance or watchful waiting?
We know that many men with low-risk and even favorable intermediate-risk prostate cancer can be managed for significant periods of time on active surveillance before treatment actually becomes necessary and that selected men with more aggressive or more advanced disease may be able to delay initiation of treatment because they have a limited life expectancy on account of their age at diagnosis or because they have other significant health issues. However, there has never been a simple tool available that a newly diagnosed patient could use to give him a reasonable estimate of how long he is likely to live and that took account of his prior and existing health issues in addition to his age.
For complex reasons this tool is not perfect. Few such tools ever are. But the authors have been able to show that their model does provide a good and reasonably accurate projection of life expectancy for most reasonably average men being diagnosed with localized prostate cancer. The men for whom it may be less accurate are likely to include those who have hereditary forms of prostate cancer and those who have a long family history of male longevity.
Watchful Waiting And Active Surveillance
Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.
Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.
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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.
Radical Prostatectomy Plus Radiotherapy Extends Os In Prostate Cancer
A study in Cancer found a lower risk of prostate cancerspecific death and improved overall survival when patients were treated with this combination.
Men with locally or regionally advanced prostate cancer treated initially with radical prostatectomy and adjuvant radiotherapy may have a lower risk of prostate cancerspecific death and improved overall survival compared with men treated with radiotherapy plus androgen deprivation therapy , according to research in Cancer.
Using Surveillance, Epidemiology, and End Results Medicare data, researchers evaluated 13,856 men with high-risk to very high-risk prostate cancers. The cohort included men with locally advanced disease and regionally advanced disease . Both treatment groups were matched by age, race, comorbid conditions, as well as tumor and nodal stage to control for factors that may influence outcomes. They then analyzed which group fared better 10 to 15 years after treatment.
In this study, all men were age 65 or older and were treated between 1992 and 2009. Among 13,856 men, 6.1% received RP plus radiotherapy and 23.6% received radiotherapy plus ADT.
The survival and functional outcomes data in our study need to be verified in the setting of a prospective clinical trial, and the data suggests the need to include a surgical arm in future trials for men with high-risk to very high-risk prostate cancer, Dr. Jang told Cancer Network.
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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.
The Ajcc Tnm Staging System
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.
The TNM system for prostate cancer is based on 5 key pieces of information:
- The extent of the main tumor *
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to other parts of the body
- The PSA level at the time of diagnosis
- The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .
*There are 2 types of T categories for prostate cancer:
- The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
- If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.
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Additional Treatment After Surgery
Additional treatment can come with one of two approaches: treatment given as adjuvant therapy , or as salvage therapy . In the modern era, most additional treatment is given as salvage therapy because firstly this spares unnecessary treatment for men who would never experience recurrence, and secondly because the success rates of the two approaches appear to be the same.
Regardless of whether an adjuvant or salvage therapy approach is taken, the main treatment options following biochemical recurrence are:
- Radiotherapy this is the commonest approach. Because scans dont show metastatic deposits until the PSA is more than 0.5 ng/ml and because radiotherapy is more effective when given before this level is reached, the radiotherapy energy is delivered to the prostate bed. This is because we know that this is the commonest site of recurrence in most men, and that 80% of men treated in this way will be cured.
- Active surveillance this is appropriate for a very slowly-rising PSA in an elderly patient who has no symptoms.
- Hormonal therapy in many ways this is the least appealing option as it causes symptoms but does not cure anyone, although it does control the recurrence and lower the PSA.
What Is My Outlook
If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.
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.
No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. 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. Speak to your doctor about your own situation and any questions or concerns you have.
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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
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.
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Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What is my Gleason score?
- How far has my cancer spread?
- What treatments are suitable for me?
- What do they involve?
- What are the advantages and disadvantages of each treatment, including their possible side effects?
- How effective is my treatment likely to be?
- Can I see the results of treatments youve carried out?
- Can I get copies of all my test results and letters about my treatment?
- Is the aim to keep my prostate cancer under control, or to get rid of it completely?
- Are all of the treatments available at my local hospital? If not, how could I have them?
- Can I join any clinical trials?
- How quickly do I need to make a decision?
- After treatment, how often will I have check-ups and what will this involve?
- If I have any questions or get any new symptoms, who should I contact?