The word cancer is often associated with significant challenges, and a diagnosis can be distressing.
We immediately think of chemotherapy, losing hair, metastasis, and pain.
However, the aggressiveness of cancer can vary based on different factors.
One of them is the type and location of the primary tumor.
The other has to do with the patient, his comorbidities, and his risk factors.
In many cases, prostate cancer has a relatively low risk of being life-threatening. In this location, most cancer cells grow very slowly and do not frequently spread.
Advancements in technology now allow us to detect low-grade prostate cancer cases at an early stage, potentially leading to higher survival rates.
However, we shouldn’t neglect prostate cancer. There will always be a patient with an aggressive type.
In this article, we’re reviewing prostate cancer survival rates, patient prognosis, and risk factors. How dangerous is prostate cancer? What makes the disease more aggressive? How can you reduce your risk?
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Prostate Cancer Is Common With Aging
Talking about prostate cancer can be a bit scary for senior men. It is statistically very likely that you will grow prostate cancer cells at some point. 1 in 7 men is diagnosed with prostate cancer. The remaining 6 men who are not diagnosed can have prostate cancer cells, too. But since they are slow-growing and not causing symptoms, prostate cancer is only detected in autopsies.
Aging is one of the most important triggers of this disease. The incidence increases as we age. The most common age of diagnosis is between 65 and 74 years. After 80 years, the prostate’s chance of malignancy is very high (around 80%).
However, no screening is typically made in this age group. That is because prostate cancer usually has a very long survival rate. Thus, they are more likely to continue living without a complication and die from other causes (1).
There is a type of prostate cancer diagnosed in young males. It is early-onset prostate cancer, and it is diagnosed before age 55 years. Fortunately, this type is not the most common because it is usually more aggressive. This group of patients is likely to have an underlying cause that triggers the disease at a younger age. The rest of us will start having some risk after 55 years, increasing as we get older.
It is postulated that prostate cancer increases with age due to overlapping mutations in prostate cells. They slowly turn into prostate cancer cells, and the volume of the prostate starts growing. This process can begin when we are around 50 years of age. But then, it takes a lot of time for cancer to develop. It takes up to 15 years to start giving out symptoms and more time to cause complications.
Young Men With Prostate Cancer
That is why prostate cancer is common in seniors and not in young men. If a young man is diagnosed with prostate cancer, the chances are that he has simultaneous risk factors and probably a genetic component to the disease. These young men with an early-onset diagnosis should be evaluated very closely.
The risk of aggressiveness is higher than older patients. Additionally, they have a longer life expectancy, giving prostate cancer enough time to grow bigger and cause complications (2).
Prostate Cancer Risk factors
Age is probably the most critical risk factor of prostate cancer, but not the only one. We can list a few others (3):
Ethnicity
Prostate cancer is more common in African American men as compared to White men. Hispanic men have almost the same risk as White men, but their mortality is a bit lower. In contrast, African American mortality is higher. Their prostate cancer cases are more likely to be aggressive. This probably has to do with genetic factors. However, we shouldn’t rule out other cultural or social implications.
Genetic mutations
People who carry a mutation to breast cancer genes BRCA1 and BRCA2 have a higher chance of being diagnosed with prostate cancer. That’s why the medical history of breast cancer tendency in the family can be important for some patients. Another gene mutation associated with prostate cancer involves the p53 gene. This is a rare mutation but often associated with aggressive prostate cancer. It is very likely found in metastatic prostate cancer, and it is considered a lousy prognosis. Besides these two, there are over 100 polymorphisms associated with prostate cancer incidence.
Obesity and dietary habits
High-fat intake, the Western diet, obesity, and sedentary behavior are all associated with a higher incidence of prostate cancer. High calcium intake and a diet high in milk products can increase the risk. After being diagnosed with prostate cancer, calcium can increase the risk of aggressive types. On the other hand, whole milk increases the risk of recurrence of prostate cancer. Obese and overweight men are particularly prone to this increase in recurrence. Another dietary risk factor is vitamin D insufficiency. Meat consumption increases cancer risk, while fish consumption lowers the mortality rate.
Family history
If you have prostate cancer in your family, your risk can be higher. This is particularly the case when it is a first-degree relative (brother or father). The risk doubles in these patients compared to the general population. Between brothers and fathers, if your brother has prostate cancer, the risk is even higher. If you have two or more first-degree relatives with prostate cancer, you have a 5-fold greater risk.
Hypertension
Many patients with prostate cancer also have hypertension. According to studies, this is probably because both hypertension and prostate cancer share an androgen-mediated mechanism.
Testosterone imbalance
Androgens play a significant role in prostate growth. They also play a role in prostate cancer development. Having deficient testosterone levels can make the prostate sensitive to androgens and increase the risk of prostate cancer. The opposite is also true. Elevated levels of androgens maintained for a long time can also have the same effect.
Young age
As noted above, patients diagnosed with prostate cancer at a young age should be carefully evaluated. Their risk of complications or aggressiveness is very high. The same happens if you have a family history of cancer at a young age. If this is your case, informing your doctor about this family predisposition is fundamental. Suppose you were diagnosed with prostate cancer with a history of early-onset disease in your family. In that case, the risk of cancer recurrence after radical prostatectomy and radiation therapy is also increased.
Prostate Cancer Survival Rates Are Favorable Overall
Throughout the article, we have discussed how prostate cancer compares favorably to other cancer types.
Actually, the fact that prostate cancer is diagnosed in seniors contributes to its survival rate. To understand this, let’s have an example.
Let’s say that a male patient is diagnosed with prostate cancer at 74 years. He has urinary symptoms such as nocturia and weak urinary flow at the moment of the diagnosis. Other than that, he has no signs. Cancer is confined to the prostate and growing very slowly in follow-up exams. There is no reason to treat prostate cancer aggressively, and this man dies 6 years later. Prostate cancer did not play a significant role in his death.
This case is more common than we think. To measure what to expect of cancer, there’s something called survival rate. Researchers take a group of patients and follow them up year after year. Then, they write down statistics of life expectancy after the diagnosis. They would only record prostate cancer-related deaths. So, our example above was not included in the statistics because he didn’t die from cancer-related causes.
In the case of prostate cancer, the survival rate is higher than other types of cancer.
According to statistics, 92% of cases are diagnosed at an early stage. They are localized prostate cancer or have a regional and minimal spread. Almost all of them are still alive 5 years after the diagnosis is made. But what about 10 years or 15 years?
The American Society of Clinical Oncology has revealed very favorable data. They mention that 98% of patients survive for 10 years. 96% of patients survive for 15 years or more (4,5).
On the other hand, we can’t be too optimistic about advanced prostate cancer. If a patient is initially diagnosed with prostate cancer and metastasis, the survival rate starts to fall. Only one-third of these men are still alive after 5 years of their diagnosis. Luckily, most cases are detected early in the course of the disease.
That is why staging is crucial at the moment of diagnosis.
Staging, Spread, and Survival Rates
The staging of prostate cancer depends on different factors. Physical exams and evaluating your symptoms are both critical steps. However, you will need diagnostic exams to complete the staging process.
The most accurate exam to stage prostate cancer is a prostate biopsy. However, not all patients with prostate cancer will undergo a prostate biopsy. The decision to perform a biopsy depends on the patient’s age, risk factors, and symptoms.
The most basic staging system does not rely on a prostate biopsy. It is the TNM system, which is almost the same in most types of cancer. T stands for tumor. N stands for lymph nodes. M stands for metastasis (6).
Tumor
We can have a very small tumor that invades less than 5% (T1a) or more than 5% (T1b). Another classification is T1c when you have alarming signs and needed a prostate biopsy. Bigger tumors take the stage of T2a when it is invading less than 50% of one side of the prostate. They are T2b when they invade more than 50% of one side of the prostate. If the tumor is big and found in both halves, it will be termed T2c. T3 prostate cancer is massive and has spread locally (for example, the seminal vesicles). T4 is the most significant tumor, which invaded other organs such as the bladder or rectum.
Lymph nodes
Invasion to the lymph nodes is the first sign of distant spread. Thus, it is essential to evaluate if the lymph nodes are taken, especially in locally spread cancer. N0 means that no lymph nodes are taken. N1 means that at least one lymph node was taken by cancer. This is sometimes apparent in imaging studies. However, it is only confirmed after taking out the affected lymph nodes and performing a biopsy.
Metastasis
This is a distant spread of cancer to other organs. In this case, metastasis is a late stage of prostate cancer with a very poor prognosis. M0 means that you don’t have any metastasis. M1 means that you have metastasis, and it is subdivided into three. In M1a, metastasis is located in lymph nodes outside of the pelvis. In M1b, patients have bone metastases. And, in M1c, metastasis is in other distant organs.
Besides the TNM classification, there’s also the Gleason score. This grading system is made for patients who undergo a prostate biopsy. The Gleason score system gives cancer a number from 6 to 10. 6 is low-grade cancer, and 10 is very aggressive prostate cancer, depending on how it looks under the microscope.
Staging is fundamental because it gives doctors a prognosis of prostate cancer. In most cases, localized prostate cancer links with a higher survival rate. When prostate cancer is only spread locally in the pelvis, the 5-year survival is also favorable. But when cancer cells have spread to the bones and other distant areas, the prognosis is not promising. As noted above, one-third of these patients survive for more than 5 years.
In a nutshell, having M1 in your TNM classification links with a bad prognosis. If this is not your case, chances are that your survival rate will be much longer than 5 years. Your treatment options are also limited, and most of these patients need hormone therapy.
What is a 5-year relative survival rate?
If you’ve recently been diagnosed with prostate cancer, you may wonder about your prognosis.
To answer your question, the doctor will consider statistics and estimates. He will rely on trends and numbers to give you an answer. This is the only way we can predict what will possibly happen with cancer. Still, remember that cancer is a multifactorial disease, and anything can happen.
Survival rate statistics mostly depend on the stage of cancer and your age. Then, they are placed in a time period. That is why your doctor talks about the 5-year, 10-year, and 15-year survival rates. This is the percentage of people like you who survive 5, 10, and 15 years after the diagnosis.
But what is a 5-year relative survival rate?
The word “relative” makes the difference because people can die from many causes, not only prostate cancer. Unlike overall survival, a 5-year “relative” survival rate does not count prostate cancer patients who died from unrelated causes. For example, if a patient died from a stroke 4 years after the prostate cancer diagnosis, he will not be counted in the statistics.
This way, you have a more accurate prognosis and know what to expect.
Reducing your risk of prostate cancer
Some people would prefer not to know when they are going to die. Thus, talking about 5-year or 10-year survival might not be the answer that you’re looking for. Maybe you do not want to know how many years you have left. But even people who prefer not to know feel interested to learn how to reduce their risk.
Doctors emphasize the importance of prevention in reducing the risk of prostate cancer. There are two types of prevention:
- Primary prevention: It starts before a prostate cancer diagnosis. Primary prevention is recommended to patients at risk of prostate cancer. For example, in African Americans and males with prostate cancer history in first-degree relatives.
- Secondary prevention: It starts after a prostate cancer diagnosis. Secondary prevention aims to reduce the risk of complications and spread of cancer. It reduces the patient’s mortality rate and the aggressiveness of cancer.
Primary and secondary prevention have similarities and differences. But most recommendations are the same. They include lifestyle modifications and dietary habits that you can adopt from now on. For example (7,8):
Keep a healthy weight
As noted above, overweight and obesity increase the risk of prostate cancer. They also induce faster growth and spread of cancer. Why is that? Because obesity causes a chronic inflammatory state. Cancer uses inflammation to its advantage to keep growing. So, you don’t want to have any excess body weight. At least not in body fat.
Be careful with saturated fat
This is essential dietary advice if we want to counter inflammation. Saturated fat converts into inflammatory cytokines in the body. That’s why high-fat diets link with more aggressive diseases. We recommend consuming low-fat dairy, avoiding red meat fat, and healthier cooking methods different from frying.
Look for omega 3 fat sources
Fat is not the enemy, and we have plenty of healthy sources. The best fat you can get is omega-3. In contrast to saturated fat, omega-3 fatty acids are anti-inflammatories. They protect your prostate and the rest of the body and link to a better prognosis. Another source of omega-3 fatty acid is peanuts, almonds, pumpkin seeds, and others.
Add tomatoes to your shopping list
Tomatoes have lycopene, a potent phytonutrient that protects plants. This is a free radical scavenger, an antioxidant. According to studies, lycopene consumption reduces the damage to the DNA in prostate cells. Tomatoes are one of the best sources of lycopene. You will benefit from there even more by cooking tomatoes instead of eating them raw.
Be wary around calcium
This nutrient is vital for muscle contraction and bone density. But too much calcium increases the risk of prostate cancer. If you want to stay safe, do not consume more than 1,200 mg of calcium a day.
Stop smoking
This recommendation works for almost every type of cancer. Tobacco smoke has hundreds of carcinogens, and some of them increase the risk of prostate cancer.
Find ways to reduce stress
Studies also show that chronic stress can influence your prostate cancer risk. It lowers your immune function and favors cancer progression. It might be difficult to control stress when you feel overwhelmed. But coping strategies should also be a part of your prostate cancer treatment.
Keep your chronic disease in control
Diabetes and kidney disease can influence your prostate cancer risk and your survival rate. But controlling hypertension, diabetes, kidney disease, and other chronic health problems may also lower the chance of prostate cancer and its complications.
Communicate with your doctor
The most critical recommendation to reduce your risk is to keep in communication with your doctor. Your case is different from any other, and you deserve personalized treatment. These recommendations should adapt to your case, too. Thus, talk to your doctor and follow recommendations. If your doctor considers it appropriate to screen with PSA testing, talk about the pros and cons with him. And if you need treatment, discuss the benefits and drawbacks of your treatment options. Ask questions and inform yourself about prostate cancer and what to do about it.
Conclusion
Cancer in the prostate gland is common in seniors but not always lethal. Small tumors and older adults can benefit from watchful waiting instead of surgery, external beam radiation therapy, or androgen deprivation therapy.
If your tumor had not spread at the moment of diagnosis, the survival rate is very high. In most cases, prostate cancer grows very slowly, and it takes more than 10 years before the patient starts experiencing problems. However, doctors need to be aware of specific risk factors that increase the chance of aggressiveness.
Black people, patients diagnosed at a young age, obese patients, those with chronic disease, or a history of prostate cancer in first-degree relatives need closer follow-up and sometimes more aggressive treatment to improve their outcomes.
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