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.
Survival Rate After Prostate Removal And Radiation
Radical prostatectomy can provide cancer-specific survival of 15 years or more in 80% of patients with limited prostate cancer.
- In patients with well differentiated prostate cancers having Gleason scores of 2 to 4, the 10-year PSA progression-free survival is about 70 to 80% with radiation therapy or surgery.
- The 10-year PSA progression-free survival drops to 50 to 70% for Gleason scores of 5 to 7. Eight-year survival for clinically localized tumors with Gleason score less that 7 is 85-95%.
- The 10-year PSA progression-free survival drops further down to 15% to 30% for Gleason scores of 8 to 10 with a 8-year survival rates of about 70%.
- The distant metastasis-free survival response to radiotherapy is influenced by the dose of radiotherapy.
- High-risk patients with Gleason scores of 7 have 8-year survival rates of about 70%, while those with Gleason scores of 8 to 10 have an 8-year survival of about 50% following radiation therapy.
Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
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Survival By Disease Recurrence
If a man develops an elevated PSA level after cancer surgery, then the disease is viewed as recurrent.
The number of lymph nodes at the time of prostatectomy can influence the risk of recurrence. One study suggests the removal of a large number of nodes is associated with an improvement in odds of recurrence, but this doesn’t appear to impact overall survival.
But disease recurrence doesn’t always influence survival times. If a recurrence does occur, the 15-year survival rate at the time of diagnosis may be as high as 94% in those with low-risk recurrence.
The main factors influencing survival rates are:
- The Gleason score
- The PSA doubling time
- Whether the recurrence occurred within three years or after three years
A recurrence that occurs within three years reduces survival rates by anywhere from 15 to 20%and even more, if the doubling time is short.
Gleason Score For Grading Prostate Cancer
Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.
The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.
Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
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Should I Get A Second Opinion About My Gleason Score And Prostate Cancer Diagnosis
It is always the patient’s right to obtain a second opinion about a cancer diagnosis or any other medical condition. Talking to a radiation oncologist will allow them to review your pathology report and request any other tests they may need to make sure you have the right information to make a decision about your treatment plan.
If you would like one of our radiation oncologists to review your pathology report, you only need to sign a release so we can have your biopsy material sent to us. We can then determine the Gleason score our team sees. Most of the time, the Gleason score we determine is the same, but not always. Because the Gleason score is the most important issue about your particular cancer, we want it to be as accurate as possible.
It’s critical to personally research prostate cancer treatment options to make an informed decision that is best for you and your family. And, with few exceptions, your first treatment gives you the best chance for success. If your urologist has told you that you have a Gleason score of 6 – 10, or you would like a second opinion, request an appointment for a consultation.
Table 1 Why A Low Psa Does Not Mean You Are Cancer
The Prostate Cancer Prevention Trial included a provision that men randomized to receive placebo undergo a prostate biopsy at the end of the study, even if they had normal PSA levels and digital rectal exams. To their surprise, investigators found that many of these men had prostate cancer in some cases, high-grade prostate cancer.
PSA level 13 *Note: A PSA level over 4.0 ng/ml traditionally triggers a biopsy. Adapted with permission from I.M. Thompson, et al. Prevalence of Prostate Cancer Among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004, Table 2.
This study inadvertently provided evidence not only that prostate cancer occurs more often than once believed, but also that PSA levels may not be a reliable indicator of which cancers are most aggressive. Both findings add weight to the growing consensus that many prostate tumors currently being detected may not need to have been diagnosed or treated in the first place.
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What Are The Risks Of Radiation Treatment
Radiation treatment for prostate cancer may increase a mans risk for having another cancer later in life, such as bladder or rectal cancer.
Some radiation side effects, like urinary problems, are usually short-term problems that go away with time. But a radiation side effect can become a long-term problem. Common side effects from radiation treatment include:
- Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
- In one study, 67 out of 100 men had erections firm enough for intercourse before they had radiation. Six years later, 27 out of 100 men who had radiation had erections firm enough for intercourse.footnote 4
For men with intermediate-risk or high-risk prostate cancer, radiation treatment may be given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.
Your doctor might advise you to have surgery if:
- You are healthy enough to have major surgery.
- Radiation therapy isnt a good option for you because you have had previous radiation therapy to your pelvic area or you have a serious bowel disease such as ulcerative colitis.
Your doctor might advise you to have radiation if:
- You want to avoid the side effects of surgery, such as leaking urine and erection problems.
- You have other health problems that make surgery too risky.
Seminal Vesicle And Lymph Node Positive
The determination of risk is not straightforward. As discussed earlier, the three standard prognostic factors are Gleason score, PSA and stage. There are subgroups in each that appear to have a very high risk of recurrence. So the first place to start is whether there are any single factors that portend such a great risk that they alone would indicate the need for adjuvant treatment. One that easily falls into this category is that of positive lymph node metastasis. The risk of failure in these patients is non-controversial and we won’t discuss it further. We would submit that the second of these is that of seminal vesicle involvement, which has been extensively studied .
Definition of failure and disease free survival: based on biochemical failure and includes biopsy proven local recurrence and radiologically detected distant metastasis
* 2 year endpoint for all groups. Mar+ is margin positive Mar- is margin negative EPE+ is extraprostatic extension present EPE- is extraprostatic extension absent foc is focal Ext is extensive Est is established Gl is Gleason score
The limitations of the small numbers of patients in the more favorable subgroups make selecting those patients for avoidance of intervention a risky proposition. In a subgroup analysis of the SWOG adjuvant study , all the subgroups benefitted from adjuvant radiation to the same degree .
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How We Treat Prostate Cancer
The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.
What Is A Bad Gleason Score For Prostate Cancer
Gleason scores aren’t good or bad, per se. They predict how quickly your prostate cancer might grow. Tumors with higher Gleason scores are likely to grow quickly. And Gleason scores aren’t the only factors healthcare providers consider when creating your treatment plan.
What other factors do healthcare providers consider?
Providers consider the results of other tests and additional biopsy information. For example, when you had your biopsy, your healthcare provider obtained several samples or cores from your prostate. They checked how many cores contained cancer and whether most of the cells in the cores were cancerous cells.
Other factors may include:
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Radical Prostatectomy Versus Radiation Therapy
The natural history of the disease, life expectancy of the patient, and potential for cure provide compelling reasons to treat the patient presented in this point-counterpoint discussion aggressively, with the intent to cure the prostate cancer. The next question, and the primary subject of this point-counterpoint discussion, is whether to offer radical prostatectomy or radiation therapy. The decision to offer one treatment or the other must reflect a critical analysis of benefits and risks.
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Prostate Cancer Survival Rates: What They Mean
As cancer diagnoses go, prostate cancer is often a less serious one. Prostate cancer is frequently slow-growing and slow to spread. For many men, prostate cancer is less serious than their other medical conditions.
For these reasons, and possibly because of earlier detection of low-grade prostate cancers, prostate cancer has one of the highest survival rates of any type of cancer. WebMD takes a look at prostate cancer survival rates and what they mean to you.
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Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.
What Is A Normal Gleason Score For Prostate Cancer
Your Gleason score doesn’t rank potential ranges like ranges set for elevated PSA tests. Instead, providers break Gleason scores into three categories:
- Gleason 6 or lower: The cells look similar to healthy cells, which is called well differentiated.
- Gleason 7: The cells look somewhat similar to healthy cells, which is called moderately differentiated.
- Gleason 8, 9 or 10: The cells look very different from healthy cells, which is called poorly differentiated or undifferentiated.
What are grade groups?
Healthcare providers established grade groups to clarify the Gleason score system. Those grade groups are:
- Grade Group 1 = Gleason 6 .
- Grade Group 2 = Gleason 3+4=7.
- Grade Group 3 = Gleason 4+3=7.
- Grade Group 4 = Gleason 8.
- Grade Group 5 = Gleason 9-10.
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Prognostic Factors For Failure After Prostatectomy
Gregory P. Swanson1, Joseph W. Basler2
1. Departments of Radiation Oncology, Radiology and Urology, UT Health Science Center San Antonio, San Antonio, TX 78229, USA.2. Department of Urology, UT Health Science Center San Antonio, San Antonio, TX 78229, USA.
Corresponding author: Gregory P. Swanson, MD, Associate Professor of Radiation Oncology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive MC7889, San Antonio, TX 78229, USA. Tel: 210-450-1109 Fax: 210-450-5085 Email: swansongeduMore
What Is A Gleason Score
If you have prostate cancer, your Gleason score is one factor healthcare providers consider to develop your treatment plan.
Your score reflects what providers learned about your cancer after examining tissue samples from your prostate cancer biopsy. They looked for patterns of normal and abnormal cells, noting where your cells look more like cancerous cells and where they look more like healthy cells.
Then they graded each piece of the pattern on a 3 to 5 scale. Pattern pieces with cancer cells that look like healthy cells were graded low. Pieces with cancer cells that don’t look like healthy cells get high grades.
Providers add those scores to set an overall Gleason score between 6 and 10. They might refine their analysis by classifying your cells by group, with Gleason scores listed in grade groups 1 to 5.
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Get Your Free Prostate Cancer Guidebook
Make an informed prostate cancer treatment decision. Our 40-page, comprehensive guidebook provides answers to our most frequently asked questions from men diagnosed with prostate cancer, and compares various treatment methods, cure rates and side effects. Our team can also connect you with one of our oncologists at no cost.
The Most Common Symptoms Of Stage 3 Mesothelioma Include:
- Shortness of breath
As the tumors continue to grow and spread throughout the chest, symptoms will become more problematic. Stage 3 symptoms vary from patient to patient depending on where the cancer is spreading and if the tumor mass damages vital organs. Some patients may experience referred pain felt in the neck, back or shoulders.
A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties. Pleural mesothelioma tumors also cause increased pleural fluid, which puts pressure on the lungs. Symptoms and characteristics of stage 3 mesothelioma vary based primarily on cancer type.
Connect with a Top Mesothelioma Specialist
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What Does It Mean If My Biopsy Mentions That There Is Perineural Invasion
Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber with the prostate. When this is found on a biopsy, it means there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion does not mean that the cancer has spread, and other factors, such as the Gleason Score and amount of cancer in the cores are more important. In some cases, findings perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.
How Important Is The Gleason Score
The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:
- The blood PSA level
- How much of each core is made up of cancer
- The number of cores that contain cancer
- Whether cancer was found in both sides of the prostate
- Whether the cancer has spread outside the prostate
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What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.