Prognosis of Prostate Cancer
Prostate malignancy is the second most frequently reported malignancy in adult males (preceded only by skin cancer) within the United States. However, due to slow growth and even slower rate of metastasis, the cancer of prostate gland is generally not lethal. For example, statistics indicate that about 2/3rd of very elderly males who die of natural causes (or other medical illnesses) have undiagnosed prostate cancer on the autopsy findings.
Survival statistics and prognosis are generally discussed in the specified time periods such as 5-years, 10-years and 15-years. For example, a survival rate of 5-years is referred to as the percentage of patients who survive after a period of 5 years post-diagnosis. Fortunately, the remarkable improvements in the detection and treatment of prostate cancer has resulted in a much better prognosis and long-term survival rate in the patients after initial therapy.
What are some factors that may influence the prognosis of prostate cancer?
Based on the latest available data, the mortality rate of prostate cancer is 1 in 36; with invasive disease. The primary cause of this relatively lower mortality is the fact that most cases of prostate cancer are reported in elderly males. The risk of aggressive disease and advanced metastasis is also low because the serum levels of testosterone (the key growth factor that potentiates the growth and spread of prostate cancer cells) are generally low in elderly males.
The prognosis or survival rates are predicted by the history of the patient, staging and grading of tumor, nature of treatment modalities available, co-morbid medical conditions, response to the therapy and other related factors. For example:
- Race: According to a new study (2), investigators suggested that racial factors can greatly influence the prognosis and overall risk of mortality in prostate cancer patients. For example, mortality rate in African American males is 2.4-times higher than in Caucasian males.
- Family history: The risk of severe disease and early mortality is twice in males with a positive family history of prostate malignancy. The mortality rate increases by 9-folds two or more index relatives (such as father and brother) have a positive history of prostate cancer.
Based on the latest recorded data, all- stage prognosis of prostate cancer with adequate medical therapy (anti-cancer treatment) is fairly satisfactory. For example, the relative 5-year, 10 years and 15-year survival rates are 100%, 99% and 94% respectively.
Survival rates according to the Staging of Prostate Cancer
SEER database compiled by National Cancer Institute (NCI) collects and analyze the data on the prognosis of different types of malignancies. In this database, the cancer is not grouped in stages by AJCC stages but by a unique type of staging (3).
- Local stage: Local stage (corresponding to the AJCC stage I and II) is characterized by localized disease i.e. no sign of migration of cancer cells beyond the confines of the prostate gland. It has been observed that approximately 4 out of 5 cases of prostate cancer are diagnosed at the local stages. 5-year survival is approximately 99.9%
- Regional stage: This stage corresponds to stage III and IV cancers that are locally aggressive but hasn’t metastasize to distant organs/ tissues. In this stage, cancerous cells are confined to the prostate gland and surrounding region. This includes T4 tumors and cancers that have invaded the local lymph nodes i.e. nodal status 1 and 5-year survival rate is 99%.
- Distant stage: This stage refers to advanced disease with widespread metastasis and spread to lymph nodes, major organs as well as bones and other tissues (M1). Fortunately, only less than 5% patients are diagnosed at this stage. 5-year survival rate is 28%
Study reported in the peer reviewed European Urology (4) journal suggested that active treatment is usually recommended in individuals with localized disease and longer life expectancy. Likewise, prognosis of surgical procedures like radical prostatectomy is higher when compared to less invasive interventions.
It is highly advised to seek your healthcare professional at intervals and learn more about the treatment options to live a longer and productive life.
References:
1. http://www.cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional/page1
2. Wilson, K. M., Giovannucci, E. L., & Mucci, L. A. (2012). Lifestyle and dietary factors in the prevention of lethal prostate cancer. Asian J Androl, 14(3), 365-74.
3. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-survival-rates
4. Heidenreich, A., Bellmunt, J., Bolla, M., Joniau, S., Mason, M., Matveev, V., … & Zattoni, F. (2011). EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. European urology, 59(1), 61-71.