As it does every year, the American Cancer Society (ACS) has just published it’s annual update cancer statistics update: Cancer Facts & Figures 2017. Those who are interested are of course welcome to peruse this detailed document for themselves. What follows is a quick summary of the prostate cancer-related data in the ACS update.
According to the ACS, here in America, in 2017:
- The incidence of prostate cancer (i.e., the number of newly diagnosed cases) will drop to 161,360.
- The number of prostate cancer-specific deaths will remain roughly stable at 26,730.
- The prostate cancer incidence rate will be 123.2 per 100,000, age adjusted to the 2000 US standard population.
- The prostate cancer-specific mortality rate will be 20.0 per 100,000, age adjusted to the 2000 US standard population.
- Prostate cancer will be
- The commonest cancer diagnosed in men, accounting for 19 percent of all cancers diagnosed in males.
- The third most common cause of cancer-related deaths in males (after lung cancers and colorectal cancers).
- The risk of diagnosis with prostate cancer will be 74 percent higher in blacks than in whites (and we still don’t really know why).
- The risk of death from prostate cancer will remain about twice as high for blacks compared to whites.
A basic summary of the current state of knowledge about prostate cancer and its management can be found on pages 23-24 of the ACS document.
The ACS statement about screening for risk of prostate cancer, as it appears in this document, reads precisely as follows:
The American Cancer Society recommends that beginning at age 50, men who are at average risk of prostate cancer and have a life expectancy of at least 10 years have a conversation with their health care provider about the benefits and limitations of PSA testing and make an informed decision about whether to be tested based on their personal values and preferences. Men at high risk of developing prostate cancer (black men or those with a close relative diagnosed with prostate cancer before the age of 65) should have this discussion beginning at age 45, and men at even higher risk (those with several close relatives diagnosed at an early age) should have this discussion beginning at age 40.
The ACS also notes that:
- 92 percent of prostate cancers are diagnosed at a local or regional stage.
- The 5-year survival rate for local and regional forms of prostate cancer is very close to 100 percent.
- The 5-year survival rate for “distant-stage” (i.e., widespread, metastatic) prostate cancer is 29 percent.
- Overall survival rates for all forms of prostate cancer are
- 98 percent at 10 years
- 96 percent at 15 years
Finally, the document also makes the following comment about the issue of over-treatment and risk for complications and side effects of treatment:
Treatment often impacts a man’s quality of life due to side effects or complications, such as urinary and erectile difficulties, which may be temporary or long term. Current research is exploring new biologic markers for prostate cancer in order to improve the distinction between indolent and aggressive disease to minimize unnecessary treatment.
Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk | Tagged: epidemiology, incidence, mortality, risk, survival |
THE "NEW" PROSTATE CANCER INFOLINK 
Nice job in providing an accessible and very readable summary for the prostate cancer community.
As you indicate, the elephant in the room is what factors account for the enormous discrepancy between white and Afro- American men in these vital statistics. Whatever the ultimate explanation, these differences point to the importance for more research on the complex interactions between genetic and lifestyle variables as relate to the diagnosis and long-term management of this multifaceted disease.
“The 5-year survival rate for distant stage … prostate cancer is 29%”. Does this mean that once you get to this stage you have on average 5 years to live? What is the range of years of survival depending on what treatments you get? In other words how many years of additional life can one hope for depending on what treatments one gets? Are there any statistics on life expectancy for guys who opt for no treatment vs. guys who opt for different types of treatments? My attitude so far has been to treat the disease as aggressively as possible until such time as quality of life deteriorates to the point where I’m unable to live an active life.
Bob
Dear Bob:
So yes, the stated phrase does mean that for men with widespread, distant, metastatic prostate cancer (i.e., not just one single metastasis in the rib cage or the pelvis or the spine), the average life expectancy is another 5 years. However, there are many provisos that come with that statement and the range of life expectancies among such patients is enormous — anything from as little as 6 months for a man with a highly aggressive form of prostate cancer that is unresponsive to every known form of treatment to as much as 15 years or more in some men who respond really well to treatment with one or more types of therapy.
The fundamental problem we all have to deal with in making prognoses about what is going to happen to a man with metastatic prostate cancer is that it is nearly impossible, today, to make any really categorical predictions about individual survival times after a man reaches the stage at which he may need to initiate some form of androgen deprivation therapy. The range of responses to this type of therapy is huge.
The only thing that we can tell any individual patient with certainty is that if he is a patient with a very high-risk form of prostate cancer (e.g., a man who is diagnosed with Gleason 9 or 10 disease who consecutively fails surgery, radiation, and ADT, with a PSA doubling time of, say, 3 months or less), then he is not long for this world. On the other hand, a man who is diagnosed with a Gleason 7 cancer, has a biochemical failure 5 years after surgery, responds well to salvage radiation therapy, and then, another 5 years later, responds well to ADT when it is needed and gets a single metastasis after yet another 5 years (we are now about 15 years post-diagnosis), could well be around for another 10 years or longer (especially if his PSA doubling time is still > 2 years).
There are plenty of data on overall survival over time for different types of patient, and there are plenty of data on the survival of patients once they become metastatic, but using any of these data to predict what is going to happen to an individual patient is extraordinarily difficult.
While I recognize this as controversial, in my opinion the reduction in diagnosed disease reflects the lagged impact of the USPSTF recommendation to reduce PSA testing.
Disease-specific mortality has barely fallen whilst diagnoses have dropped from a recent high around 232,000+ (from memory) to 161,000 — more than a third. It is only a matter of time before we see disease-specific mortality climbing.
Dear Rick:
The data provided by the ACS are statistical projections … and so I don’t think it is reasonable to attribute cause. They could turn out to be way off. They have in the past.
Based upon these statistics, a man diagnosed with prostate cancer will actually live longer than the average man who does not have prostate cancer. How so? The life expectancy of the average man in the United States is about 78 years. The average age a man is diagnosed with prostate cancer is about 66 years. According to the ACS statistics reported in your article, overall survival of men diagnosed with prostate cancer is 96% at 15 years. That means at about age 81, 96% of men diagnosed with prostate cancer are still alive, while on average, only about 55% of all men, including those with prostate cancer, will be alive at age 78. Even if you consider that a man reaching age 65 years today can expect to live, on average, until 84, a whopping 96% of prostate cancer patients will still be alive at age 81. The USPSTF should be researching ways for men to acquire prostate cancer instead of how to prevent it (at least the indolent kind, and of course, without considering quality of life side effects, or pain and suffering at or near the time of death). This can’t be correct, but I cannot find the fault in this logic given the ACS statistics. Perhaps Sitemaster can enlighten. Thank you.
Richard
Dear Richard:
I am no statistician, but I think you are muddling up the difference between life expectancy and lifespan and also ignoring the fact that all these data are age-adjusted.
For example, you can’t just take the average age at which men are diagnosed with prostate cancer and add 15 years to it to get the average life expectancy of men with prostate cancer because that 15 years of survival is itself an average based on men who were diagnosed as young as 30 (who are extremely rare) and as old as 90 (who are also relatively rare but nothing like as rare as the 30-year-olds). The 30-year-olds may well have lived for another 40+ years if they had effective, curative therapy, but the chances that all the 90-year-olds lived to 105 is near to non-existant.
Nice post! Thanks for sharing.
Sitemaster,
I am clearly even less of a statistician than you are, so I cannot dispute your analysis with any credibility. I accept your explanation, but that said, and after thinking about it for awhile, there may be a good reason for the extraordinary 15-year average longevity. The vast majority of prostate cancers are indolent. It wouldn’t be unreasonable to expect that most men who are diagnosed with prostate cancer thereafter improve their diets, exercise more, and/or watch their health more closely. Thus, compared to those men who have not been diagnosed with prostate cancer, men who have been, on average, live longer than men who haven’t. I know that’s why I will live longer than the average man.
: – )
Best regards,
Richard