Men who face the diagnosis of prostate cancer are challenged not only with the prognosis of the disease itself but also with facing the side effects of the potential treatments. Treatments for prostate cancer include chemotherapy, radiation and surgery. All of these often leave men impotent and with bladder control problems. So while the treatment may save some lives they also decimate their masculinity.
The criteria for prostate cancer prognosis isn’t always related to the diagnosis, treatment or disease staging but should also include factors related to the mans quality of life, while he’s living. Based on the side effects of the disease some men choose to take a calculated gamble and hold out against the disease for as long as possible.
For most prostate cancer is slow growing and not immediately lethal. Unfortunately this prognosis isn’t equal among men who are diagnosed with the disease. The ultimate outcome of the cancer appears to be related more to the stage and histology of the cancer when it is discovered than to the treatment path which is chosen.
In a published study in May 2005 more than 90% of men with low grade tumors had not died of prostate cancer within 20 years of the diagnosis despite the ‘watchful waiting’ treatment they had chosen. This treatment strategy, essentially no treatment with consistent monitoring, is sometimes overlooked as an option for men who fit specific criteria. (1)
In a Scandinavian study also published in 2005 found that approximately 8.5% of patients who had surgery died from the cancer within 10 years as opposed to the 14.4% who chose watchful waiting. These rates may be different today because screening methods in 2008 are much improved over those of 1995 when the men first entered this study. (2)
Oncologist have found that men who have smaller, slow-growing and well-differentiated tumors tend to have the best overall prognosis. This means that finding patients alive and disease free for 10 or 15 years after a diagnosis tends to be related more to the stage and grade of the cancer than on the choice of treatment. For instance if the cancer is limited to the prostate and the cells are well differentiated the 5-year prognosis is excellent.
Because of the improved screening abilities available today the good news is that approximately ¾ of all new diagnosed prostate cancers are localized and considered stage one or two. Only about 15% are stage three and 11% stage four.
If the man finds the diagnosis at stage one or two and the cells are well-differentiated the outcome is excellent if watchful waiting, surgery or radiation therapy is chosen. And because the median age of men at diagnosis is 72 years many men die of a variety of other natural causes in the next 10 to 15 years and don’t succumb to the cancer itself. This means that the disease specific survival rate for men in stage I or II is very close to 90% irregardless of treatment options chosen.
Other options for treatment are also available outside of the U.S. in Canada which include the use of high frequency sound waves to kill the cancer cells and leave the man without the other side effects that are common with surgery and radiation. This treatment, High Intensity Focused Ultrasound (HIFU) is available in Canada and Europe but not yet available in the United States.
(1) NY Times: Prostate Cancer In-Depth Report
(2) Institute for Clinical and Economic Review: Active Surveillance and Radical Prostetectomy
Northern Institute of Urology: Clinically Localized Prostate Cancer
American Cancer Society: Prostate Cancer
MayoClinic: Prostate Cancer
Manchester University: Prostate Cancer Prognosis Hope
University of Maryland Medical Center: Prostate Cancer Prognosis
National Cancer Insitute: General Information about Prostate Cancer
Cancer Research UK: Statistics and Outlook for Prostate Cancer