Prostate cancer natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Prostate cancer testing is a partially observable process, and planning for testing requires either extrapolation from randomised controlled trials or, more flexibly, modelling of the cancer natural history. No long-term outcome data are available from the [[PSA]] era. Patients and clinicians therefore need to evaluate historic series in the context of contemporary practice. Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55-69 years was predicted to reduce prostate cancer incidence by 14% and increase prostate cancer mortality by 2%. [[Prognosis]] of prostate cancer is generally good, and the 5-year [[survival rate]] is approximately 98.9%. The [[prognosis]] varies with the stage of [[tumor]]; Localized and regional tumors have the most favorable prognosis. Malignant cells are widely disseminated in men with advanced prostate cancer. However, metastases preferentially develop in the bones of the [[axial skeleton]], where red marrow is most abundant. Complications include pain requiring irradiation, pathologic fractures, [[Spinal cord compression|spinal cord compressio]]<nowiki/>n.


==Natural history==
==Natural History==


==Complications==
*Public health records document that men in the United States have a one in six lifetime risk of developing prostate cancer.<ref name="pmid12735499">{{cite journal |vauthors=Kessler B, Albertsen P |title=The natural history of prostate cancer |journal=Urol. Clin. North Am. |volume=30 |issue=2 |pages=219–26 |date=May 2003 |pmid=12735499 |doi= |url=}}</ref>
*Many men will die from competing medical hazards, not prostate cancer. Prostate cancer is often a slowly progressive disease.
*Men with newly diagnosed disease often face difficult choices regarding appropriate treatment. To make an informed decision, men require information concerning the natural history of prostate cancer, the impact of competing medical hazards, and the efficacy of treatment.
*During the last several decades, a number of researchers have contributed to the understanding of the natural history of prostate cancer. *Their work was performed in the era preceding widespread testing for [[prostate-specific antigen]] ([[PSA]]).
*Since the introduction of testing for [[PSA]] during the late 1980s, the incidence of prostate cancer has risen dramatically and mortality from this disease has declined.
*Unfortunately, no long-term outcome data are available from the [[PSA]] era. Patients and clinicians therefore need to evaluate historic series in the context of contemporary practice.
*Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55-69 years was predicted to reduce prostate cancer incidence by 14% and increase prostate cancer mortality by 2%.<ref name="pmid30763406">{{cite journal |vauthors=Karlsson A, Jauhiainen A, Gulati R, Eklund M, Grönberg H, Etzioni R, Clements M |title=A natural history model for planning prostate cancer testing: Calibration and validation using Swedish registry data |journal=PLoS ONE |volume=14 |issue=2 |pages=e0211918 |date=2019 |pmid=30763406 |doi=10.1371/journal.pone.0211918 |url=}}</ref>
*A total of 17% of men with no visible lesion developed a visible lesion at a median follow up of 3.6 years.<ref name="pmid30038388">{{cite journal |vauthors=Giganti F, Moore CM, Punwani S, Allen C, Emberton M, Kirkham A |title=The natural history of prostate cancer on MRI: lessons from an active surveillance cohort |journal=Prostate Cancer Prostatic Dis. |volume=21 |issue=4 |pages=556–563 |date=November 2018 |pmid=30038388 |doi=10.1038/s41391-018-0058-5 |url=}}</ref>


==Prognosis==
==Prognosis==
Prostate cancer rates are higher and prognosis poorer in developed countries than the rest of the world. Many of the risk factors for prostate cancer are more prevalent in the developed world, including longer life expectancy and diets high in red meat and dairy products (although it must be noted, that people who consume larger amounts of meat and dairy, also tend to consume fewer portions of fruits and vegetables. It's not currently known whether or not both of this factors, or just one of them, contributes to the occurrence of prostate cancer).<ref>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_prostate_cancer_36.asp ACS :: What Are The Risk Factors for Prostate Cancer?<!-- Bot generated title -->]</ref> Also, where there is more access to screening programs, there is a higher detection rate. Prostate cancer is the ninth most common cancer in the world, but is the number one non-skin cancer in United States men. Prostate cancer affected eighteen percent of American men and caused death in three percent in 2005.<ref>{{cite journal| last=Jemal| first=A| coauthors=Murray T; Ward E; Samuels A; Tiwari RC; Ghafoor A; Feuer EJ; Thun MJ| title=Cancer statistics, 2005| journal=CA Cancer J Clin| year=2005| month=Jan-Feb| volume=55| issue=1| pages=10–30| pmid=15661684}} Erratum in: CA Cancer J Clin. 2005 Jul-Aug;55(4):259.</ref> In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s.<ref>{{cite journal| last=Wakai| first=K| title=Descriptive epidemiology of prostate cancer in Japan and Western countries| journal=Nippon Rinsho| year=2005| month=February| volume=63| issue=2| pages=207–12| pmid=15714967}} Review. {{Ja icon}}</ref> In India in the 1990s, half of the people with prostate cancer confined to the prostate died within ten years.<ref>{{cite journal| last=Yeole| first=BB| coauthors=Sunny L| title=Population based survival from prostate cancer in Mumbai (Bombay), India| journal=Indian J Cancer| year=2001| month=Jun-Dec| volume=38| issue=2–4| pages=126–32| pmid=1259345}}</ref> African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China.<ref>{{cite journal| last=Hsing| first= AW| coauthors=Tsao L, Devesa SS| title=International trends and patterns of prostate cancer incidence and mortality| journal=Int J Cancer| year=2000| month=January 1| volume=85| issue=1| pages=60–7| pmid=10585584| doi=10.1002/(SICI)1097-0215(20000101)85:1<60::AID-IJC11>3.0.CO;2-B}}</ref> In Nigeria, two percent of men develop prostate cancer and 64% of them are dead after two years.<ref>{{cite journal| last=Osegbe| first=DN| title=Prostate cancer in Nigerians: facts and nonfacts| journal=J Urol| year=1997| month=April| volume=157| issue=4| pages=1340–3| pmid=9120935| doi=10.1016/S0022-5347(01)64966-8}}</ref>


In patients who undergo treatment, the most important clinical prognostic indicators of disease outcome are stage, pre-therapy PSA level and Gleason score. In general, the higher the grade and the stage, the poorer the prognosis. [[Nomogram]]s can be used to calculate the estimated risk of the individual patient. The predictions are based on the experience of large groups of patients suffering from cancers at various stages.<ref>{{cite journal | author=Di Blasio CJ, Rhee AC, Cho D, Scardino PT, Kattan MW | title=Predicting clinical end points: treatment nomograms in prostate cancer | journal=Semin Oncol | year=2003 | pages=567–86 | volume=30 | issue=5  | pmid=14571407 | doi=10.1016/S0093-7754(03)00351-8}}</ref>
*Between 2010 and 2016, the 5-year relative survival of patients with prostate cancer was 97.8%.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
*When stratified by age, the 5-year relative survival of patients with prostate cancer was 99.1% and 98.8% for patients <65 and ≥ 65 years of age respectively.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2015/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
*The survival of patients with prostate cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of prostate cancer:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2015/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
{| style="cellpadding=0; cellspacing= 0; width: 400px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''5-year relative survival (%), (2010-2016)'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''All stages'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |97.8%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Localized'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |100%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |100%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |30.2%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |83.3%
|}
 
*Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1975 and 2011 of prostate cancer by stage at diagnosis according to [[SEER]]. These graphs are adapted from [[SEER]]: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
[[File:5 YEAR SEER.jpg|thumb|792x792px|center]]
 
==Complication==
 
*Most prostate cancers are diagnosed in the local stage and are asymptomatic.
*Prostate cancer may present with nonspecific urinary symptoms, hematuria, or hematospermia; however, these are usually due to non-malignant conditions. Among the six percent of patients whose prostate cancer is metastatic at the time of diagnosis, bone pain may be the presenting symptom. Bone is the predominant site of disseminated prostate cancer, and pain is the most common manifestation of bone metastases. other complication includes:<ref name="pmid19541477">{{cite journal |vauthors=Collin SM, Metcalfe C, Donovan JL, Athene Lane J, Davis M, Neal DE, Hamdy FC, Martin RM |title=Associations of sexual dysfunction symptoms with PSA-detected localised and advanced prostate cancer: a case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study |journal=Eur. J. Cancer |volume=45 |issue=18 |pages=3254–61 |date=December 2009 |pmid=19541477 |doi=10.1016/j.ejca.2009.05.021 |url=}}</ref><ref name="pmid16983113">{{cite journal |vauthors=Keating NL, O'Malley AJ, Smith MR |title=Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer |journal=J. Clin. Oncol. |volume=24 |issue=27 |pages=4448–56 |date=September 2006 |pmid=16983113 |doi=10.1200/JCO.2006.06.2497 |url=}}</ref>
**Sexual dysfunction
**Fatigue
**Pathologic fractures
**[[Spinal cord compression]]
**[[Hypercalcemia]] or [[Hypocalcemia]]
**[[Anemia]]
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Disease]]
[[Category:Urology]]
[[Category:Types of cancer]]
{{WH}}
{{WS}}

Latest revision as of 15:55, 14 January 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]

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Overview

Prostate cancer testing is a partially observable process, and planning for testing requires either extrapolation from randomised controlled trials or, more flexibly, modelling of the cancer natural history. No long-term outcome data are available from the PSA era. Patients and clinicians therefore need to evaluate historic series in the context of contemporary practice. Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55-69 years was predicted to reduce prostate cancer incidence by 14% and increase prostate cancer mortality by 2%. Prognosis of prostate cancer is generally good, and the 5-year survival rate is approximately 98.9%. The prognosis varies with the stage of tumor; Localized and regional tumors have the most favorable prognosis. Malignant cells are widely disseminated in men with advanced prostate cancer. However, metastases preferentially develop in the bones of the axial skeleton, where red marrow is most abundant. Complications include pain requiring irradiation, pathologic fractures, spinal cord compression.

Natural History

  • Public health records document that men in the United States have a one in six lifetime risk of developing prostate cancer.[1]
  • Many men will die from competing medical hazards, not prostate cancer. Prostate cancer is often a slowly progressive disease.
  • Men with newly diagnosed disease often face difficult choices regarding appropriate treatment. To make an informed decision, men require information concerning the natural history of prostate cancer, the impact of competing medical hazards, and the efficacy of treatment.
  • During the last several decades, a number of researchers have contributed to the understanding of the natural history of prostate cancer. *Their work was performed in the era preceding widespread testing for prostate-specific antigen (PSA).
  • Since the introduction of testing for PSA during the late 1980s, the incidence of prostate cancer has risen dramatically and mortality from this disease has declined.
  • Unfortunately, no long-term outcome data are available from the PSA era. Patients and clinicians therefore need to evaluate historic series in the context of contemporary practice.
  • Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55-69 years was predicted to reduce prostate cancer incidence by 14% and increase prostate cancer mortality by 2%.[2]
  • A total of 17% of men with no visible lesion developed a visible lesion at a median follow up of 3.6 years.[3]

Prognosis

  • Between 2010 and 2016, the 5-year relative survival of patients with prostate cancer was 97.8%.[4]
  • When stratified by age, the 5-year relative survival of patients with prostate cancer was 99.1% and 98.8% for patients <65 and ≥ 65 years of age respectively.[4]
  • The survival of patients with prostate cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of prostate cancer:[4]
Stage 5-year relative survival (%), (2010-2016)
All stages 97.8%
Localized 100%
Regional 100%
Distant 30.2%
Unstaged 83.3%
  • Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1975 and 2011 of prostate cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[4]

Complication

  • Most prostate cancers are diagnosed in the local stage and are asymptomatic.
  • Prostate cancer may present with nonspecific urinary symptoms, hematuria, or hematospermia; however, these are usually due to non-malignant conditions. Among the six percent of patients whose prostate cancer is metastatic at the time of diagnosis, bone pain may be the presenting symptom. Bone is the predominant site of disseminated prostate cancer, and pain is the most common manifestation of bone metastases. other complication includes:[5][6]

References

  1. ↑ Kessler B, Albertsen P (May 2003). "The natural history of prostate cancer". Urol. Clin. North Am. 30 (2): 219–26. PMID 12735499.
  2. ↑ Karlsson A, Jauhiainen A, Gulati R, Eklund M, Grönberg H, Etzioni R, Clements M (2019). "A natural history model for planning prostate cancer testing: Calibration and validation using Swedish registry data". PLoS ONE. 14 (2): e0211918. doi:10.1371/journal.pone.0211918. PMID 30763406.
  3. ↑ Giganti F, Moore CM, Punwani S, Allen C, Emberton M, Kirkham A (November 2018). "The natural history of prostate cancer on MRI: lessons from an active surveillance cohort". Prostate Cancer Prostatic Dis. 21 (4): 556–563. doi:10.1038/s41391-018-0058-5. PMID 30038388.
  4. ↑ 4.0 4.1 4.2 4.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  5. ↑ Collin SM, Metcalfe C, Donovan JL, Athene Lane J, Davis M, Neal DE, Hamdy FC, Martin RM (December 2009). "Associations of sexual dysfunction symptoms with PSA-detected localised and advanced prostate cancer: a case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study". Eur. J. Cancer. 45 (18): 3254–61. doi:10.1016/j.ejca.2009.05.021. PMID 19541477.
  6. ↑ Keating NL, O'Malley AJ, Smith MR (September 2006). "Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer". J. Clin. Oncol. 24 (27): 4448–56. doi:10.1200/JCO.2006.06.2497. PMID 16983113.

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