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Prognosis of prostate cancer

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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