What is the outlook for prostate cancer?

Niamh van Meines
Nursing Specialist

Prostate cancer is usually a slow growing cancer and there are a number of treatments. Depending on the age of the person when diagnosed, the extent of the disease and the treatment, the risks of dying from prostate cancer vary. Many men live long productive lives after a diagnosis of prostate cancer due to the slow progression of the disease over time and the treatment that they receive. Having said that, over time, the likelihood of dying from prostate cancer eventually is high.

Like most cancers, the ability to survive depends on the patient’s stage and the grade of the disease. The stage refers to “how much” cancer one has. The grade tells you “how aggressive” the cancer is.

The good news is, rates of prostate cancer have dropped considerably in the United States. The National Cancer Institute reports that in 1992 there were 234 new cases for every 100,000 Americans; now that figure is under 100 per 100,000. Overall, the American Cancer Society (ACS) projects 164,690 new cases of prostate cancer in 2018 and 29,430 deaths. From a male US population of 161 million, that's a tiny .02 percent chance of dying from prostate cancer in a given year. Of course, the figures change as you narrow the population based on factors like age, and risk factors like smoking, being overweight and not getting proper exercise. The ACS estimates that 1 in 9 American males will be diagnosed in their lifetime with prostate cancer, and 1 in 41 will die of the disease.

The outlook or likely prognosis for prostate cancer is affected by different factors. The main factors affecting the outcome of your cancer are the:

  • PSA level
  • Gleason grade and score
  • Stage

PSA level: PSA (Prostate Specific Antigen) is a protein produced by both normal and prostate cancer cells. A high level of PSA can be a sign of cancer. However, the PSA level can also be raised in prostate conditions that are non-cancer (benign). Most common examples are BPH (Benign Prostatic Hyperplasia) and Prostatitis (infection). PSA is checked by taking a blood sample.

The major challenge (for PSA testing), is to identify the cases that need to be treated while avoiding diagnosing patients who will not benefit from being diagnosed and who will only suffer from the stigma of being a cancer patient and possible consequences/complications of overtreatment.

Gleason grade or score: A prostate biopsy is used to confirm the diagnosis. The tissue is viewed with a microscope and the results are reported using a Gleason grade and a Gleason score. The Gleason grade is based on how the cells vary from normal prostate cells. The cells are graded on a scale of 1 – 5 and reflect the aggressiveness of the tumor. More than one Gleason grade is often present. Therefore, the 2 predominant Gleason grades are added together to give a Gleason score.

  • Scores 2 - 4: Low-grade cancer
  • Scores 5 - 7: Intermediate- (or in the middle-) grade cancer. Most prostate cancers fall into this category.
  • Scores 8 - 10: High-grade cancer (poorly-differentiated cells)

Stage: Similar to other types of cancer, the outcome or prognosis of prostate cancer depends on whether or not it has spread when it is diagnosed. The American Joint Committee on Cancer (AJCC) TNM system is the most widely used staging system for prostate cancer. It is based on 5 key pieces of information:

  • The extent of the primary tumor (T category)
  • Whether the cancer has spread to nearby lymph nodes (N category)
  • The absence or presence of distant metastasis (M category)
  • The PSA level at the time of diagnosis
  • The Gleason score, based on the prostate biopsy (or surgery)

The best prostate cancer outlook or prognosis is for patients with well-differentiated (low-grade), small, slow-growing tumors. It is very important for you to speak with your healthcare provider or be referred to a cancer specialist when making treatment decisions.

Most prostate cancer patients can live a long time after diagnosis. In this video, William Oh, MD, an oncologist at The Mount Sinai Medical Center, explains that some kinds of prostate cancer, however, are aggressive and have a higher mortality rate.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.