Prognosis and survival for prostate cancer

If you have prostate cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis.

The following are prognostic factors for prostate cancer.

Stage

Prostate cancer with a lower stage at diagnosis has a more favourable prognosis. Cancer that hasn’t spread outside of the prostate at the time of diagnosis has a better prognosis than cancer that has spread outside of the prostate.

Grade

Prostate cancer with a Gleason score lower than 7 has a more favourable prognosis. Prostate cancer with a score higher than 7 is considered high grade, which means the cancer cells are growing quickly and are more likely to spread.

Prostate-specific antigen (PSA) level

Some research shows that a higher than normal PSA level may indicate a poor prognosis. This is because a high PSA level is linked to a greater risk that prostate cancer will spread.

PSA doubling time

PSA doubling time measures the time it takes the PSA level to double. For example, a PSA doubling time of 3 years means that, on average, the PSA level doubles every 3 years. PSA doubling time can help doctors find out if a prostate cancer is aggressive, which means it is more likely to grow quickly and spread. Shorter doubling times are linked to a worse prognosis.

Smoking

There is some evidence that men who smoke at the time of diagnosis are more likely to have a biochemical recurrence (also called a biochemical failure) and die from prostate cancer than men who don’t smoke. A biochemical recurrence means that the PSA level starts to rise after treatment but there are no other signs of cancer.

Levels of certain chemicals in the blood

The levels of certain chemicals in the blood can predict a worse prognosis in men with metastatic castrate-resistant prostate cancer. This includes:

• high alkaline phosphatase
• low hemoglobin
• low albumin
• high lactate dehydrogenase

Learn more about chemicals measured in the blood.

Genetic signatures

Gene expression profiling is a way to analyze many genes at the same time to see which are turned on and which are turned off. Doctors have found several abnormal gene patterns (called a genetic signature) in prostate cancer. These genetic signatures can help doctors make a prognosis. Some genetic signatures are linked to a better prognosis and better response to treatment. Other genetic signatures are associated with a worse prognosis.

Using nomograms to predict a prognosis

Nomograms are statistical models that predict a probable outcome. They take into account the stage, Gleason score, PSA level, pathology reports based on biopsy samples, use of hormone therapy, radiation dosage and other specific information about the man, such as age or treatments he has already received.

The nomograms used to predict a prognosis for prostate cancer include:

Cancer of the prostate risk assessment (CAPRA) nomogram

Doctors use the CAPRA nomogram to help them predict the risk that prostate cancer will spread, predict the risk of dying from prostate cancer and make treatment decisions. This nomogram is based on the:

• PSA level
• Gleason score
• percentage of biopsy samples that contain cancer
• stage of the cancer at the time of diagnosis (called the clinical stage)
• man’s age when he is diagnosed

Partin tables

Partin tables are a nomogram that helps doctors predict the chance that cancer will spread before a man has surgery to remove the prostate and make treatment decisions. Partin tables are based on the:

• Gleason score
• PSA level
• stage

TNM prognostic groups

TNM prognostic grouping for prostate cancer is based on the stage, PSA level and Gleason score. This grouping is more accurate in predicting a prognosis than TNM staging alone. Men in group I have the best outlook and chance that their cancer can be successfully treated without the cancer coming back (recurring). Men in group II have the next best prognosis, followed by men in group III. Although men in group IV have the poorest prognosis compared to the other 3 groups, there may still be treatment options to control their cancer, improve their quality of life and prolong their survival.

Learn more about staging prostate cancer (including tumour details), the PSA test and grading prostate cancer (including the Gleason score).