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Prognosis of prostate cancer

In 2013, there were an estimated 2,850,139 men living with prostate cancer in the United States. The earlier prostate cancer is caught, the better chance a person has of surviving five years after being diagnosed. 80.0% are diagnosed at the local stage and the 5-year survival for localized prostate cancer is 100.0%. Because there is screening for prostate cancer, most of the time it is caught before it spreads to other parts of the body. Men who have prostate cancer that is characterized as localized or regional are not as likely to die as men whose cancer is distant. In general prostate cancer has excellent survival rates, but death rates are higher in African American men, men who have advanced stage cancer, and men who are between the ages of 75 and 84. Prostate cancer is the sixth leading cause of cancer death in the United States. Death rates have been falling on average 3.5% each year over 2004-2013. (6)

The natural course of untreated prostate cancer is local growth without symptoms. After time, often multiple years, the disease causes local side effects, either due to the size or infiltration of the area around the gland, surrounding areas, or through the urethra. In principle, all types of prostate cancer can metastasize to the lymph nodes and possibly further to bone or organs. The time frame for such development is dependent on the type of tumor.  With a Gleason score of ≤ 6, development may take 10-20 years or longer. With a Gleason score of ≥ 8, the disease metastasizes before it is evident in the prostate.

Multiple factors are known to be significant in assessment of disease prognosis such as PSA, Gleason score, and T stage. The risk for recurrence can be calculated with nomograms based on serum PSA, Gleason score, and T stage.

Risk stratification (EAU guidelines 2008)
Risk group PSA Gleason score Clinical stage
Low risk ≤10 mg/dL ≤ 6   ≤T2a
Intermediate risk >10 < 20mg/dL = 7 =T2b
High risk PSA ≥ 20 8-10  ≥T2c

After curative treatment, regardless of treatment type, 80% of patients with organ localized disease survive for the first 5 years. The corresponding figure is about 75% for patients with locally advanced disease. Average survival for patients with distant metastases at the time of diagnosis is 3 years, but tumor type (Gleason grade and score) is also of importance.

Up until 30 years ago, 70-75% of all known prostate cancer was locally advanced (T>2) or metastatic. The introduction of the PSA test (see diagnostics) has led to a 75% localized disease at the time of detection (T≤2).

 

 

Five-year relative survival for patients with prostate cancer, in percent, according to stage and diagnosis period 1974-2013.

Source: Cancer Registry of Norway

 

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