Prognosis

Prostate cancer is often curable. Biochemical disease-free survival and overall survival depend on the initial stage of disease at the time of diagnosis.

Five-year relative survival rates by prostate cancer stage at diagnosis (2014 to 2020 data):[1]

  • 100% (localised disease)

  • 100% (regional)

  • 36.6% (distant)

Ten-year relative survival rates by prostate cancer stage at diagnosis (2011 data):[1] 

  • 100% (localised disease)

  • 99.3% (regional)

  • 16.4% (distant)

Genetic factors may have an impact on prognosis. Germline BRCA mutations are associated with a high risk of early-onset prostate cancer, more aggressive disease, and poor survival outcomes.[35][36]

One retrospective study found that CDK12-mutated prostate cancers were characterised by aggressive disease features, poor survival outcomes, and poor response to hormonal therapy, PARP inhibitors, and taxanes.[392]

Morbidity

Morbidity resulting from treatment of prostate cancer can be high. Further improvement in radiotherapy planning and delivery will decrease adverse effects and complications (e.g., dysuria, urinary frequency, erectile dysfunction, rectal bleeding, incontinence) and permit administration of higher doses.[393]

Mortality and Gleason score at diagnosis

A retrospective cohort study reported on 767 men (ages 55-74 years) diagnosed with localised prostate cancer between 1971 and 1984 who were treated with observation, or with immediate or delayed hormonal therapy.[394][395] Men with low-grade prostate cancers (Gleason score 2-4) were at low risk of dying from prostate cancer during 20 years of follow-up (6 deaths per 1000 person-years [95% CI 2 to 11]). Men with high-grade prostate cancers (Gleason score 8-10) were at relatively increased risk of dying from prostate cancer within 10 years of diagnosis (121 deaths per 1000 person-years [95% CI 90 to 156]).[395] Few men with low-grade tumours at diagnosis progressed to prostate cancer death; conversely, men with Gleason score 8-10 disease at diagnosis faced a high risk of death from prostate cancer when treated conservatively.[394][395] Increasing Gleason score predicted survival difference.

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