On July 8, we wrote about the long-term survival of patients initially diagnosed with metastatic forms of prostate cancer — and a new article on this subject has just appeared in the Journal of Urology.
Hsiao et al. have attempted to establish the 5- and 10-year survival of men diagnosed with AJCC stage IV prostate cancer (which includes clinical stages T4N0M0 through TxNxM1) in the period 1995 through 2003, using information from the SEER database.
The results of this careful epidemiological analysis show the following:
- The full study cohort included 14,697 patients initially diagnosed with Stage IV disease, including
- 615 men with clinical stage T4N0M0 (locally advanced, extracapsular disease)
- 3,189 men with stage TxN1M0 (node-positive disease)
- 10,893 men with stage TxNxM1 (truly metastatic disease)
- The average (mean) ages of patients in the cT4, N1, and M1 stage groups were 70.8, 63.6, and 71.3 years, respectively.
- Overall survival data showed that
- For patients with cT4 disease, 59 percent of patients had at least 5-year survival and 40 percent had at least 10-year overall survival.
- For patients with N1 disease, 79 percent of patients had at least 5-year survival and 55 percent had at least 10-year overall survival.
- For patients with M1 (truly metastatic) disease, 22 percent of patients had at least 5-year survival and 11 percent had at least 10-year survival.
- Prostate cancer-specific survival (PCSS) data showed that
- For patients with cT4 disease, 71 percent of patients had at least 5-year survival and 60 percent had at least 10-year overall survival.
- For patients with N1 disease, 84 percent of patients had at least 5-year survival and 68 percent had at least 10-year overall survival.
- For patients with M1 (truly metastatic) disease, 35 percent of patients had at least 5-year survival and 21 percent had at least 10-year survival.
- 56 percent of men (6,100/10,893) with truly metastatic disease at the time of diagnosis actually died of prostate cancer.
- The ages of patients at the time of their diagnosis had significant effects on their overall and prostate cancer-specific survival.
- For men < 50 years of age, diagnosed with truly metastatic disease, the median PCSS is ~ 36 months.
- For men of 50 to 70 years of age, diagnosed with truly metastatic disease, median PCSS is ~ 58 months.
- For men ≥ 71 years of age, diagnosed with truly metastatic disease, median PCSS is ~ 38 months
- For men ≥ 71 years of age, diagnosed with cT4 disease, median PCSS is ~ 125 months
- Men with cT4 disease who were ≤ 70 years of age and all men with N1 disease, regardless of age, had a median PCSS of > 125 months
What are the implications here?
In this cohort of men, diagnosed between 7 and 19 years ago with advanced forms of prostate cancer, it is clear that for any man diagnosed with evident metastatic disease (i.e., a positive bone scan or CT scan), there was still a high probability of death (from prostate cancer or from other causes) within 5 years of diagnosis. But 11 percent of these patients lived for ≥ 10 years after diagnosis. Unfortunately this study does not report overall median survival times for the various cohorts of patients.
By contrast, the men who are diagnosed with a high probability of micrometastatic disease (because they are cT4 or N1) but with no actual, evident metastases beyond the lymph nodes, had at least a 40 percent probability of 10-year overall survival, which correlates well with other data suggesting extended survival for such patients. Indeed, the median PCSS for all men in this study who did not have evident metastatic disease at the time of diagnosis was at least 125 months (10 years).
These data seem to suggest (but do not prove) the postulate that long-term survival of men with advanced forms of prostate cancer is greater today than it was 20+ years ago. Specifically, within the study data, there is the suggestion that — for men ≤ 70 years of age — both overall survival and prostate cancer-specific survival was longer for men diagnosed in the time period 2000-2003 than they were in men diagnosed between 1995 and 1999. However, the data in this paper are perhaps not as dramatic as one might have hoped for.
Filed under: Living with Prostate Cancer Tagged: | metastatic, node-positive
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Reducing access to screening probably won’t improve the long term survival rate for men under 70…
Tracy: Reducing access to individual testing of men who believe that they need to be tested is not something anyone I know would support. However, as I have said over and over again, there is a massive difference between acknowledging and ensuring the rights of individuals to choose to be tested and instructing every man over a specific age that he absolutely should be getting tested every year or 2 years or whatever.
I note that the abstract concludes that the improved survival was a function of patient age, not year of diagnosis. Where is the data for improved survival as a function of year of diagnosis that you mention (95-99 versus 00-03)?
It is in the actual paper — not the abstract, but (as the article says above) the evidence for this is limited.
I assume that this study considered clinical stage, and not pathological stage, if available. The term diagnosis suggests clinical staging for T4, N, and M rather than pathological staging. If so, many of this group would not have had treatment to the primary site by radiation or/and surgery. How many of these men received such treatment? Would such treatment to primary site make a difference in survival for any of these men, or their subgroups? That is a comparison I would like to see this group determine from their data.
Dear John:
– The 615 T4N0M0 patients were all clinical T4.
– Among the 3,189 TxN1M0 patients, 145 were also clinical T4 as well as being N1.
– Among the 10,893 TxNxM1 patients, 71 were also clinical T4 as well as being M1.
– Of the patients with N1 disease, 53% had undergone surgery.
– Of the patients with cT4 disease, 13.3% had undergone surgery.
– Of the patients with M1 disease, 1.4% had undergone surgery and 78% had neither radiation nor surgery (implying that about 20.6% must have had radiation).
The population was predominantly white and most patients were unmarried.
That’s all it tells me in the paper. If you want more, I suggest you contact the senior author of the paper, Dr. Viraj McMaster (vmaster@emory.edu). I am sure he would be happy to send you a copy of the paper on request.
This research is an interesting complement to a couple of studies of high- and intermediate-risk cancer highlighted by the Prostate Cancer Research Institute in their pamphlet “What’s Your Type?”
“Good news: Even with High-Risk Prostate Cancer, Survival is Excellent
“Compared to other cancers, prostate cancer has an excellent 10-year survival rate. With High-Risk prostate cancer, 95 out of 100 men are still alive in 10 years.1 Remarkably, men with Low or Intermediate-Risk disease are not at any increased risk for dying of prostate cancer within the first 10 years after diagnosis.2 …”