While any cancer diagnosis is serious, the vast majority of men diagnosed with prostate cancer do not die from it. Many cases are slow-growing and may never pose a significant threat to a person’s life. The likelihood of fatality depends on a combination of specific factors, including the cancer’s characteristics and how far it has progressed at diagnosis.
Understanding Prostate Cancer Survival Rates
To understand the prognosis of prostate cancer, experts use the 5-year relative survival rate. This rate compares men with the same type and stage of prostate cancer to men in the overall population. For example, a 100% rate means that men with that cancer are, on average, just as likely to live for at least five years after diagnosis as men without it. These statistics are drawn from large databases like the Surveillance, Epidemiology, and End Results (SEER) program.
The overall 5-year relative survival rate for prostate cancer is nearly 100%, reflecting frequent early detection and effective treatments. This number changes based on how much the cancer has spread. For cancer that is “localized” (confined to the prostate) or “regional” (spread to nearby tissues or lymph nodes), the 5-year relative survival rate is nearly 100%.
This high survival rate for localized and regional disease highlights that many men, particularly older individuals, are more likely to die with prostate cancer than from it. Their cancer may be so slow-growing that it never causes symptoms or becomes life-threatening.
The outlook shifts if the cancer is “distant,” meaning it has metastasized to parts of the body far from the prostate, like the bones. For distant prostate cancer, the 5-year relative survival rate is about 32%. This difference underscores why the extent of the disease at diagnosis is so influential.
Factors Determining Prognosis
Two primary factors help doctors predict the behavior of prostate cancer and determine a patient’s prognosis: the stage and the grade. Staging describes how far the cancer has spread, while grading assesses how aggressive the cancer cells appear under a microscope.
The most common staging system is the TNM system. The ‘T’ stands for tumor and describes its size and if it has grown outside the prostate. ‘N’ indicates whether the cancer has spread to nearby lymph nodes. ‘M’ signifies metastasis, meaning the cancer has reached distant parts of the body. These elements classify the cancer as localized, locally advanced, or metastatic.
Cancer grading is determined by examining biopsied tissue. The long-standing method for this is the Gleason score, which ranges from 6 to 10. Pathologists assign a grade to the two most common patterns of cancer cells and add them together to get the total score. A score of 6 is considered low-grade, while a score of 10 is high-grade.
A newer, simplified system called Grade Groups (1 through 5) is also used. Grade Group 1 represents the least aggressive cancer and Grade Group 5 the most aggressive.
Other factors, such as the Prostate-Specific Antigen (PSA) level in the blood at diagnosis, also play a role. A high PSA level can be linked to a more advanced cancer. Doctors combine all this information—stage, grade, and PSA level—to assign a risk group (low, intermediate, or high) that helps guide treatment decisions.
The Role of Treatment in Preventing Fatality
Medical interventions are aimed at either curing the disease or controlling its growth to prevent it from becoming fatal. The specific approach depends on the cancer’s risk level, as not all prostate cancers require immediate, aggressive treatment.
For men with low-risk, slow-growing cancers, a strategy called active surveillance is often recommended. This approach involves closely monitoring the cancer with regular PSA tests, physical exams, and periodic biopsies, but delaying treatment. The goal is to avoid the side effects of treatment for a cancer that may never become a threat, while still offering a chance for a cure if it progresses.
When the cancer is localized but more aggressive, the goal of treatment is a cure. Definitive treatments like surgery (radical prostatectomy) to remove the prostate gland or radiation therapy are used. These treatments are meant to eliminate the cancer before it can spread beyond the prostate and surrounding area.
If the cancer has already spread beyond the prostate, becoming advanced or metastatic, the focus of treatment shifts from cure to control. Systemic treatments, which travel through the bloodstream to reach cancer cells throughout the body, are used. Hormone therapy, also known as androgen deprivation therapy, is a foundational treatment that lowers the levels of male hormones (androgens) that fuel cancer growth, which can control the disease and extend life.
When Prostate Cancer Becomes Life-Threatening
Prostate cancer becomes most dangerous when it metastasizes, meaning cancer cells have broken away from the original tumor and established new tumors in distant parts of the body. This advanced stage, also called Stage IV, is when the disease is considered life-threatening. The process involves cancer cells entering the bloodstream or lymphatic system to travel to new sites.
The most common site for prostate cancer metastasis is the bones, including the spine, pelvis, and ribs. When cancer spreads to the bones, it can cause significant pain, fractures, and other complications that impact quality of life. This spread to distant organs is reflected in the lower 5-year survival rate for metastatic disease.
Even at this advanced stage, the goal of medical care is to manage the cancer as a long-term condition. While a cure is not possible once the cancer has widely metastasized, treatments can control its growth and alleviate symptoms like bone pain. These interventions can extend a person’s life and maintain the best possible quality of life.