Accurate survival rates?

Hi,

I found a website with survival rates for prostate cancer but finding it hard to believe they are accurate.

According to the most recent data, when including all stages of prostate cancer:

The 5-year relative survival rate is almost 100%

The 10-year relative survival rate is 98%

The 15-year relative survival rate is 95%

cancer.org/cancer/prostate-...

My dad was diagnosed with low grade prostate cancer that hadn't spread and died 8 years later, now according to this site he was in the very unlucky 2% to not make it to even 10yr survival when 15yr survival is as high as 95%. All I can think is that when he chose Brachytherapy as his treatment it made his cancer spread as according to this site he should've had a very good chance of surviving 10+ years. But then what of the 10,000 men dying every yr of prostate cancer? Granted that is in the UK and the site I found is American, but same sort of survival rates I would think. It worries me that men will see that site and not get a prostatectomy-I mean who would with survival rates as high as 95% for 15yrs? Is this site accurate because prostate cancer is one of the biggest cancer killers so it seems contradictory...

15 Replies

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  • Rachel201,

    I agree PCa is a killer, and lots of articles, opinions, and the info Urologist, Oncologist, and genetic testing gives one, I find contradictory. I have been on Active Surivillance, because Prolaris (genetic testing) revealed I had non aggressive PCa. My Gleason score was 4+3 =7.. I found that contradictory, so the more I thought about it, AS was not for me. I had the worry of it going out of the capsule, and just ever day knowing I had a killer in my body. Plus, I had 2 biopsies, and I do not want another one. So I had my first radiation treatment yesterday Feb. 1. I am 76 years old, and been told something else will kill me besides cancer. Well, that might be true, but I did what I thought was in my best interest.

    Regards,

    Roger

  • Roger-sounds like you did the right thing. Much better to not have that worry on your mind, I know my dad worried about it coming back. My dad said his oncologist probably told him he'd live to his 80s with the cancer but he died age 73. I was a teenager at the time of his diagnosis and did a lot of research on it and the impression I got was that this was not a "serious" cancer and now I can see why I thought that based on sites like that with such high survival rates. If I had known different I might've tried harder to convince my dad to have his prostate out. I had felt pretty guilty that I didn't treat it seriously at the time but it was based on what I read I guess.

    The stats are definitely confusing-if most men don't get PC until around say 65 on average, but most live for 15+ years with it, then the 10,000 who are dying of it must be 80+, but then lots of men don't even make it to 80 anyway, average age men live to in UK being about 79 I think, then who are all these 10,000 men that are dying FROM it?

    Jim-I'm not sure how they worked it out, it's pretty confusing. But then of course as soon as it spreads life expectancy goes WAY down-so suddenly a man can go from a life expectancy of 10yrs to probably 2 or less. And no way of knowing when or if it will spread.

    Maybe they need to divide the stats into groups of people who have non-aggressive vs aggressive cancer? I guess they can't do that though as there is no way to know-my dad's was obviously aggressive despite his gleason score (that basically meant nothing) There are probably guys out there living far longer than my dad did with a gleason of 8 or more whereas my dads was only a 6 at diagnosis. His father also died of PC in only his fifties so I suppose that was a warning sign. I know lots of men have PC for decades without a problem but somehow 10,000 men dying every year of PC doesn't seem to go with a 95% survival rate at 15 years. Trouble is the docs seem to think practically every older guy has prostate cancer (or will eventually) so it's hard to differentiate between the aggressive ones and the type that does little harm. Just thinking out loud!

  • Totally agree with your comment. I was in a simular situation but at least I was given the choice of all the options which wete explained to me in detail. My diagnosis was a new trial involving a biopsy taking samples the traditional way and through the soft skin between the scrotum and anus. This was an overnight in hospital. I then had an MRI and CT scans. I decided to have my prostate removed by keyhole surgery. That was in 2014. So far so good. Its your decision its your body.

  • I don't know whether these rates are accurate or not, no claims here! but since 1) so many of us are "older" when we get it, and 2) since the disease usually progresses very slowly, I wonder if the people who die of something else (before the prostate cancer has a chance to kill them) are included in these rates somehow or not?

  • Hi Rachel

    Mine was diagnosed in 2003 High psa (forget what it was) Gleeson score of 7. Was given Zoletex and then radiotherapy. 10 years later psa started to rise, when it got to 12 was given Zolatex again and at the moment psa is down to 0.1 the plan is to stop the Zolatex if it stays stable for a couple of months, monitor psa again and keep doing that. I am 77 at the moment so I seem to be fitting into the survival data you have seen. Maybe even improving on it. The survival rate is definitely better than it was some years ago.

    Ray

  • Ray your results give me even more hope. No need for me to go into my circumstances but would love to think I would have your survival.

    David

  • Rachel,

    The U.S. statistics you cite are made meaningless by the large number of cases that should never have been diagnosed. Overscreening in the U.S. makes the survival rate look impressive. The situation is less rosy for metastatic disease, e.g.

    "The relative 5-year survival rate for distant stage prostate cancer is about 28%."

    In the UK, where less screening occurs, 10 year survival is 84%.

    cancerresearchuk.org/health...

    In the UK (2014): PCa deaths = 11,287; new cases = 46,690. i.e. ~24% of cases will die of PCa.

    Projected US numbers (2017): PCa deaths = 26,730; new cases = 161,360. i.e. ~17% of cases will die of PCa.

    Those percentages are merely indicative of the difference in screening.

    With less screening, cases go down & the death rate goes up. According to EU stats, the PCa death rate in Greece is 56%:

    eco.iarc.fr/eucan/CancerOne...

    but the incidence rate is low (18% of the Norwegian rate), so less screening occurs.

    -Patrick

  • Patrick, I live in the US. The US Preventative Taskforce issued a statement last year asking Drs to NOT test for PSA until age 50 unless a father/uncle was diagnosed. Had I not been tested when I did, I wouldn't be here today. Three years ago, just after my 45th birthday I was diagnosed with G8 Pca. (4+4). I've read several studies that show the younger you are diagnosed, chances are it will be an aggressive cancer. The task force requested this due to over-treatment here in the US. Drs here were ripping prostates out only to find it was indolent 3+3 cancer that was not life threatening.

    If any of you have not yet been treated, I urge you to search for Focal Laser Ablation. (FLA) It's what I had done with zero side effects. I heard this easy procedure is much more accessible in Europe than here in the USA where it is not yet covered by insurance. Out of pocket cost was $20,000 US dollars so it may not be for everyone but it did save my life & it did leave me with all of my faculties intact.

    As far as statistics go, I agree.... the more men tested, the more they will find, regardless of whether the cancer will cause death. Unfortunately, Drs here see dollar signs & immediately want you to rush to surgery. These statistics don't mean much to me. Each person is different, each cancer will grow at its own pace & each person going through this needs to study as much as possible before agreeing to any treatment. I've also read several times that surgery itself can cause the cancer to spread. (Search salvage prostatectomy or salvage radiation).

    I wish you all the best,

    Ray

  • Patrick-very interesting stats there, thanks. I didn't think about the over diagnosis in America, I just assumed the rates would be around the same. Makes more sense now.

  • Rachel, you said "Maybe they need to divide the stats into groups of people who have non-aggressive vs aggressive cancer? " Yes, I agree. That would be a much more useful set of statistics.

    A big problem is that Trans-rectal biopsies miss 30% or more of the small aggresssive prostate cancers, so your dad probably had one of those aggressive ones hidden in the front of his prostate away from the reach of the trans=rectal biopsy needles.

    Brachytherapy actually has a very good success rate with relatively low side effects compared to surgery and external radiation.

  • Well my dads was certainly aggressive. But then his best friend died of PC also in only his early 60s (didn't go to the doc until it was too late but then given how prostate cancer is treated they may have told him to watch and wait anyway)

    Yes I remember being a teenager and reading up about Brachytherapy and telling my dad it was supposed to be as good as surgery (something I have felt guilty for that maybe he chose it because of that). Oddly it never brought his PSA down by much though, most men on here after treatment are saying their PSA was less than 1, I don't think Brachytherapy brought his PSA down much at all.

    What probably hastened his death is that he was put on hormone therapy (when we found the cancer had spread 4 years later) and then he stopped taking it for a few months as he didn't realise he was supposed to keep taking it..he didn't have the best oncologist.

    This was before I knew much about PC and he was put on hormone therapy after finding a lump in his neck-back then none of us knew this could be a sign of cancer so we thought it was nothing much and didn't go to the doctor with him that time so did not realise this meant his cancer had spread or how serious it was.

    I really feel for men having to deal with this, it's so hard to know what the best course of action is.

  • That's a very sad story. It sounds like he had an undetected relatively small but very aggressive lesion (poorly differentiated cells, behaving like other aggressive cancers and not behaving much like prostate cells), perhaps in the front ('anterior') of the prostate which trans-rectal biopsy samples very poorly) which had already metastasised substantially before diagnosis - that's why the brachytherapy didn't bring the PSA down much. Quite a few men get surgery or external beam radiation therapy and have similar sad outcomes.

    If I'm right then he was actually at either the "Regional Stage" or the "Distant stage". They don't give statistics for Regional stage, and it varies a lot depending on how well it was detected and whether effective treatment was possible, given and successful. For Distant stage they give a 5 year survival rate of 28%/

    Identifying the aggressive cancers more accurately and staging the accurately so they are treated more appropriately are the purposes of modern multi-parametric prostate MRI, but that technology had not been developed when your day was diagnosed.

  • David-maybe you are right that his cancer had already spread-that would certainly make things easier-knowing that there was nothing that would've made a difference. I presumed that when he was diagnosed the fact he was gleason 6 and low PSA meant his cancer hadn't spread. I didn't know about aggressive lesions not being detected-so thanks for that info.

    I suppose only if he'd had the surgery would we have known what we were dealing with for sure. But maybe the outcome would've been the same. I did start to suspect he may've had it long before diagnosis due to his own father dying so young from it, though he had very few symptoms. In his medical notes we requested, it did say he may not be suitable for Brachytherapy due to either his family history or something else-can't remember now, but they decided in the end it was ok to treat him with that. Seems odd to have a biopsy that won't actually diagnose the most aggressive types of cancers-surely that should be the point of a biopsy. Well I am glad the technology is more able to diagnose the type of cancer better now at least.

  • Yeah. It's difficult. Trans-rectal biopsy is quick and easy but only 70% accurate. Aggressive cancers in most of the prostate get picked up but not the anterior ones.

    There is a better biopsy - trans-perineal - but it's more cores, usually involves general anaesthetic and operating theatre, costs more and takes longer. It also avoids infections. I had one and it sampled my large anterior cancer well. But they are relatively rare.

    The Gleason 6 was the bits the trans-rectal biopsy sampled. Given the spread there almost certainly was an undetected more aggressive cancer in his prostate that had either already spread or spread before the seeds could kill it. Gleason 6 very rarely spreads like that.

    If it had already spread, surgery couldn't have cured him, and special aggressive radiation therapy would only have helped if the spread at that time was very local. Basically his cancer was probably incurable, even with the best diagnostic tools and treatments as of 2017, at the time it was diagnosed. The advances we've made improve outcomes like his by only a couple of years.

  • Thanks David-maybe we did the best we could-surgery might not have worked and he might have had side effects for all those years whereas he had very few side effects from Brachytherapy so was very healthy up until the last year and a half of his life really.

    I'm glad you have had the better biopsy for your peace of mind. it's a shame my dad didn't get a PSA test earlier-but he did go to the doctors at the first sign of symptoms-he was very good about going to the doctors.

    This has really helped me understand what happened better so thanks again.