Diagnosed with Prostate Cancer : What will happen to me?

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What will happen to me?
BMJ Group, Monday 13 October 2008
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If you or someone you know has been diagnosed with prostate cancer, you may want to find out all you can about what lies ahead. But no one can say for certain what will happen to you.

Doctors usually talk about the percentage of men who are likely to be alive in five years or ten years. You may find it easier to cope if you know these figures. On the other hand, you may find this kind of information confusing and frightening.

If you don't want to read about figures on surviving prostate cancer, then skip this page. If you do read on, please remember that we cannot tell you what your own chances of surviving the disease are.

What lies ahead?

Most prostate cancers grow slowly, and many men live for years without experiencing any symptoms. So although 1 man in 14 will be diagnosed with prostate cancer, only 1 in 25 will die of the disease.[3] [1] [2] Three-quarters of men with prostate cancer will still be alive 1 year after being diagnosed.[1] And about half live for at least 5 years after it is diagnosed.[1] [2]

There are two factors that doctors use to predict what may happen to you. The first is the TNM stage of your cancer. TNM stands for 'tumour, node, metastasis', and this staging system looks at how far your cancer has spread and whether any lymph nodes have been affected.

The second factor doctors look at is the grade of your tumour. Your cancer grade is determined by your Gleason score, a system that rates how aggressive your cancer looks under a microscope. The more your cancer cells look like normal prostate cells, the lower your grade and the better your chances. A low-grade tumour (Gleason score 2 to 4) is likely to be growing slowly, while a high-grade tumour (Gleason score 8 to 10) is more likely to grow aggressively or to have already spread.

If you have been diagnosed at an early stage of the disease (stages 1 and 2) and the cancer has not spread beyond your prostate, there's a good chance that you will live as long as someone who does not have prostate cancer. Between 65 and 98 out of every 100 men with the early stage of prostate cancer are still alive 5 years after their diagnosis (even without any treatment).[2] It's great to be alive 5 years after doctors told you that you have prostate cancer, but it doesn't necessarily mean that you are cured. (Many men don't get any treatment, so they can't be called 'cured'). You will probably always need to have regular check-ups.
If your cancer has spread to the organs close to your prostate, the cancer is not usually curable, but your chances of surviving the disease are still good.
Most men who have prostate cancer that has spread to more distant parts of their body or to their bones (called metastatic disease) will die from it. Only a third of these men will still be alive five years after being diagnosed.[2]
Your age and general health can affect whether you will survive your cancer. If you are older, say, over 70, and have other health problems, such as heart disease or diabetes, you may be more likely to die from these conditions than from your cancer. The chances of dying from prostate cancer is larger if you are a younger man, as you are less likely to have other health problems. You also have longer to live, which means the disease has more time to get worse.
Here is some more detailed information about what may happen to you:

If your cancer has not spread beyond your prostate

This is known as clinically localised cancer. Doctors classify it as T1 or T2 in the TNM system.

Almost all men whose cancer has not spread beyond their prostate will be alive 5 years after diagnosis. [2]

If your cancer has spread into tissues or organs next to your prostate

This is called locally advanced cancer, and doctors classify it as T3 or T4 in the TNM system.

Around 20 to 30 percent of men diagnosed with prostate cancer have cancers that have already spread outside the prostate to nearby tissue.[2]
About 6 in 10 of these men (60 percent) will live for at least 5 years.[2]
You have about a 30 percent chance that your disease will have spread to other organs and bones (called metastatic disease) 10 years after your diagnosis.
Men whose cancer has spread may develop symptoms such as blood in their urine (called haematuria), problems passing urine and swollen lower legs.
Treatments for locally advanced cancer may help you live longer, but the evidence on this is not certain. For more about treatments, see What treatments work for prostate cancer?
If your cancer has spread to your bones and other distant parts of your body

This is called metastatic disease.

About one-third of men whose cancer has spread to other places in their body will live for 5 years. Most men will live between 2 and 3 years.[4]
Cancer that has spread to your bones can be very painful. Men with metastatic disease may also develop anaemia, which means they have too few red blood cells. This causes extreme tiredness. Advanced cancer may also lead to loss of appetite.
What to ask your doctor about what will happen to you

What is the stage and grade of my cancer?
How does the stage and grade of my cancer affect my chances of survival?
What about my age and my general health? Will this affect what will happen to me? (If you are older and the disease is in its early stages, you may be less likely to develop any symptoms in your lifetime and you may not die from this disease.)
What treatments can I have? Can they stop my cancer from spreading and causing symptoms? Will they increase my chances of surviving?
If you have other health problems, you may also want to ask how serious these conditions are compared with your stage of prostate cancer.

References

NHS cancer screening programmes. NHS Prostate Cancer Risk Management Statistics. Available at http://www.cancerscreening.nhs.uk/prostate/statistics.html (accessed on 19 November 2006).

Majeed A, Babb P, Jones J, et al. Trends in prostate cancer incidence, mortality and survival in England and Wales 1971-1998. BJU International. 2000; 85: 1058-1062.

Cancer Research UK. Prostate cancer: statistics and prognosis. Available at http://www.cancerhelp.org.uk/ (accessed on 5 March 2004).

Pound CR, Partin AW, Eisenberger MA, et al. Natural history of progression after PSA elevation following radical prostatectomy. Journal of the American Medical Association. 1999; 281: 1591-1597.

Glossary

lymph nodes

Lymph nodes (also called lymph glands) are small, bean-shaped lumps that you can't usually see or feel easily. You have them in various parts of your body, such as your neck, armpit and groin. Lymph nodes filter lymph and remove unwanted things from your body, such as bacteria and cancer cells.

diabetes

Diabetes is a condition that causes too much sugar (glucose) to circulate in the blood. It happens when the body stops making a called (type 1 diabetes) or when insulin stops working (type 2 diabetes).

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