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Glossary


Prognosis and survival for prostate cancer

Men with prostate cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

 

A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.

 

More than 95% of prostate cancers are adenocarcinomas. The majority are slow growing and respond well to treatment. Rare types of prostate cancer include sarcomas, small cell carcinomas and transitional cell carcinomas. These make up less than 5% of all prostate cancers, and their prognosis is different.

 

The following are prognostic factors for adenocarcinoma of the prostate:

Stage

Stage is an important prognostic factor for prostate cancer. The less advanced a prostate cancer is at diagnosis, the more favourable the prognosis.

 

Tumours confined to the prostate (T1 and T2) have a better prognosis than tumours that have spread outside the prostate (T3 and T4).

Gleason score

The Gleason score indicates the aggressiveness of the prostate cancer:

  • Scores less than 7 indicate a more favourable prognosis.
  • A score of 7 indicates an intermediate prognosis.
  • Scores greater than 7 indicate a less favourable prognosis.

Prostate-specific antigen (PSA) level

The prostate-specific antigen (PSA) level at the time of diagnosis may indicate how much prostate cancer is in the body (tumour burden). Higher PSA levels indicate that there is a higher tumour burden in the body. A PSA less than 10 is favourable, while a PSA greater than 20 is considered unfavourable. A PSA between 10 and 20 is intermediate.

Other factors

Other factors may have an effect on a man's overall prognosis for prostate cancer:

  • resistance to hormone treatment
  • age
    • Younger men may have tumours that are more aggressive, with higher Gleason scores.
    • Older men may have other illnesses that could affect the type of prostate cancer treatment they can tolerate.

Stage/prognostic grouping of prostate cancer

The stage/prognostic grouping of prostate cancer is based on the stage, PSA level and Gleason score. This grouping is more accurate than TNM staging alone in assessing prognosis. Men in group I have the best chance of a cure, least chance of a recurrence and a better outlook for survival compared to men in group IV. Group II has the next best prognosis followed by group III. Although men in group IV have a poorer prognosis compared to the other three groups, they may still have effective treatment options to control the cancer, improve quality of life and prolong survival.

UICC stage/prognostic grouping – prostate cancer

 

Group

T

N

M

PSA level

Gleason score

I

T1a–c

N0

M0

PSA <10

Gleason =6

 

T2a

N0

M0

PSA <10

Gleason =6

 

T1–2a

N0

M0

PSA X (unknown)

Gleason X (unknown)

IIA

T1a–c

N0

M0

PSA <20

Gleason 7

 

T1a–c

N0

M0

PSA =10 and <20

Gleason =6

 

T2a–b

N0

M0

PSA <20

Gleason =7

 

T2b

N0

M0

PSA X (unknown)

Gleason X

(unknown)

IIB

T2c

N0

M0

any PSA

any Gleason

 

T1–2

N0

M0

PSA =20

any Gleason

 

T1–2

N0

M0

any PSA

Gleason =8

III

T3a–c

N0

M0

any PSA

any Gleason

IV

T4

N0

M0

any PSA

any Gleason

 

any T

N1

M0

any PSA

any Gleason

 

any Gleason

 

Doctors also use nomograms to predict prognosis in different prostate cancer situations. Nomograms are statistical models that predict probable outcome. They take into account the stage, Gleason score, PSA level, biopsy pathology reports, use of hormone therapy, radiation dosage as well as other specific individual information such as age or treatment already received.

 

Cancer of the Prostate Risk Assessment (CAPRA) nomogram calculates the risk of metastasis and the risk to the life of the man with a high degree of accuracy. It uses the following data:

  • PSA level
  • Gleason score
  • percentage of biopsies positive for cancer
  • clinical tumour stage
  • man's age at the time of diagnosis

 

Treatment recommendations are based on the level of risk of metastasis or risk to the life of the man.

 

The pathological stage of prostate cancer is determined after microscopic examination of the tissue removed by radical prostatectomy. The pathological stage is the actual extent of the cancer. This can be predicted before surgery using Partin tables. Partin tables are a widely used nomogram to predict the pathological stage using the PSA level, Gleason score and estimated clinical stage. This information helps in making treatment decisions as well as estimating prognosis.

 

 

References

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