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What is the life expectancy of prostate cancer?

introduction

Prostate cancer is the most common malignant cancer in men. It is generally a slow growing or slow progressive cancer compared to other cancers, so the prognosis is generally relatively good.

The likelihood of developing prostate cancer increases with age.

Often there are no symptoms or symptoms at the onset of the disease, which is why preventive examinations are recommended from a certain age (since prostate cancer is a very common cancer).

From the age of 45, the preventive medical check-up should be carried out once a year, so that in the event of an illness, an early detection and thus an early initiation of therapy can take place.

What positively influences the life expectancy of prostate cancer?

The following factors are important for the prognosis of life expectancy:

the classification of the tumor according to the TNM classification,
the Gleason score and
the condition of the resection margins after surgery.

The TNM classification is a classification of cancers. These include the spread of the tumor (T), the involvement of lymph nodes (N) and the degree of metastasis (M).

The spread of the tumor is given in T1-T4. T1 is a sparse tumor that cannot be seen or felt. T2 is also a sparse tumor that is only limited to the prostate. At T3 the capsule of the prostate is already affected by the tumor and at T4 the spread has already spread to the surrounding tissue.

The classification of lymph node involvement states that either there is no involvement (N0) or that there is an involvement of the lymph nodes (N1).
The metastasis is classified in the same way: M0 means that there are no metastases, while M1 represents the presence of metastases.

The low values in this classification are positive for life expectancy. That means, T1 or T2 are cheaper than T3 or T4. It is also true that the absence of lymph node involvement (N0) and the absence of metastases (M0) have a positive effect on life expectancy.

The Gleason score can be calculated after a tissue removal (biopsy) or after surgery through the removed prostate. In the Gleason score, the change in the prostate cells is assessed under the microscope. The value of the Gleason score gives the most frequent cell proportion together with the most changed cell proportion. A low value in the Gleason score is a favorable factor for the prognosis.

Another point that is important for the prognosis is the condition of the surgical resection margins after an operation, these are referred to as R0 - R2. This means that after an operation, the edges of the removed tumor are examined to see whether everything has really been removed from the tumor (R0) or whether the tumor tissue still reaches the resection edges (R1). The latter would mean that there is probably still tumor tissue left in the body. A completely removed tumor (R0) is positive for the prognosis.

There is evidence that lifestyle, and especially eating habits, promote and influence the development and progression of prostate cancer.

So it happens e.g. in America to 10 times as many new cases compared to Japan. This is justified by the Japanese diet, which is plant-rich and fish-based. Especially fried red meat and animal fats are suspected of promoting cancer. A change in diet can definitely have a positive effect on life expectancy. But it cannot replace medical treatment.

Taking statins, which are actually prescribed for high choleseterin levels, can improve the prognosis of prostate cancer. Cholesterol is needed for the formation of new cells and by lowering it, the formation of new tumor cells is also inhibited.
The attending physician decides whether it makes sense to take cholesterol-lowering drugs for prostate cancer or not.

All of these factors are considered together and, together with the age and general condition of the person concerned, influence life expectancy.

You might also be interested in this topic: What are the chances of a cure for prostate cancer?

What negatively affects prostate cancer life expectancy?

The factors explained in the above section can also have a negative influence on life expectancy, depending on their severity.

With regard to the TNM classification, higher values have a rather negative impact on life expectancy. In the spread of the tumor, T3 or T4 are less favorable than T1 or T2. If the lymph nodes are already infected (N1) or if there are already metastases (M1), this has an unfavorable influence on the prognosis and life expectancy.

If the values in the Gleason score are high, this has a rather negative impact on the prognosis. This means that the prostate cells show frequent and severe changes under the microscope.

If, after surgical removal of the prostate cancer, there are still remnants of tumor cells (R1) at the resection margins, the influence on the prognosis is more negative than a completely removed tumor (R0).

Apart from the stage of prostate cancer, the general state of health plays a role in the course of the disease.
The Charlson score can be used to determine the effects of comorbidities on prognosis. The points assigned to the various diseases are added up. The most serious of these are AIDS and a metastatic solid tumor.

The number and severity of additional illnesses as well as the age of the patient have a negative effect on life expectancy, but no precise prognoses can be made.

In general, these factors have more of an influence on therapy planning. For example, old age can speak against an operative intervention. This differs from patient to patient and the expertise of several doctors is used when deciding on therapy.

Of course, the patient can also refuse the treatment or opt for a palliative concept. This can shorten survival time.

It should also be noted that an unhealthy lifestyle (little physical activity, a one-sided diet low in plants, alcohol abuse, etc.) does not help to improve prostate cancer either.

The influence of the psyche on the course of the disease should not be underestimated, even if scientific data are difficult to collect. However, if you are convinced in advance that you will die soon, no treatment measures will help in the long term.
Psychological or spiritual support can solve negative thought patterns and thus contribute to improvement.

How is life expectancy related to the Gleason score?

Together with the PSA value and the TNM classification, the Gleason score can determine the prognosis for prostate cancer. To determine the Gleason score, after a removal of prostate tissue (biopsy) examines the stages of cell degeneration under a microscope.
In the histological picture, cancerous ulcers no longer show the normal layering of tissue.

To determine the Gleason Score, the worst and the most frequently occurring value in the tissue sample are added. The lowest degree of degeneration is 1 and the highest 5, so that in the worst case a Gleason score of 10 can occur.

A Gleason score of> 8 indicates a rapidly and aggressively growing carcinoma. A lower value in the Gleason score represents a more favorable prognosis.

Risk of developing a relapse:

low risk with Gleason score up to 6 and / or PSA up to 10 ng / ml
Medium risk with a Gleason score of 7 and / or PSA greater than 10 ng / ml to 20 ng / ml
high risk with Gleason score from 8 and / or PSA over 20 ng / ml

In palliative treatment of prostate cancer, a Gleason score of up to 6 results in a mortality of less than 25%, a Gleason score of 7 with 50%, and a Gleason score above 8 with a mortality of over 75%.

How is life expectancy related to PSA value?

PSA stands for “Prostate Specific Antigen”, i.e. this enzyme is only produced in the prostate. The value is checked for early diagnosis, to assess the course of treatment and to classify the tumor.

This value is therefore indirectly related to life expectancy because it is used to classify the tumor as a high-risk or low-risk tumor or to check the success of the therapy initiated.

It is a protein that can be determined in blood serum. However, it not only indicates prostate cancer, but is also increased in the case of infections, urinary retention or benign prostate enlargement.

The normal value is below 4 ng / ml.

In order to be able to estimate whether a relapse will occur, the tumor stage, the Gleason score and the PSA value can be used for prognosis.
For example, a PSA value below 10 ng / ml has a low risk, below 20 ng / ml a medium risk and a PSA value above 20 ng / ml a high risk of recurrence.

In the event of a relapse, i.e. the recurrence of cancer, the prognosis worsens and life expectancy decreases. However, it is not possible to make an exact time estimate of life expectancy based on the changing PSA values.

Read more about the PSA level in prostate cancer or generally to PSA value.

Life expectancy in stage 1

Stage 1 prostate cancer describes a condition in which the cancer is confined to the prostate, less than 50% of one side of the prostate is involved, and there are no lymph node involvement or metastases.

Also read: What are the stages in prostate cancer?

In addition to the stage, the value of the Gleason score is also important; at this low stage, the assessment of the PSA value also plays a role, and if an operation has already taken place, the assessment of the resection margins is important.

If both the Gleason score and PSA are low and the resection margins do not show any remains of tumor cells, the prognosis for life expectancy is good. For more detailed information, the present values should be discussed with the attending physician.

Life expectancy in stage 2

In stage 2, more than 50% of one side or both sides of the prostate is affected. But the tumor is still limited to the prostate, no other organs are involved and there is no involvement of the lymph nodes or metastases.

One can still speak of the early stage and there are numerous options for treating prostate cancer.

At this stage, prostate cancer is still in a locally limited form. Again, the values of the Gleason score, the PSA value and the nature of the resection margins (in the case of an operation that has already taken place) must be taken into account.

If these values are low and the resection margins show no signs of remaining tumor cells, there is still a relatively good prognosis for life expectancy.

Life expectancy in stage 3

Stage 3 describes a condition in which the capsule of the prostate has already been breached by the tumor or the seminal vesicle has already been infected by tumor cells. This stage therefore already describes a locally advanced form of prostate cancer.

Compared to the previous stages, life expectancy is limited due to the greater spread.

But here, too, it is again the case that in addition to the stage, the values from the Gleason score, the PSA value and the resection margins must be assessed. The values are discussed with the attending physician and the potential course of the disease is assessed on the basis of the values available.

Life expectancy at stage 4

Prostate cancer is already very advanced in stage 4. It has either already affected other organs such as the bladder, rectum or pelvic wall, or the lymph nodes, or distant metastases already exist. A combination of the states is also possible.

The prognosis for advanced or metastatic prostate cancer is worse compared to the other stages. But even at this stage, life expectancy is estimated taking into account the Gleason score, the PSA value and the resection margins of the prostate cancer as well as the general condition and age.

You might also be interested in this topic: What is the terminal stage of prostate cancer?

What is the life expectancy if I have metastases?

Prostate cancer is a type of cancer that progresses rather slowly overall. It is therefore difficult to say exactly how long the life expectancy is in the presence of metastases.

Prostate cancer that has already caused metastases (daughter ulcers) has a worse prognosis than a tumor that is confined to the prostate. The further away the metastases are from the prostate, the more advanced the cancer is.

Metastases of the lymph nodes in the pelvis, the spine and other bones are typical of prostate cancer. The metastases can often cause back pain.

In addition, it plays a role in life expectancy whether the metastases can be surgically removed, whether they are fused with nerve fibers or important blood vessels or not.

In addition, aspects such as comorbidities, the general condition and the age of the person affected are important for the prognosis. If, in addition to the metastases, there are also many concomitant diseases, a weakened general condition and a very old age, this has a rather negative effect on the prognosis.

Read more on the subject at: Metastases in prostate cancer

What is life expectancy without treatment?

In some forms of prostate cancer, it is not possible to initiate active treatment immediately.

This process is called “Active Surveillance” and includes check-ups that must be carried out regularly so that therapy can be initiated immediately if the condition deteriorates. The decision should only be made after careful information and detailed discussion with the attending physician.

The idea behind this is that there are also less aggressive variants of prostate cancer that do not require immediate treatment and so the person affected is not over-treated. But close monitoring is necessary in order to ensure that the person concerned receives adequate treatment in the event of deterioration.

If the person concerned has a very advanced tumor, for which no healing (curative) Treatment is more possible, there is the possibility of initiating palliative therapy. The aim is to improve the quality of life of the person affected by alleviating the symptoms. Complaints such as pain, depression or exhaustion are reduced as much as possible in palliative treatment.

Also read our topic: Treatment of prostate cancer

However, prostate cancer often grows very slowly and not every patient has to expect a reduction in life expectancy. There are numerous indications that there are significantly more undiagnosed prostate cancer sufferers who do not know anything about the tumor and do not die from it.

The Center for Cancer Registry Data of the Robert Koch Institute gives a relative 5-year survival rate of 91% and a relative 10-year survival rate of 90% of all prostate cancer patients, while for comparison half of all patients with cancer of the mouth and throat have none Survived 5 years and only a little more than a third are still alive after 10 years (data from 2014).

This shows that life expectancy with prostate cancer (even without active measures) is generally much better than with other types of cancer.