The prognosis of prostate cancer or the probability of relapse following primary therapy depends on the clinical stage of the tumor, Gleason score (histologic grade) and the PSA level before the primary treatment. The other important independent prognostic factors include the pathologic stage of the tumor, invasion of capsule, seminal vesicle involvement, positive surgical margins and lymph node metastases. The prognosis in prostate cancer is poor in :
- clinical stage above T2
- high PSA level at diagnosis
- biopsy Gleason score of 8 to 10
- PSA velocity of more than 2 ng/mL/year
Survival Rate After Prostate Removal and Radiation
Radical prostatectomy can provide cancer-specific survival of 15 years or more in 80% of patients with limited prostate cancer. Read more on Prostate Cancer Gleason Scores.
- In patients with well differentiated prostate cancers having Gleason scores of 2 to 4, the 10-year PSA progression-free survival is about 70 to 80% with radiation therapy or surgery.
- The 10-year PSA progression-free survival drops to 50 to 70% for Gleason scores of 5 to 7. Eight-year survival for clinically localized tumors with Gleason score less that 7 is 85-95%.
- The 10-year PSA progression-free survival drops further down to 15% to 30% for Gleason scores of 8 to 10 with a 8-year survival rates of about 70%.
- The distant metastasis-free survival response to radiotherapy is influenced by the dose of radiotherapy.
- High-risk patients with Gleason scores of 7 have 8-year survival rates of about 70%, while those with Gleason scores of 8 to 10 have an 8-year survival of about 50% following radiation therapy.
Changes in PSA Levels After Surgery
In patients with rising PSA levels after radical prostatectomy, the important prognostic factors are the :
- pathologic stage
- time taken post-operatively to reach detectable PSA levels
- Gleason score at the time of prostatectomy
- time required for doubling of PSA values
PSA doubling time of 15 months or more are better managed with surveillance. The have median time to metastatic disease in these years is about 8 years and the median survival is about 13 years. Patients with PSA doubling times of less than 3 months are at very high risk of prostate cancer related death and have a median survival of 5 to 6 years.
Prostate Cancer Metastases Prognosis
Major factors in metastatic disease pointing to adverse prognosis at the time of diagnosis include :
- low hemoglobin levels
- elevated alkaline phosphatase (ALP) levels
- poor performance status
Extent of the disease, Gleason score of 8 to 10 and presence of bone pain are other important prognostic factors in metastatic prostate cancer. Read more on treating metastatic prostate cancer.
- The median progression-free survival in patients with minimal disease (metastatic disease confined to pelvis, spine or nodes) is about 2 years and in extensive disease (metastatic disease affecting viscera, long bones, skull or ribs) about 18 months.
- The median overall survival with androgen deprivation therapy in patients with metastatic disease is 3 to 5 years.
- For men with resistance to androgen the overall survival ranged from 8 months to 20 months depending on the extend of spread.
- In patients with HRPC, higher baseline PSA levels and greater PSA velocity predicts higher-risk for metastatic disease and shorter overall survival.
- Significant rise in the acute-phase reactants is often a finding in the late stages of disease and suggest a poor prognosis.