A new article in CA: A Cancer Journal for Clinicians provides updated issues on the numbers of people surviving after a diagnosis of cancer in America, and includes data specific to prostate cancer survival. The full text of this article is available on line.
The key points made in the article by Siegel et al. that are of specific relevance to prostate cancer can be summarized as follows:
- As of January 1, 2012, about 2.8 million men were living in the USA after a diagnosis of prostate cancer. (This is the “prevalence” of prostate cancer.)
- These 2.8 million men represent about 43 percent of all men living after a diagnosis of any form of cancer.
- The estimated prevalence of prostate cancer in the USA as of January 1, 2022 is currently 3.9 million (about 45 percent of all men living after a diagnosis of any form of cancer).
- 76 percent of all cancers in men (not just prostate cancer) are diagnosed in males aged 50 years and higher.
- The median age at diagnosis for prostate cancer is 67 years (which is very similar to that in the 1990s).
- > 90 percent of all prostate cancers are now diagnosed in the local or regional stages (T1-3N0M0).
- The absolute 5-year survival rate for men newly diagnosed with local or regional forms of prostate cancer is now approaching 100 percent.
- The relative survival rates (compared to death from other causes) for men diagnosed with any stage of prostate cancer are now
- 99.9 percent for relative 5-year survival (as compared to 68.3 percent 25 years ago)
- 97.8 percent for relative 10-year survival
- 91.4 percent for relative 15-year survival
- 57 percent of men aged < 65 years at diagnosis are treated with radical prostatectomy.
- 42 percent of men aged 65 to 74 years of age ar diagnosis are treated with some form of radiation therapy.
- Active monitoring (active surveillance, as opposed to immediate treatment) is a reasonable and commonly recommended management approach, especially for men who are older, have less aggressive tumors, and/or have more serious comorbid conditions.
- However, the use of active monitoring (including “watchful waiting” and “active surveillance”) declined from 44 percent in 1994 to 34 percent in 2008.
These data appear to reflect the variations of belief by clinicians about the appropriate treatment of prostate cancer over the past 20 years — as opposed to what might be considered the “best” treatment of each individual patient as of today.
Siegel et al. also note that:
- Prostate cancer survivors treated with surgery or radiation therapy commonly experience incontinence, erectile dysfunction, and bowel complications.
- Patients receiving hormonal treatment may experience loss of libido; menopausal-like symptoms including hot flashes, night sweats, and irritability (which are often short term and treatable); and osteoporosis.
- Hormone therapy also increases the risk of diabetes, cardiovascular disease, and obesity.
Alas, they fail to mention the other well-known, major, long-term effect of hormone therapy, which is the risk for serious impact on mental function.
In dealing with cancer survivorship generally, Siegel and her colleagues also offer a useful summary of issues relevant to “life after” an initial diagnosis and treatment for cancer (on patinets themseleves as well as on their caregivers and other family members).
Patients and their caregivers should be aware that the Institute of Medicine recommends that after initial treatment for cancer, all patients and their primary care providers should be provided with both a treatment summary and a comprehensive survivorship care plan developed by one or more members of the cancer treatment team. The treatment summary, which should provide the foundation for the survivorship plan, should contain the complete details of diagnosis, treatment, and complications. The survivorship care plan may include a schedule of follow-up visits, symptoms of which to be aware, potential long-term treatment effects, health behaviors to enhance recovery, and community resources. Unfortunately, however, very few prostate cacner patients are currently provided with such a plan — even after treatment at National Cancer Institute-designated cancer centers (let alone in the cxommunity setting).