Prostate cancer natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D.  Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.
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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.
- Public health records document that men in the United States have a one in six lifetime risk of developing prostate cancer.
- 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%.
- A total of 17% of men with no visible lesion developed a visible lesion at a median follow up of 3.6 years.
- Between 2010 and 2016, the 5-year relative survival of patients with prostate cancer was 97.8%.
- 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.
- 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:
|Stage||5-year relative survival (%), (2010-2016)|
- 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.
- 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:
- Sexual dysfunction
- Pathologic fractures
- Spinal cord compression
- Hypercalcemia or Hypocalcemia
- ↑ Kessler B, Albertsen P (May 2003). "The natural history of prostate cancer". Urol. Clin. North Am. 30 (2): 219–26. PMID 12735499.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 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.
- ↑ 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.