How is prostate cancer diagnosed?Doctors describe the growth and spread of prostate cancer in stages. Doctors use these stages as guides when choosing treatment options or offering prognoses to their patients. Show
Prostate cancer staging is based on a number of different factors, including prostate cancer screening tests such as a digital rectal exam or prostate-specific antigen (PSA) test and imaging studies like bones scans, MRIs, CT scans, and trans-rectal ultrasounds. In order to determine the stage of a patient’s prostate cancer, most doctors start by using the TNM staging system, which helps describe different aspects of the cancer’s growth.
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 patient’s Gleason score and PSA levels assigning of a specific stage to the patient’s 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. Stage-1 Prostate Cancer (I)The tumor is non-detectable by an imaging test or a physical examination in this early stage of prostate cancer. Meaning, the cancer has not spread outside of the prostate. Discovery of prostate cancer at this stage is almost 80%, with a 5-year survival rate of almost 100%. Stage-2 Prostate Cancer (Divided Into IIA and IIB Stages)The tumor may or may not be detectable through a physical examination or imaging tests and still has not spread outside of the prostate. However, in stage-2 the cells have a higher Gleason score and may grow more quickly. Stage-3 Prostate Cancer (III)In this stage, the cancer has now spread beyond the prostate and may spread to the nearby seminal vesicles. This can include some stage-4 prostate cancers that, while they have other advanced indicators, still have not moved to other organs. As with local stage prostate cancers, the 5-year survival rate is nearly 100%. Stage-4 Prostate Cancer (IV)This is the last stage of prostate cancer and describes a tumor that has spread to other parts of the body, including the lymph nodes, lungs, liver, bones, or bladder. For these cancers, the 5-year survival rate is 29%. Keep in mind that every case is different and that statistics such as these are only general guidelines. With advancements in prostate cancer treatment happening at a greater rate, your chances for surviving this disease are increasing. In general, prostate cancer actually has a very high survival rate – one of the highest among all types of cancers. Because prostate cancer is often a slow moving disease, the majority of men diagnosed with prostate cancer will actually pass away from an unrelated cause. General Prostate Cancer Survival RateAccording to the American Cancer Society:
Note: Relative survival rate means the percentage of patients who live [x] 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 Definitions and overviewAdvanced prostate cancer means your disease has spread out of the prostate through the lymph nodes and into other parts of your body. Locally advanced prostate cancer means cancer has spread to the area immediately outside. It may have spread to the seminal vesicles, the lymph nodes in the pelvis or the neck of the bladder. Advanced prostate cancer is the description for cancer has spread (or metastasized) into the soft tissues and bones of your body. This means your cancer cannot be cleared or cured, but the options and life expectancy for men with advanced prostate cancer has been transformed very significantly in recent years. Improvements in life expectancyA decade ago, a man with metastatic prostate cancer would typically have a life expectancy of two to three years. Today, life expectancy for men with the same advanced disease is likely to be five to six years. In the UK the survival rate for men with stage 4 prostate cancer is approximately 50%, meaning that 50 out of every 100 men will survive their cancer for 5 years or more after they are diagnosed with stage 4 prostate cancer*. There is now a much broader range of chemotherapy drugs available for men with advanced disease with greater efficacy (effectiveness). We also have better treatments to control the symptoms of advanced prostate cancer, such as pain from metastases. In this section, we consider in more detail the different treatments that are available and evidence for their effectiveness. First line treatment for advanced prostate cancerThe 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 (including testosterone) 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 can’t, 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 (or MAB) and may be used if hormone treatment alone is not working sufficiently. Recently, a landmark study has called into question the approach of starting with hormone therapy and only introducing chemotherapy one hormone deprivation ceases to have an effect (known as castrate resistant or castrate refractory prostate cancer). The trial, E3805, involved 790 men between July 2006 and November 2012, who were randomly assigned to anti-androgen treatment (ADT) plus six cycles of the chemotherapy drug Docetaxel or ADT alone. 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. “This is an unprecedented improvement in survival,” comments Dr Ahmed El-Modir, Birmingham Prostate Clinic oncologist. “Normally, an improvement in survival of two or three months is considered significant, but 17 months is groundbreaking. “What it tells us is that particularly for men with high volume disease, there is a real benefit in ‘hitting hard’ early on with treatment, rather than taking the traditional stepped approach of hormone therapy then chemotherapy.” Castrate refractory prostate cancer: a wider range of optionsIn this section, we explain the treatments available at Birmingham Prostate Clinic for patients once their disease becomes resistant to hormone treatment, called castrate refractory prostate cancer. Two types of treatments are needed to:
Treatments to control and prevent further cancer spread in patients with castrate refractory advanced prostate cancer:At BPC we offer:
Other treatment options ongoing clinical studies:
Treatments to control and prevent symptoms caused by the spread of prostate cancer to the bonesPalliative External beam radiotherapy Radiopharmaceuticals: Strontium-89 (Metastron), samarium-153 Radium-223 dichloride is now licensed and called Xofigo. This is not widely available in the UK but BPC is one of a relatively small number of specialist centres using this treatment. Zolidronic acid (Zometa) is a bisphosphonate given by a 15-minute intravenous infusion every 3–4 weeks. It reduces the risk of bone complications, including pain and fractures. Xgeva (Denosumab): this is a newly licensed drug available at BPC. Pain medications Surgery may be undertaken to treat bone fractures or to relieve the pressure on the spinal cord by bone metastases. *https://www.cancerresearchuk.org/about-cancer/prostate-cancer/survival How long can you live with metastatic prostate cancer?A decade ago, a man with metastatic prostate cancer would typically have a life expectancy of two to three years. Today, life expectancy for men with the same advanced disease is likely to be five to six years.
How long can you live with Stage 4 metastatic prostate cancer?When prostate cancer reaches stage 4 and has spread (metastasized) to other organs such as the lungs, liver, or bones, the five-year survival rate falls below 30%. At stage 4, prostate cancer is unlikely to be cured, although with effective therapy, many people can live for several years.
Can prostate cancer that has metastasized be cured?This is also called metastatic prostate cancer. Currently, no treatments can cure advanced/metastatic prostate cancer. However, there are effective ways to help slow its spread, prolong life, and control its symptoms, including immunotherapy, hormone therapy, chemotherapy, precision medicine and clinical trials.
What is the survival rate for Stage 4 metastatic prostate cancer?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.
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What is the survival rate of metastatic prostate cancer
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