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).
Filed under: Living with Prostate Cancer | Tagged: care plan, prevalence, survivorship |
THE "NEW" PROSTATE CANCER INFOLINK 
Yes! Must have a plan. Unfortunately many caregivers haven’t the faintest. It is of geat importance for a patient to know and to choose an oncologist who is a prostate cancer specialist.
Amen to a “survivorship plan!” There is so little [information] provided to patients and their caregivers following what may be not just the initial treatment, but the only treatment, and that may likely be accompanied by several side effects never explained to them, nor possible remedies to those side effects. As a result, our online prostate cancer support lists are loaded with patient and caregiver concerns when, subsequently, they begin to experience those side effects.
Dear Gus:
I think it should be clearly understood that the majority of prostate cancer patients may never need to see a medical oncologist … but they still need to have a post-treatment care plan provided by the urologist or the radiation oncologist who treats them. For patients with progressive disease who do need the care of a medical oncologist, the importance of a post-treatment care plan is critical, and is more likley to be provided by a medical oncologist with extensive experience of prostate cancer management.
Some of us would not end up with progressive disease if we had an “oncologist with extensive experience of prostate cancer management”. I know, I’m one of the victims of a botched up no plan.
Dear Gus:
With the very greatest respect, I have no idea how anyone could possibly tell with certainty whether or not you might have had progressive disease at the time you were first diagnosed. It can happen with men who are diagnosed with low-risk disease who are entirely appropriately treated.
You may well have been poorly treated by whoever treated you, but that has nothing to do with whether you saw an experienced medical oncologist or not.
I attended a survivorship conference on Saturday and discharge plans are a part of accreditation of all cancer programs. Hospitals are working hard to be ready for the deadline.
Ever hear of Gleason score. ‘Nuff said.
Kathy:
Unfortunately, I suspect that the effect of such accreditation on the private practice urology and radiation oncology community will be limited at best.
Dear Gus:
Thank you. You have just made my point. Any competent urologist should know how to interpret a Gleason score, but (on its own) a Gleason score of 6 or less is no guarantee of non-progression and a Gleason score of 8 – 10 doesn’t guarantee progression after appropriate first-line therapy.
The fact that you were poorly evaluated and treated doesn’t imply that everyone who is diagnosed with prostate cancer needs evaluation by a medical oncologist, although everyone diagnosed with prostate cancer does need to make an effort to ensure they are being evaluated and treated by appropriate and competent specialists.
I agree that prostate cancer patients may not benefit as much unless they are at a facility like the Cleveland Clinic or Mayo. I spoke to the oncologist who gave the presentation and he acknowledged the gaps even beyond the specialties you mentioned but if patients begin asking or telling their doctors about others who are getting the discharge plans, they might be pressured into it. Nothing happens fast in medicine, but eventually ….
EMR may also make a difference. If the data points are worked into the software it could help for patients of doctors who buy that software. Some of my non-prostate cancer advocacy friends are talking/working on this avenue to get it implemented.
It may be a marketing tool for some?
The 5-, 10-, and 15-year survival data for prostate cancer says the data is derived from patients diagnosed with local or regional forms of prostate cancer, and elsewhere for patients with “any stage” of disease at diagnosis. The data obviously includes patients with mild disease such as Gleason grade 4, 5, and 6. … Did the administrators of the study include patients witrh Gleason grade 8, 9, and 10? The article doesn’t specifically state that all patients including those diagnosed with aggressive Gleason grade 8 or 9 disease are included in the study.
If the answer is “Yes”, then these statistics are wonderful news. If “No”, then the stats are not as significant as they sound. Can we please find out?
Dear Barrie:
These data include prostate cancer patients with all Gleason scores — from the lowest to the highest levels.
Thanks for your reply on Gleason scores. I have also been thinking about age. For example, almost all men get diagnosed with some prostate cancer by the age of 80. All of these people will die of something else before prostate cancer. So this could potentially skew the results as well it would if heavily weighted with low Gleason scores. So I have contacted Rebecca Siegal to ask how the patient database was screened on both of these counts. Usually this info is included with reports on such studies, but I don’t see it here. It would also be interesting to know the percentages of patients with each Gleason score. If I hear back from Rebecca on the answers to my questions, I will pass the info along.
Dear Barrie:
Actually “almost all men” do not, by any means, get diagnosed with prostate cancer by the time they are 80 years of age. What is, however, true is that something like 70-80 percent of men who die of other causes will be found to have some amount of cancer in their prostate at autopsy (if an autopsy is carried out). However, only about one in six men are actually diagnosed with prostate cancer during their lifetimes.
Rebecca Siegal has told me that the survival statistics presented are for all ages combined and are not weighted by tumor characteristics, but she pointed out that the survival rates for all stages combined may somewhat overestimate the statistics for people having later stage disease because the results are more driven by people with early stage disease.
On the other hand, she also said it is important to consider that long-term survival rates reflect diagnosis and treatment practices from many years ago, and this may underestimate the survival experience of patients diagnosed today.
The statistics reported seem to be great news for everyone, regardless of age and grade of tumor. On the 10-year statistic of 97.8%, only 2.2% had died whereas the percentage of patients with later stage disease is reported to be 10% of all patients studied. So only about 20% of patients with later stage disease had died, and 80% of them were still living at 10 years. Is this a correct deduction? Cheers to the findings!
WILL THE USPSTF CONNECT THE DOTS? (NOT COUNTING ON IT!)
I have some hope that this new look at survival data showing a 97.8% survival for basically all prostate cancer patients at 10 years will penetrate the minds and consciences of the voting members of the U.S. Preventive Services Task Force.
For some time many of us have been aware, based on published research, that around 95% of even those prostate cancer patients categorized as “high-risk” survive prostate cancer at the 10-year point. I have some hope the Task Force will realize that the two screening studies upon which it relied heavily (the PLCO and ERSPC studies) did not feature median follow-up from date of diagnosis (contrasted with study enrollment) as long as even 10 years for all risk-levels of patients, a circumstance making both studies far too premature to serve as the basis for any sound estimate of the survival benefit of screening. (There were other problems with those studies, but the follow-up issue is critical and starkly clear.)
MISTAKES IN PAPER REGARDING ACTIVE SURVEILLANCE
I am puzzled by statements in the paper that are clearly faulty regarding “active surveillance.” Here is the exact wording in the paper: “… Active surveillance rather than immediate treatment is a reasonable and commonly recommended approach, especially for older men and those with less aggressive tumors and/or more serious comorbid conditions. … However, according to SEER data, the use of active surveillance declined from 44% in 1994 to 34% in 2008. …”
The problems are in the second sentence. Firstly, in 1994 active surveillance was not even a well-accepted term; indeed, “watchful waiting,” the most similar (but critically different) option was the common approach at that time when no curative treatment was employed.
Secondly, active surveillance was an investigational approach in the later 1990s; it is highly likely that this option was used by a very small percentage of patients, a small fraction of the 44% use claimed for active surveillance in 1994. I just checked PubMed to see if any paper in 1994 included “active surveillance” in the title. None did, but I got a list of 19 publications. A quick search showed no use of “active surveillance” in any of the abstracts either. The same was true in 1993 (4 publications), and 1992 (1 publication).
Thirdly, I would be surprised if 44% of patients diagnosed in 1994 — a year when many late-stage patients were being diagnosed based on their first ever PSA tests, chose watchful waiting. Perhaps someone knows the correct percentage for watchful waiting for that year.
Finally, the percentage I have heard from experts of recently diagnosed low-risk patients choosing active surveillance is about 10%, an increase from 5% (that based on my less confident recollection) a few years earlier. Obviously, 10% is a much lower percentage than the 34% stated in the paper for active surveillance in 2008.
Frankly, I’m dismayed by the inaccuracies regarding active surveillance in this report. I am also concerned that these deeply flawed figures will be propagated in other publications.
How could they have made such mistakes?!
HORMONAL THERAPY SIDE EFFECTS MENTIONED IN PAPER AND COMMENT
The paper should have noted that the risk of osteoporosis can be substantially reduced with appropriate treatment (bisphosphonate drugs, or denosumab, with calcium and vitamin D supplementation, transdermal estrogen patches) and intermittent instead of continuous hormonal therapy.
The comment about serious impact on mental function must relate to long-term continuous hormonal therapy, as I am not aware that this is an issue for the vast majority of us on intermittent therapy. Some of us do experience a degree of impact on mental function during therapy, but, as with most other side effects of hormonal therapy, mental function recovers as testosterone recovers during the vacations from therapy.