The common question when we are diagnosed with prostate cancer is how long do I have to live? The exact same question is asked again when we discover that we have had a prostate cancer recurrence.
Times have changed and so has our potential life span. In the late 1980s and early 1990s men diagnosed with hormone responsive, but metastatic prostate cancer were told that they could expect an estimated survival of 18 to 36 months from the time of diagnosis. PSA scores, velocity etc. were not factored into this magic formula.
Today, the common belief is different, with the overall anticipated survival of men with metastatic prostate cancer is often claimed to be much greater. We are lacking any hard and fast data, but I have heard that many doctors believe that the median survival today is closer to 5 to 6 years, it could even be longer. Even without hard data, I don’t think many people would dispute the assertion that survival can be anticipated to extend well beyond the 18 to 36 months projection.
Today, with wide spread PSA testing men are actually diagnosed at an earlier stage of disease, our better understanding of hormone manipulation therapies and with the approvals of taxane chemotherapy, Provenge and cabazitaxel (Jevtana) survival has been extended. How long, no one really knows the answer, but it has been extended.
Knowing this still does not answer that initial question, how long do I have to live?
Duke University Medical Center researchers (as published in Cancer) recently came to the conclusion that men with a baseline PSA value of 10 or higher the first time they are tested are up to 11 times more likely to die from prostate cancer than are men with lower initial values.
The researchers used the Duke Prostate Center database to identify 4,568 men who had PSA tests during the past 20 years and who were eventually diagnosed with prostate cancer. They evaluated the patients’ age and race and analyzed each variable to assess any association with risk of death from prostate cancer or other causes.
*The baseline median age for an initial PSA test in their study was 65 years.
* The median baseline PSA was 4.5
* The average follow-up period was over nine years.
* 3.5 % of the men died from prostate cancer during the study period, while more than 20 percent died from other causes.
Their analysis showed:
*Men with a baseline PSA of less than 4 had a very low risk of death from prostate cancer.
* 4 to 9.9 were three times more likely to die from prostate cancer than those with lower scores.
*Men with baseline PSA values of greater than 10 were 11 times more likely to die from prostate cancer than were men with PSAs under 2.5.
*African-American race and increasing age were also associated with a higher risk of death from prostate cancer and death from other causes.
These findings clearly demonstrate that the early diagnosis (with a lower PSA) of prostate cancer will cut the mortality rate from prostate cancer. PSA screenings coupled with digital rectal exams (DREs) among healthy men with normal life expectancy will save men from an early unnecessary death.
“The most important result from our study was that baseline PSA was a future predictor of death from prostate cancer,” says Ping Tang, MD, a member of the Duke Prostate Center and the department of urology at Guangzhou First Municipal People’s Hospital, Guangdong, China, and the lead author of the study. He also said that “It’s commonly held that men over the age of 75 don’t need to bother with PSA screening any longer, but this tells us that chronological age alone may not be enough. Patients need to take into account their initial baseline value, and if it’s over 4, continuous screening may be beneficial.”
Although this study does not answer our initial question, how long do I have to live, it does allow us to add to our understanding of our risk profile.
Joel T Nowak, MA, MSW
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