Stages and outlook for prostate cancer
In 2019, the American Cancer Society (ACS) expect that around 174,650 people will have a new diagnosis of prostate cancer, and around 31,620 people will die from the disease.
The outlook for prostate cancer is usually good. In the early stages, it is highly treatable, and many people receive effective treatment.
There are different ways of staging cancers, including prostate cancer. Staging is when a doctor decides how far cancer cells has progressed and how much they may have spread.
Estimates suggest that around 174,650 people will receive a new diagnosis of prostate cancer in 2019.
The simplest way to stage cancer is to look at how far it has spread from its original site.
Localized cancer: Cancer cells remain in the area where they started. In this case, within the prostate gland.
Regional cancer: Cancer has spread to nearby tissues and possibly nearby lymph glands, but not to other parts of the body.
Distant cancer: Cancer has spread throughout the body and affects other organs, such as the lungs or liver.
PSA and Gleason score
Two other important factors that doctors and specialists use to assess cancer cells are the prostate specific antigen (PSA) and the Gleason score.
PSA levels: PSA is a protein that appears in higher levels in the bloodstream when there is a problem with the prostate. Normally, PSA levels in the blood are very low, and a test cannot detect them. However, in some circumstance, such as prostate cancer, PSA levels start to rise.
Screening for prostate cancer uses a blood test for PSA. If PSA levels are high, the doctor may recommend further tests to see if prostate cancer is present.
There are various other reasons why PSA levels may rise, including sexual stimulation or an infection.
The grade and Gleason score: Different types of cancer cell act differently. Some types, or grades, are more aggressive and can spread more easily. The Gleason score and grade are different measures, but they both reflect how likely it is that a tumor will spread, and how quickly it will do so. Either a biopsy or surgery can determine the types of cancer cells present in the prostate tissues.
Nearly 50% of males have a condition known as prostatic intraepithelial neoplasia (PIN) by the time they are 50 years old. PIN is when there are changes in the cells that line the prostate gland.
High grade PIN is not cancer, but the cells can become cancerous in the future. For this reason, a doctor may recommend treatment to remove the cells.
Another name for this is carcinoma in situ. You can learn more here about this stage.
Unlike stage 1 prostate cancer, doctors can identify stage 2 with a physical exam.
Healthcare professionals also use numbers to describe and identify the stages of cancer, including prostate cancer.
Stage 1: There are cancerous cells, but the tumor is small and only affects one area. The Gleason scores and PSA levels are low. There may be no noticeable symptoms at this stage. A digital rectal exam (DRE) or ultrasound will not reveal a tumor. The PSA is below 10. The grade group is 1, and the Gleason score is 6 or lower. Routine screening can detect cancer at this stage, making early treatment possible.
Stage 2: Medical tests may not reveal a tumor, but as this stage progresses, a doctor may detect changes during a DRE or a rectal ultrasound. Cancer has not spread beyond the prostate gland. The PSA score is between 10–20. An early stage 2 tumor is grade 1, rising to 3 in the later phases of stage 2. The Gleason score is 6, rising to 7 or 8.
Stage 3: Cancer has spread beyond the prostate gland. It may have reached the seminal vesicles, the glands that secrete a fluid that helps make up the semen. However, it has not reached the bladder or the rectum. The PSA can be any value but may be 20 or more. The grade group is 1–4 at first, and as high as 9–10 at the end of stage 3.
Stage 4: Cancer has spread to other areas, including nearby organs, such as the bladder, rectum, or lymph nodes. It may have spread to distant organs, such as the bones and liver. When prostate cancer spreads to other parts of the body, it is called metastatic prostate cancer. The grade group, Gleason score, and PSA levels can be any number.
Find out more here about metastatic prostate cancer.
Symptoms may not appear in the early stages of prostate cancer, but a tumor can start to have an impact on how a person feels as it grows.
When symptoms appear, they may include:
- changes in urination patterns
- blood in the urine or semen
- erectile dysfunction
Anyone who notices these symptoms should ask their doctor for an assessment.
Effective treatment is often possible for prostate cancer, especially if a person receives a diagnosis in the early stages.
If tests show that prostate cancer is present, the doctor will discuss treatment options with the individual. Factors affecting the decision will include:
- the stage and grade of the cancer
- the person's age and overall health
- personal preferences
Watchful waiting: The person will attend regular health checks to monitor for further changes.
Surgery: It may be necessary to remove the prostate gland.
Chemotherapy: Doctors prescribe drugs that kill cancer cells either throughout the body or in a specific area. Chemotherapy is an effective treatment, but it targets both healthy and unhealthy cells and can lead to severe adverse effects.
Radiation therapy: This can help reduce the size of a tumor and kill cancer cells after surgery. Methods include directing an external beam of radiation at the affected area or introducing radioactive material in the area where cancer is present.
Hormone therapy: In some cancers, high levels of certain hormones can encourage cancer growth. Blocking these hormones can help slow or stop the growth.
Immunotherapy: A vaccine treatment can boost the immune system or direct it to attack cancer cells.
Some newer treatments include:
Cryotherapy: This uses very cold temperatures to kill early stage cancer cells.
High intensity focused ultrasound therapy: A doctor uses a rectal probe to deliver ultrasound waves. The waves destroy the cancer cells.
Proton beam radiation therapy: This is another type of radiation therapy that targets cancer cells.
Photodynamic therapy: This combines the use of a drug with laser light to kill cancer cells in a specific area.
Other treatments can help manage symptoms, such as pain relief mediation or drugs to help strengthen the bones.
Outlook for prostate cancer can vary, depending on a person's age, overall health, and type of cancer.
The outlook for prostate cancer is excellent, especially if doctors can diagnose it in the early stages.
Figures from 2008–2014 suggest that a person with a diagnosis of prostate cancer has the following chance of surviving at least 5 years after the diagnosis:
- Localized — nearly 100%
- Regional — nearly 100%
- Distant — 30%
- Overall — 98%
The outcome for any individual will depend on various factors, however. These include the person's age, overall health, the type of cancer, and so on.
After treatment, the individual may need to continue to see the doctor for some time. The doctor will monitor PSA levels and other indicators, which could indicate that the cancer is recurring, or coming back.
Following the treatment plan can help a person stay healthy.
How do PSA levels change after treatment for prostate cancer? Find out here.
Prostate cancer is a common type of cancer that affects males. There are different types, but the overall outlook is excellent, as long as the person has an early diagnosis.
Males and anyone who was assigned male at birth should ask their doctor about their risk levels and screening options.
Doctors do not yet know how transitioning from male to female affects the chances of prostate cancer, but there may be a risk. For this reason, anyone who was born with a prostate gland should continue to receive monitoring for prostate cancer.
Routine screening can help detect prostate cancer at an early stage, when it is highly treatable. People should speak to their doctor about screening.
At what age should I start screening for prostate cancer and how often should I do it? Will my insurance cover it?
When to start screening depends on an individual’s risk profile, which includes age, ethnicity, and family history. According to the Prostate Cancer Foundation — which follows the U.S. Preventative Services Task Force (USPSTF) updated screening recommendations from 2017 —screening age varies, depending on your risk.
The USPSTF recommend screening at the following ages:
|40 years||for people with a family history|
|45 years||for African Americans|
|50 years||for those at average risk|
|55–69 years||if the doctor recommends it|
|70 years and over||no screening|